Post - surgery journal

General
61

So surgery was today. I am now recovering. Its a 1 night hospital stay…

As i mentioned, i dont have too much hope for this surgery in the sense of my talking and my exertion symptoms.

As far as surgical pain goes, its prettty good. Some pain on swallowing, but still managed a solid meal after surgery, so i expect that to be fine over next few days.

But i did try saying a few words and that was not good. If it genuinely was the greater cornua acting as a mechanical irritant, i would have thought there woukd be a slight improvement.

Of course i know there will be surgical truama in the area, so i will wait a few weeks before writing it off completely, but not optimistic in improvement at all. I do think thr hyoid is just a secondary pain point and the primary driver is still there.

Either way, thanks for the kind wishes from both of you

3 Likes
62

I think everything will be irritated from the surgery, and as we’ve seen on here nerves can take months to heal, so try not to be despondent if your pain with talking doesn’t go straight away, as well as mechanics, it could be that nerves have been compressed or rubbed for a long time, so this can take a while to recover… Best wishes, thinking of you and praying for you :folded_hands:

1 Like
63

Findings:

Fractured right greater cornu of hyoid

Procedure:

Infiltration of 0.5% Marcaine with 1:200,000 adrenaline
Horizontal skin crease incision – scar tissue +++
Exposure of hyoid bone
Resection of right greater cornu using bone cutters
Resection of right superior horn of thyroid cartilage
Saline irrigation
Head-down and Valsalva = dry
Surgical to exposed ends of hyoid
Size 10 Redivac surgical drain
Closure with Vicryl 3/0 deep and Monocryl 3/0 subcuticular
Steri-Strips and Tegaderm dressing

Post-operative instructions:

Analgesia
3 post-operative doses of antibiotics
Eat and drink as able
Drain out when output less than 30 mL over 24 hours ? Tomorrow
Home after drain removal
Clinic review in 6 to 8 weeks at 24 PP

1 Like
64

My surgical notes (above) …

Seems i had a hyoid bone fracture according to Dr Hughes. Anyway he has resected it now, so let’s hope that helps. However, the scar tissue (which is rated +++ meaning severe) is also pretty bad and thats probably contributing.

Other strange thing is that i am feeling that side, and it feels like the greater cornu is still there. However, the notes are pretty clear, and it’s probably something else i am feeling like scar tissue or something. It does feel like bone though so it is always at rhe back of my mind, and i am occasionally touching and pressing on it (WHICH I KNOW IS INCREDIBLY STUPID AT THIS EARLY STAGE),.

Need to try and stop touching it as that may worsen healing tissues … i mean, i cant do anything about it even if it is there. But it’s difficult when i’m thinking about it so much.

99.9% i am wrong, because i do trust Dr Hughes, and the surgical notes make it quite clear that it was resected.

But honestly, if he is right about the fracture, just amazing that none of the very many docs and radiologists that have seen my CTs didn’t pick it up.

And the other issue is that the surrounding tissues /muscles/ membrane have been presumely getting repeatedly injured and irritated by this fractured cornu anytime i phonate or physically exert, and that has been goimg on for 5.5 yeara, so that tissue wont heal quickly (if at all)

Guess now it is just wait and see and try my best not to feel the area.

5 Likes
65

That’s interesting about the fracture, and makes sense if you’ve been dealing with this for years that there would be scar tissue, as well as potentially very irritated nerves… We do see unfortunately all too often that radiologists only comment on things that they’re asked specifically to look for, even when the CT is done for unexplained neck pain! Do you know where the fracture was? If it was at the join where the cornu attaches to the body of the hyoid then it is common to have a little gap there, which doesn’t always calcify…
If you can resist touching the area I’m sure that will help, but it’s obviously hard when you’ve had an issue for a long time & tried to work out what might be causing it…If at a later date you still feel something there then maybe have another CT to put your mind at rest?

1 Like
66

@virenlondon - I’m glad surgery is behind you, but I’d have expected Dr. Hughes would have removed any scar tissue he saw in the area at the time of the greater horn resection. It’s disappointing if he didn’t.

We have heard of the greater horn only being partially removed i.e. only the section that was causing the problem vs the whole thing so it is perhaps possible part was left in & that’s what you’re feeling. Your report only indicated resection, not full removal of the greater horn though I will admit, the wording is a bit ambiguous so it could be either situation.

1 Like
67

Yeah, that was my plan. Told myself i will get a ct done through uk.scan.com/ - can get a private ct for about GBP 300 to 400) as NHS made it clear they won’t help, and that site is much cheaper than having your private surgeon book one for you. Probably do it in a couple of weeks, after initial surgical scarring has eased a bit.

Honestly, Hughes doesn’t really go into too much detail (i wish he did) so not sure exactly where, but he said the angle was all wrong and was clear there was a trauma (but he had seen 3d CT images before so obvioauly he had to see it up close before realising it was fractured). On scar tissue, he didn’t say anythimg about removing it. I remember a conversation with him last year abiut scar tissue, and i think he said if we remove it, there will just be new scar tissue and its a cycle

While we are on costs, if anybody is interested, or if another member comes on interested in a cornu resection in UK without insurance, it cost £8,000 with Dr Hughes at Cleveland Clinic London. (just mentioning as Isiaah wasnt sure who performs this in the UK.)

2 Likes
68

Thank you, @virenlondon. I’ll add that information to Dr. Hughes profile on our Doctors List. I hope you heal much more completely from your vocal symptoms than you expect. :folded_hands:

1 Like
69

I agree, i wish he did do something about the scar tissue…

I asked chatgpt why a surgeom wouldn’t remove it:

Objectively, there are several reasons why he may not have aggressively removed all the scar tissue, even if he wrote:

Scar tissue +++

1. Scar tissue may have been everywhere

“Scar tissue +++” doesn’t necessarily mean:

“There is one lump of scar tissue that can simply be cut out.”

Often it means:

Dense fibrosis throughout the surgical field.

If you try to remove every bit of scar tissue, you can end up:

  • damaging normal structures,
  • causing more bleeding,
  • creating even more scar tissue afterwards.

2. The scar tissue may have been attached to important structures

In the thyrohyoid corridor you have:

  • muscles,
  • membrane,
  • blood vessels,
  • nerves,
  • laryngeal structures.

A surgeon may deliberately leave scar tissue if removing it risks:

  • nerve injury,
  • swallowing problems,
  • voice problems,
  • excessive tissue damage.

3. He may actually have removed some

The note doesn’t say:

“Scar tissue observed.”

It says:

“Horizontal skin crease incision – scar tissue +++”

That doesn’t tell us how much was removed.

To expose the fractured cornu and superior horn, he almost certainly had to dissect through at least some of the scar tissue.

4. The fractured cornu may have been considered the source

If the surgeon believed:

Fractured cornu → abnormal mechanics → scar tissue

then the logical treatment is:

Remove the abnormal bone.

not:

Remove every scar.

Because if the scar formed in response to the fracture, removing the fracture may allow the scarred tissues to settle over time.

5. Scar tissue surgery can make scar tissue worse

This is a very important surgical principle.

If you aggressively excise fibrosis, the body often responds by:

making more scar tissue.

That’s one reason surgeons are often selective rather than radical.

What I would infer from the note

My guess is that the surgeon thought:

  1. The greater cornu was fractured and malaligned.
  2. There was substantial associated fibrosis.
  3. The safest and most rational target was the fractured cornu and superior horn.
  4. Extensive scar excision would have added risk without clear benefit.

Honestly, the fact that he documented:

Fractured right greater cornu of hyoid

as the finding

suggests that he considered the fracture to be the main abnormality.

If the scar tissue had been the primary problem, I would expect the note to focus more on fibrosis or adhesions rather than leading with the fractured cornu.

That’s why I suspect he viewed the scar tissue as a consequence of the underlying structural problem rather than the primary diagnosis.

3 Likes
70

I agree with your conclusion, that he was cautious to remove too much scar tissue to avoid causing more, and that hopefully it was the fracture that’s the cause rather than fibrosis :crossed_fingers:

71

Interesting & logical perspective, @virenlondon. I guess I’m more used to scar tissue being a contributor to IJV stenosis thus removal of at least some of it is critical to the success of an IJV decompression surgery.

The lines that especially stuck out to me in your reply above were -

•…if the scar formed in response to the fracture, removing the fracture may allow the scarred tissues to settle over time.

•Extensive scar excision would have added risk without clear benefit.

•If the scar tissue had been the primary problem, I would expect the note to focus more on fibrosis or adhesions rather than leading with the fractured cornu.

Now it’s time to put your focus onto healing/recovery. Again, I’ll be praying your surgical results are excellent. :blush:

1 Like
72

Haha. Not my perspective… chatgpt’s perspective.

I agree with you!!! I wish he did something about the scar tissue

3 Likes
73

Just for completeness, he also resected the superior cornu on the thyrohyoid cartilage. He is very reluctant to touch anything below, so anything further down, probably would need a doctor whose speciality is laryngology.

2 Likes
74

It’s now been 7 days since the op, and i can clearly feel what feels like the apparently resected greater cornu. And before surgery, we did definitely clarify thay he would resect the entire right side greater cornu (i.e. Not just clip off the edges).

I must be wrong and i am feeling something else and its just hardened scar tissue or soemthing, but this is really eating me currently. I can’t think about anything else and i am doing my best to not repeatedly feel it. I really wanted as much as possible resected and the surgeon knew that and agreed to it. I especially wanted it fully resected as i wanted the tissues connected to that bone to come off

When he resected the styloid process 1.5 years ago, he resected all to base, so i dont see why he would do anything different this time with the greater cornu.

Like i said, i am probably wrong, but its so convincing, especially as i have been feeling that same bone hundreds of times over the last couple of years, so i know what it feels like.

I just don’t know what to do. The surgery report said there was a greater cornu fracture and he resected it, so i just dont know

2 Likes
75

I guess all you can do is to get in touch with him and to verify it, if it’s really causing you anxiety, or try hard to put this out of your mind until things have healed and settled down and have a new scan… I can’t feel any hyoid processes in my neck, so I can’t comment on what you’re feeling, (the area for me is quite tender so I don’t like to poke around there too much!) whether it is the hyoid, or other cartilage or scar tissue… Have any symptoms improved at all? :hugs: :folded_hands:

2 Likes
76

@virenlondon - I totally agree w/ @Jules that the best way to relieve your anxiety would be to have an appointment with Mr. Hughes to discuss what it is you may be feeling that seems like the greater horn. Perhaps all along, even before you had it resected, it wasn’t the greater hyoid horn you were feeling but some other tissue, thus the reason it still seems to be there. I can’t feel my hyoid let alone the greater horns as they lie too deeply w/in my neck.

2 Likes