Hello everyone. I love this forum as it has been very helpful. I had surgery on January 25th with Dr Annino in Boston Massachusetts. My left stylohyoid ligament was calcified and measured 6.9 cm. He removed 2.9 cm in the middle and assured me that it would not grow back. He has been doing this for 18 years with about two or three cases a year and says that he has never seen it grow back. He equates it to cutting a rope essentially. I literally asked him three times as I know so many of you have said to take it down to the skull base. Just wondering about any feedback on this. I will be having the right side done in a few months as that one is calcified as well. He likes to avoid the area near the skull base as it is around so many nerves. Post-op was quite easy. Just a lot of swelling as it was external, but I didnāt have much trouble eating once the swelling went went down.
Hi! Glad youāre doing so well! I had my first side done January 10th by my beloved (I do practically love the man for how he improved my life!) surgeon Dr. Dedhia in Atlanta. His words were almost identical to what you were told. He called it an āuntetheringā. I feel lucky he got 3 cm out because he said he stops when he sees carotid artery/jugular territory so I wasnāt expecting a lot to come our, just the cut like you said. It took a lot of trust but his approach worked for me in particular because my swallow was better instantly. Iāve had an unfortunate tongue issue post op but Iām told itās nerves reconnecting and will resolve. Iām hoping to have the other side done in May. I think you found a good doctor. How have your symptoms improved? 
Hi ddemaso!
As you noted, the idea behind complete removal of the styloid process(es) & s-h ligament(s) is to prevent regrowth, however, there are cases where the styloid cannot be removed to the skull base due to nerve placement or involvement. Regrowth is most often seen in people whoāve only just had the tips of the styloids cut off i.e. a minimal amount has been removed. There have been a couple of cases of regrowth where a larger portion of the styloid & ligament have been removed but those are rare.
It does sound like Dr. Annino is doing good work. It seems heās seen good results over the years with the method he uses. To reassure you, Dr. Samji did my surgeries. He is a proponent of ātake it all out from hyoid to skull baseā. My right glossopharyngeal nerve was wrapped around my right styloid process like a vine & as a result, he was not able to cut that styloid back to my skull base. He had to leave 1" of styloid process in place to keep from damaging the nerve permanently. Itās been 4.5 years since I had that surgery, & Iāve had no symptoms of regrowth & have no fear of that happening.
It sounds like youāre in very good hands. Iām glad youāre dong so well this soon after surgery.
Sewmomma
I no longer have pain or a deep itchy feeling deep in the ear. My jaw no longer hurts, feel tight, or snap. No more headache pain on that side either. My neck no longer feels really stiff on that side. I no longer have to tweak my neck around to loosen it up. So much better. Will see him on April 8th to hopefully plan surgery for the other side. Glad to hear that you are doing great as well.
Isiah
Thank you so much for the reassurance! My scar is feeling pretty fixed and i have an appointment with some people who do The John Barnes method of myofascial relief therapy. They will be able to loosen the scar tissue up. They were able to loosen the scar tissue up after i had shoulder surgery. Had fractured the humeral head.
I do have a small amount of swelling at the surgical site and numbness under my chin, but am confident that it will resolve in time. Thank you again to all of you for sharing your stories.
ddemaso -
Iām glad you have a resource to help you with your scar tissue. I know a lot of people have trouble with that post op. Fortunately, thatās one thing I didnāt have to deal with. Iām so thankful for the many things that went ārightā for me & for the final results of ES surgery - getting my life back & being able to function normally. This did take time though - probably about 1.5 years. But donāt be alarmed by that. I felt pretty doggone good by the end of the second month after each surgery.
Isaiah
So glad to hear how well you are doing! This site is so helpful in allowing us to know to be patient and that things will continue to improve.
Yes, ES & the surgery are both huge lessons in patience!!! So glad I can share the good things that come to those who wait!
Hi SewMomma, I see you had a surgeon in Atlanta. Are you aware of ES docs in South Georgia?
Hi there!
Gosh Iām so disappointed that the wonderful surgeon at Emory is leaving. I checked on my surgery appointment the other day for May 30th and his coordinator said I got one of his last surgical dates before he leaves at the end of June.
The only other place I ever considered was Georgia Medical College. If you look at their website, there are some very experienced ENTs on there and I was going to call them to see if any of them had performed Eagle syndrome surgery but I never needed to go there after I found Emory. I tend to lean toward academic institutions for big things like this so Emory and MCG would be the two in the state. Oh and I was willing to drive to Birmingham because an ENT at UAB does the surgery too but he was out of my insurance network. They could tell you his name when you call their appointment line because his name comes up when you mention ES. Maybe Florida is closer to you than either of these though.
Keep us posted on your search for a surgeon. I think when you find the right one youāll be much more at ease about the whole thing. 
Those are good places to look. Try to find skull base surgeons who operate on cancer patients if you want to have the entire styloid to stylohyoid removed if you have it throughout the two areas.
I am one of the patients who had the intra oral, 2.8 cm removed, done properly, but never felt completely well. 3 years later I was unable to move my neck and sleep on a pillow. I had to sleep sitting up. I do not have the original CT scan, but the later one showed that the styloid was 3.0 cm and had a knot in about the center that looked like a round swollen knuckle. I assume it started to grow back from there,bc for awhile, I did not feel it, but later, I could.
My skull base doctor said this when I said I should have gone external. He said," There is nothing wrong with the least invasive approach. It is often all that you need". In my case, he said the bone and thickness was impressive and my 3D viewer homemade picture told him that he would be able to operate and most likely give me relief. That was almost 7 months ago. I just had the other side done and recovering cautiously, because I now know that sometimes the nerves wake up a bit angry. So today,not bad. Like Jules said, the end result will be best known in 18 months.
Hi! Im near a Cleveland Ohio. Has anyone had an experience with Dr. Quereshy? I had an appointment and he wants to remove both calcified stylohyoid ligaments and the same time?? Along with tag teaming with a surgeon to fix bilateral nasal valve collapse and deviated septumā¦ as Iāve been told by 3 docs that is what they believe is the root cause to my 40% bone loss in jaw joint and calcification of styloid process and ligaments on both sides. That seems like an awful lot to me at one time???And Iām reading mixed feelings about not taking back to skullā¦ dr. Quereshy wonāt do that, only ligaments. Just confused on what the right path is to take. Also, I asked the question on if something needed to be reattached after ligaments were outā¦ like do they put something in to take their place, but was told no. So Iām not fully understandingā¦ do the surrounding muscles make up for ligaments not being there? ? Or can anyone give me some clarification on that? Thank you so much
I donāt think Dr. Quereshy has been mentioned on our forum before as I did a quick search, & your post is the only one that showed up w/ his name in it.
Our members whoāve had bilateral ES surgery have tougher recoveries initially but after a couple of months their healing seems to follow the same route as the unilateral surgeries do. However, that combined w/ the nasal valve & deviated septum surgery does sound like a lot. I can say that I would have loved to have bilateral ES surgery when I had mine, but my surgeon only does unilateral so I had two surgeries & 2 recoveries which potentially took double the time one recovery would have.
If youāre willing to deal w/ a couple of rough months initially, having everything done at once would definitely be worthwhile so you donāt have to go through surgery twice, however, you know your body & how well you tolerate pain & how much time you can afford to take off of work, if you have a job, etc.
Regarding Dr. Qās discussion of only removing the calcified ligaments, thatās a little confusing since there is some debate whether the styloids themselves elongate or if elongation is caused by the stylohyoid ligaments calcifying, thus, if he sees ES as calcified stylohyoid ligaments only, he will likely remove the calcification back to the normal styloid length which is about 2.54 cm/1 inch. Verifying this is worthwhile.
I asked the same question prior to my ES surgery about whatās affected when the ligaments are gone. My surgeon said they play a very minor role in swallowing, & I wouldnāt miss them. This has turned out to be true for the vast majority of our members. I can safely say, you wonāt miss your s-h ligaments once theyāre gone.
Thank you so much for your insight! That was very helpful! I am quite a fast healer so thatās a plusš I was very confused when he did say only a couple weeks of down time as everything Iāve read contradicts that. I had originally reached out and sent scans to Dr. Cognettis back in Decemberā¦ talked to nurse a couple times then nothing . Very disappointing. Iāll find my way with the help of you all and your wise words! Much appreciated!
Iām sorry for your experience w/ Dr. Cognettiās ofc. I think end of the year is crazy for most doctors offices since patients have met their deductibles so many are trying to get their more expensive medical visits/surgeries done at that time. If youāve still got interest in seeing Dr. Cognetti, please contact his office again. Theyāre usually very good w/ follow up so Iām not sure why the ball got dropped in your case.
Iām glad youāre a good healer. That bodes well if you have everything done at once. Weāll be happy to add Dr. Q to our office if he does your surgery & youāre happy with the outcome.
I have to say that those surgeries all together sound way too much! My husband looked into having a similar sounding nasal surgery- his surgeon said recovery would be fairly easy, but researching it suggested that was very underestimatedā¦expect to not be able to lay down to sleep, breathing would be difficult as your nose would be too stuffed up. With styloid surgery the throat can swell, so swallowing can be difficult, especially if you have bilateral surgery the risk of swelling is even more, & if you add in to that having a completely blocked nose I would think it would be awful! My surgeon wouldnāt do bilateral styloid surgery as he said that it would be too much, although I know that quite a few have had this done now successfully with Dr Hackmanā¦
We have some questions we suggest that people ask their doctors, they might not all be relevant but it might be helpful:
- How many ES surgeries have they done and what was the success rate?
- Whether theyāre going to operate externally, or intraoral- through the mouth. Whilst some members have had successful surgeries with intraoral, external is better for seeing all the structures, to be able to remove more of the styloids, & also thereās less chance of infection.
- You need to ask how much of the styloid heāll remove- as much as possible is best- & anything left needs to be smoothed off. The piece needs to be removed too- some doctors have snapped it off & left it in! If the styloid is only shortened a bit it can still cause symptoms.
- If your stylohyoid ligaments are calcified, then any calcified section needs to be removed too.
- Thereās usually swelling after surgery; you could ask if a drainās put in to reduce swelling, or if steroids are prescribed. Itās not essential, but can help with recovery a bit.
- Will it be a day case surgery or will you need to stay in?
- Obviously ask the risks- we know from experience on here that temporary damage to the facial nerve is quite common, and also the hypoglossal nerve and the accessory nerve. These usually recovery very quickly but in some cases members have needed physiotherapy. There is also the risk of catching a blood vessel or having a stroke, but these are very rare.
- Ask if the surgeon monitors the nerves- this should be done to see if thereās stress on the nerves to avoid damage as mentioned above.
- What painkillers will be prescribed afterwards.
- Ask about recovery- most doctors either down play it or are genuinely unaware of how long the recovery can take!
Do you know if the styloid surgery would be intra-oral or external? Bilateral intra-oral would be quite tough on itās ownā¦
Hi Jules! I cannot thank you enough for all of this amazing info! Itās incredible and what I needed to help navigate through this! My gut was leaning to it all being too much and you helped to solidify that! Your list of questions is a God send- truly thankful!
~Heather 
Thank you for the nudge- I think I will reach back out to Cognettis office! Iām slowly becoming a better advocate for myself with everyoneās help! So grateful and appreciative!
~Heather