Styloid Process Fracture - Suspected Traumatic Eagle's? VANCOUVER BC CANADA, DR OSBORNE, DR DAN OCONNELL, ETC

Hey,

I’ve become very familiar with Eagle’s syndrome after trying to resolve some structural issues/pain/all the things I had been facing causing injury during activities and nervous disregulation despite doing everythingggggg else to attempt to address things.

I’ve since come to find that I likely have either a) a very misaligned bite/fascia/skeletal system etc etc, likely from just mouth breathing as a child and having underdeveloped nasal passages, hyperextending as a compensation and favouring one side… or b) that PLUS traumatic eagle’s syndrome via wisdom tooth extraction 15 years ago. The fractures look so blatantly obvious to me but because there’s not blood around anymore the radiologists here say it’s common but not an ‘acute’ (recent) fx, plus no ENT’s fix it or are seemingly even aware of styloid processes around here so that just is what it is. They only care once all this inflammation becomes cancer and they have to cut it out - not judging them it just is what it is and not how they’ve been trained to treat patients, I understand.

I also have what appears to be minor (and imaged like a month+ after, which significantly effects imaging) mild carotid dissection on my more symptomatic side but again, MRI rads just notice it and say ‘probably genetic’ which is very unlikely seeing my veins are of normal size, and my diet is low fat (my cholesterol is better than most newborns) so the dissection ‘patch plaque’ if you will wouldn’t be as severe as they’re used to. Also don’t drink/smoke/young, perfect (not just normal: optimal BP) so like very, very healthy otherwise. Not an anxious person or have any reason to be feeling like this in the head.

ANYways all suffice to say all the ENTs say my styloids are what they see ‘all the time’ which to me just (possibly) demonstrates how many people have fractured styloids here in Canada that’s being ignored and instead treated with pain meds etc. I just want to reiterate I’m not set on this self-diagnosis, just going with what I’ve observed and meticulously looked at and analyzed in the literature (comparing naturally segmented, if they can somehow expand in adulthood, etc). Id rather get to the root of things (and even choose to ignore it) than throw $ on disjointed opinions from experts lacking the critical thinking to understand this. Pain meds, Orthodontics, jaw surgery, etc. all offered but I’m not interested at this point if fx styloids are going to be behind things.

I noticed the ‘break’ in my styloids when looking at two 3d facial bone imaging (confirming on the other, non-3d views) I had, and then comparing further with childhood dental panoramic X-rays I obtained that, to me, show a clear before and after in the styloid processes, and further that my bite moved up (decreasing stability) to accommodate the fracture site. I woke up during my wisdom teeth removal surgery WHILE THEY WERE PREPPING after I had already been put to sleep, to a shocked look on the nurses faces - I suspect this was when the styloids were fractured and since then I had just been accommodating around it. Myriad injuries, TMJ, neurological issues, insomnia, cognitive decline began after that point.

For now, since I cant do much about it either way, I’ve been just pretending all is well, but I figured hey if I post here something helpful may come of it or it could help someone else. I dont really know right now.

I have a whole folder and whatnot on articles, my own images, symptoms etc but will keep it more succinct here.

Also, I had a virtual meeting with Dr. Osbourne about it, going through my cts and dental panos and whatnot, and he said If I wanted the surgery he would do it (for 100k Canadian) but also we discussed shooting a YouTube video on it - which made me feel a little less like it was a complete trial/placebo surgery offer and perhaps he’s picking up what I’m putting down. I had had several stroke-like episodes earlier in the year which were very unpleasant and all three were denied at emerg, each time saying “well you look great!” and “we’ve already done a CT on you we would have seen something like that” [it was a facial bone CT I had -not a regular ct and they later in their notes noted this whoopsie] and confidently “that cant cause a stroke” etc. Fun times.

I’m pretty sure my GP thinks I’m crazy, but it’s whatever. She has sent referrals to Dr. Dan Mcconnell in Edmonton (denied cause OOP), Dr. Ian Whitterik in Toronto and Dr. Michael Gupta in Hamilton and Dr. Boyd Lee in Newfoundland. No word on follow up on any of those. This was months+ ago.

So yea not wanting to associate with it all I’m kind of removed from it but not anxious, never have been… just eh feeling it.

when I exercise or occlude, immense inflammation and redness occurs. Hard to breathe. Acne and redness only around the styloids immediately. It always feels sooo hot and inflamed, and I wouldn’t be wrong to believe this is the start of much neurodegenerative diseases and ent-area cancer. But that’s not my concern right now so not thinking about it. Oh I’ve also been unknowingly eating a soft-foods diet for like 15 years lol. I’ve gotten to learn lots MORE about the healthcare system here in Canada, which has been a ride.

Locally, I’ve seen (and paid soo much money for omg…) and they’ve all viewed my CT’s and heard my concerns re: possible fx:
Dr. Reichman - Oral Surgeon
Dr. Samson Ng - TMJ-specialist dentist
Dr. Dr. Arman Abdalkhani (Vancity ENT) - ENT
Dr. Oleksandr Butskiy - ENT (referred from emergency)

so which they’re all like "coz can’t help ya, and idk anyone who treats eagles/does surgery/ anything like that’ neither confirming nor denying what is presented - everyone just says ayy whatever radiology says, eyes and ears closed essentially.

radiology second opinion, specifically inquiring about the styloid FX said "cant confirm nor deny… and that ’ yes we also looked at the childhood dental panos with them in tact and again we cant confirm nor deny if they were in tact or are fractured’ which is… golden. A+ canada radiologists. Great work!

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! Chronically misdiagnosed Eagle’s syndrome, treated through transoral styloidectomy: a rare case report - PMC.pdf (1.2 MB)
! Experience with transoral styloidectomy for Eagle Syndrome in Canada: A Case Series.pdf (735.4 KB)
! Fracture of the styloid process associated with the mandible… : Contemporary Clinical Dentistry.pdf (462.7 KB)
! Fracture of the Styloid Process in an Elderly Patient Caused by Rolling Over During Sleep: A Case Report | Namiki | Journal of Medical Cases.pdf (2.5 MB)
! Nonsyndromic Isolated Temporal Bone Styloid Process Fracture - PMC.pdf (1.8 MB)





! Styloid Syndrome in Absence of an Elongated Process.pdf (1.7 MB)
!! Bilateral Fracture of the Styloid Process with Parapharyngeal Emphysema.pdf (842.2 KB)
! Chronically misdiagnosed Eagle’s syndrome, treated through transoral styloidectomy: a rare case report - PMC.pdf (1.2 MB)
! Fractured styloid process masquerading as neck pain: Cone-beam computed tomography investigation and review of the literature - PMC.pdf (2.1 MB)
! Styloid process fracture associated with the maxillofacial trauma- incidence, distribution and management…pdf (383.9 KB)

cross reference imaging site for rads: styloid process fracture unilateral congruent with mine: Temporal styloid process fracture | Radiology Case | Radiopaedia.org

cross-reference for Carotid artery dissections; crescent sign as seen in imaging below (worse cases ofc) Vertebral artery dissection | Radiology Reference Article | Radiopaedia.org + Crescent sign of arterial dissection | Radiology Reference Article | Radiopaedia.org



Hi @campsay! That was one very thorough post. We are aware that the doctors in BC have no comprehension of how to treat ES. A couple of our members did have surgery in BC but two I’m aware of ended up having revision surgery, one in the US & the other in Mexico because their surgeries were not done well in BC. This has been a long standing problem (years long) for our BC members & as you noted, seeing doctors outside of your own province is difficult if not impossible.

I’m furious that any doctor would be dismissive of your mild carotid dissection. ANY carotid dissection should be taken seriously, & yours is most likely what led to
the “several stroke-like episodes earlier in the year which were very unpleasant” you experienced. If this continues, if it is the styloid causing the dissection, a full blown stroke can eventually occur.

Styloids can appear to be fractured even when they aren’t due to a gap between an elongated (or not) styloid & a section of calcified stylohyoid ligament. When the gap is small & the two parts are close together, it can be difficult to tell for sure. Looking at your images, your right styloid/calcified stylohyoid ligament does look to be fractured due to the jagged top edge of the lower portion. The left pieces are separated by a larger gap so it’s possible they are actually two separate entities, but if what you speculate happened during your wisdom teeth extraction, actually happened, then both could be fractured. Fracture or no fracture, your styloids do seem to be doing you a disservice with the symptoms you have so getting them shortened could make a big difference especially w/ your TIAs/stroke-like symptoms.

This bodes well for considering surgery. If you can afford Dr. Osborne, his ES surgical reputation is good. You could try negotiating the price w/ his business office since you’d be having to do international travel as well as have the surgery. Some offices are more flexible than others for cash paying patients.

I feel it’s somewhat urgent that you at least consider having your styloids removed in light of the carotid involvement. I’m glad you’re not overly concerned but based on what you’ve written, I am concerned for you.

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I’m so sorry that the Canadian system seems to be in such denial about ES, it’s beyond frustrating that you potentially have vascular ES & it’s not being taken seriously…I agree with @Isaiah_40_31 that it could be calcified stylo-hyoid ligaments and not necessarily a fractured styloid, but either way it doesn’t really matter, given your symptoms the calcification needs removing really.
The redness is strange, it’s not common, but maybe if it does occur more during exercise & you have trouble breathing you should give this a miss? I had IJV compression which caused head pressure, I had to give up exercise as the exercise contributed to worsening symptoms, it’s tough, but sometimes best for your health.
Dr Witterick used to do surgery but from what we’ve heard he’s concentrating on cancer patients now. Have you looked at the Doctors list in case there’s anyone else you can reach out to? Here’s a link:
Doctor Lists – no discussion - Symptoms and Treatments / Doctor Information - Living with Eagle
We do also have a list of doctors who have authored research papers- they might not be practising, possibly just researchers, but there’s certainly one paper about VES which might be worth looking at, here’s a link to that:
Doctors Who Have Authored Research Papers - Symptoms and Treatments / Doctor Information - Living with Eagle
Quite a few of our Canadian members have had surgery with Dr Cognetti in PA or Dr Hackman in SC, obviously a longer journey but if you’ve got to fly anyway, idk if they’d be any cheaper? Dr Nakaji in AZ is also experienced with VES if you want to stick with west coast…
I really hope that you can get surgery somewhere :pray:

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Thanks, I would totally do surgery if I could afford it but alas have to stay within canada for now it seems. It would also be helpful to have an experts opinion on the styloids as far as fx vs naturally segmented. As you mentioned and again as the lit shows image wise it seems identical and knowing how bones fracture from blunt force a certain way (experience with this and seeing cad from other shattered bone in arm) it just seems so evident versus natural segmentation. The fact that the fracture cases get near immediate relief too bodes well. In the meantime i’m taking it easy and working around it but it’s a constant mental and physical practice. Would really love to meet with Edmonton Dr Oconnell as he does jaw surgery well too so if it’s something that is not styloid related but rather jaw/vertical alignment (from braces as a child/posture/habits etc) he would be well suited imo to propose the right remedy (including no surgery ofc)

thanks very much for your thoughts.

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@campsay - I think some of our CA members have been able to see doctors in other provinces although I understand it’s a bit of an ordeal to get that kind of referral. Is that something you are able to pursue so you could see Dr. O’Connell?

I’m sorry traveling & paying for surgery isn’t an option for you. That’s a tough situation. I wish there was a way you could get financial help so you could put this behind you & move on with your life. :heart:

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We’ve had members who’ve had internal carotid artery compression caused by the styloid & their symptoms did resolve once the styloid(s) was/were removed. TIAs & other stroke-like symptoms can be indicative of compromise to the ICA by the styloid or other soft tissues. It used to be thought ICA compression or irritation by the styloid was the most common vascular form of ES, but based on the statistics on this forum, it seems internal jugular vein compression is more common or at least more commonly noted.

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Hey @campsay I have a broken styliod process as well at the base of my skull.

Its really frustrating and I have alot of issues thats arised from it as well. Its taken me over 3 years to finally get diagonsed and im heading into my 4th year experiences all these symptoms. I’m trying to find a solution as well that doesnt involve invasive surgery. I have a surgery scheuled for October 2nd but im most likely going to cancel it cause i fear it might just make things worse.

Hey,

Aw I’m so sorry to hear that! It’s an everyday level of discomfort eh. How did yours happen, and how was it detected then diagnosed? Also who was the doctor who diagnosed it, where, and who/where is your surgery with? I’m in Canada so I’m curious what country you’re in. Congrats on at least getting it detected and potentially sorted with surgery. From all the literature I’ve rad on it in the case of fractures it seems to help. If it doesn’t bother you much you could try splints and whatnot (read some articles I’ve posted and I’m happy to send you more on non-surgical management). But thanks for replying to this because it honestly comforts me to know I’m not alone with the fx!

I also recently learned the bruising I experience from he skull fracture has a name, known as battle’s sign :’)

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@Cdbruce - Have you had any indication that you have CCI (craniocervical instability)? This is often a problem for people who have hypermobility or vascular Ehlers Danlos Syndrome (hEDS). If this is not something you have, the styloidectomy you have scheduled is more likely to help you than harm you further. You’re still young & your body should heal well from the surgery. I was 58 when I had mine & though recovery was slow, the surgeries I had were positively life changing.

You’re scheduled w/ one of the most experienced ES surgeons on our Doctors List. It would be best to make an appointment to talk to him prior to your surgery date to express your fears and concerns rather than just cancelling the appointment. He may be able to help you feel more confident that surgery will be helpful for you.

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WOW. I came across your story when researching Dr. Osborne. This is one of the stories where I say Oh My Gosh, at least mine isn’t that bad (at least that I know of)

Can you remember if the cost quote from Osborne was for doing both sides or just one side? Also, do you remember how much he charged for the telehealth visit.

His website does list a place for insurance information so i wondered if anyone has actually used him with insurance or Medicare.

I wish you luck in your journey. At least you have figured out that you have a styloid problem. That is a huge step in the journey.

Dr. Osborne charges about $35K for one side & $51K for both but he does his bilateral surgeries a day or two apart. I think his telehealth visits used to be $200 but you’d have to check to see if that’s changed.

We’ve had only one member who had surgery w/ Dr. Osborne who had insurance coverage & told us he takes insurance. Everyone else who has contacted his ofc or had surgery with him has been told it’s cash only & he doesn’t take insurance so it’s a bit confusing. You’d have to call & ask the office yourself to get first hand information.

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I don’t think I would do two surgeries a few days apart unless I was fairly young AND it was not complicated. It is a lot of trauma to the body plus the added problem of possible brain issues that happen during surgery. I would want to give everything a chance to heal including my brain.

I did look at the reviews online about insurance with him. I saw one pretty convoluted review about a patient trying to use insurance. She was trying to pay first out of pocket because she had already made a deal with the insurance. It was too complicated for me to understand but I am going to have to go back and see if I can figure it out. It was an interesting approach to the issue.

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@campsay hey there! I see you’re also from Vancity. I posted in another thread, but I thought you might be interested to see this study that I found from Dr. Joel Howlett and he’s performed the surgery. He’s a UBC researcher and ENT surgeon. It seems he works out of VGH and Surrey Memorial. I don’t know what his status is, or if he takes on patients. I have an appointment scheduled with our GP next Tuesday and am going to try and get a referral to him. I’ll let you know how it goes. Good luck with your journey.

https://www.cmaj.ca/content/193/28/E1091

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@Valeriet7426 thank you for that research paper link! I will add it into the Research papers category…Will you let us know if you’re able to get a referral to Dr Howlett, it could be great to have another Canadian doctor on our list!
This just popped up on my feed, I wrote the above but it never posted! Did you ever hear from Dr Howlett?

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Hey Jules,
He was kind enough to write back to me. He is not currently taking on patients or doing surgery for ES. This surgery was the result of an emergency situation. He referred me to another doctor, who also was kind enough to reply, and also wasn’t taking patients. Thus the trip to Turkey.

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Okay, thank you, so frustrating that so many Canadian doctors aren’t able to take new patients! Hoe is hubby doing?

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Thanks for asking. I’m planning to do a bigger update once he hits the 8 week mark. Every week there is a marked change, mostly for the good. Last weekend we went for a big walk and enjoyed the crisp day. This weekend we have lots of social plans. In the past he wouldn’t have had the stamina for anything that physical or emotionally taxing. The first bite lives on is a very very real way. He had a lidocaine injection into the gland last week and it reduced the pain for a few hours. The fact the lidocaine helped means that he may qualify for a Botox injection. He has to go back next week and they’ll decide what to do.

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