General question.
When I read that the styloid has been removed to the base of the skull, what exactly in measurements does this mean. How much is left of the styloid if anything? e.g 1.7 cm or 2.1 cm? Also why would a Dr say that they would want to leave 2.1 cm? Thanks in advance.
Typically with skull base removal 1 cm or less of the styloid is left behind. The reason some doctors won’t cut it that short is because the facial nerve exits the skull very close to where the styloid attaches to the skull base thus it’s a protective measure for the facial nerve. Some surgeons feel more confident getting closer to the facial nerve than others. The facial nerve innervates facial expressions. When it’s irritated or damaged during ES surgery the result is usually a one-sided lower lip droop & possibly an eyelid on the same side that won’t close. These symptoms are known to be temporary, but lack of eye blink, in particular, is quite annoying when you have to put up w/ it for a month or so.
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Thank you for explaining. I had my appointment with Chhetri yesterday and left a little disappointed to say the least. His resident did some examining before he came in, she is technically a Dr and has finished her year at his clinic. She did a swallow test and saw nothing wrong. I think she was looking at the hyoid. Then she looked at the CT and I discussed my lengthy symptoms and history with Eagles and my prior surgery. She talked about the surgery, that it would be external and all that is involved and said it would be simple and would not require an overnight stay. she left the room to get the Dr and returned with him. He did a physical exam of my neck and started explaining that he did not consider the length of my styloid to be considered Eagles, he thinks it is needs to be around 40mm. I asked him twice to repeat that number so I could be sure that was what I was hearing. I explained that it is thicker and at 3.2 approx that this is considered to be Eagles and it depends on the angle. no comment and he stated there is no guarantee of pain relief with surgery, which I understand there is never a guarantee. He did say if he did do the surgery that he would only shorten it and leave 2.1cm and would not go to the base as there are nerves there and could cause damage. He said he did not see it pushing on nerves or veins. I told him that this is a still CT and my head is in a forward position and that the pain I feel the most is when my head is turned and the CT will not show this in the position it is in, if my head had been turned it may have shown. I could see he agreed with a single head nod, but no comment.
I did explain the prior surgery and that I had relief for twelve years until the last two years the pain had returned as it has calcified again. I can see a little light when on that maybe what I was saying is true. But he seemed stubborn and set in his opinion. He did not offer any other explanation of what is causing my pain either, and said the decision of the surgery is up to me and that I can let him know. He was borderline defensive the whole time. I did wonder if he was not happy that his assistant had talked about surgery before he had a chance but this is just me speculating out of frustration. she was quiet the whole time but chimed up when I said I had relief from the first surgery, like she was trying to show him that I had success in the past. But he ignored that. So now on to the next Dr Samjii in a few weeks. Hoping for a better answer and better news. I know I could ask Dr Chhetri to do it anyways and he would but do I really want to? I think I need to at least see what a few other Drs will say.
I’m probably missing some info but as I was so flustered from once he walked in my focus got distracted.
So sorry your styloid has grown back, & that the appt didn’t go as well as expected, and that he wouldn’t take too much off the styloid- unfortunately the length of styloid which doctors believe causes ES varies tremendously, whereas we know the thickness & angle causes symptoms & not just length…I think it’s definitely worth seeing Dr Samji!
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I am super impressed with the way you stood up to Dr. Chhetri & advocated for yourself @Vkaabour! That’s impressive especially since he was a bit intimidating!! Sadly, some doctors get very set in their ways & won’t bend even in the face of evidence that they should be more flexible in their opinions. It sounds like that’s his situation. As much as I hate to say this, you may find that Dr. Samji has a similar attitude, but it’s still worth the consult to discuss your situation with him. He did help me tremendously.
I can’t remember if we discussed him, but Dr. Osborne is also in the L.A. area (not at UCLA) & has done some very successful ES surgeries. He’s another doctor you could consider seeing.
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Thank you Jules, yes it seems that the length varies for sure depending on who we see. I am learning new things every visit I go to. There is bound to be someone who will listen. I will keep trying till someone does. I will post how the appointment goes with Samjii 
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Thank you for that, I was having a flare up in the office so I think that prompted my annoyance and brought forth the questioning. Haha And hubby was there ready to pounce, so I think that kept him seated my being aggressive with my questions. I will keep my appointment with Samjii but will keep your words in my head and just remain calm and prepared with questions. Knowing he has helped you is a good hope for me. I can only hope for the same 
I had called Dr Osborne’s office months ago. They do not accept my insurance and I think that is the case with several people who have tried to get in to see him. I would have went to him otherwise.
Thank you for the heads up 
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