Surgery Completed!

Yay!!
Done, and can already see better.
Nice neat incision

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Congrats, my friend! I’m so happy to hear from you!!!

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Great news, will keep praying for swift healing, God bless :bouquet: :hugs: :pray:

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Congratulations to being on the other side! Wishing you a super speedy recovery! Great news about your eyesight! Your incision looks amazing!

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That’s great, hope you heal quickly, it looks great

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Really nice incision! So glad your vision is better! That was quick! Keep ice on your neck as much as possible (cover your skin w/ a washcloth/small towel - ice goes on top of that) for this week at least. Will look forward to updates. :hugs:

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Did Omlie take the styloid all the way back to the nub or did he leave some and did he take out some of the digastric muscle like he had mentioned?

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Congrats, wishing you a speedy recovery.

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Congrats! yes, get that ice on it. Doc giving you any prednisone?

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He took it all the way down to the bone - I will post his summary.
Procedure Date: 06/29/2022

PREOPERATIVE DIAGNOSIS: Symptomatic left Eagles syndrome.

POSTOPERATIVE DIAGNOSIS: Symptomatic left Eagles syndrome.

OPERATIVE PROCEDURE PERFORMED:

  1. Left neck exploration with excision of posterior belly of digastric muscle.
    a. Excision of styloid process and stylohyoid ligament/stylohyoid muscle/styloglossus muscle.
  2. Nasal intubation with mandibular subluxation.

SURGEON: William Omlie, MD

FIRST ASSISTANT: James Omlie, M.D. DDS (Maxillofacial Surgery).

ANESTHESIA: General with nasal intubation.

PREOPERATIVE MEDICATIONS:

  1. Ancef 2 grams IV.
  2. Tylenol 1000 mg orally.

INDICATIONS FOR PROCEDURE: A 53-year-old patient has had longstanding cerebral symptoms. She is documented to have significant compression of the left internal jugular vein that exits the skull between the styloid process and transverse process of C1 along with the digastric muscle. We feel this is the likely cause of her symptoms, though not necessarily and this has been discussed at length. We felt that surgical decompression was indicated. She is aware that this may not resolve her symptoms, may have some temporary or permanent numbness of the left ear, and potential facial nerve issues from retraction. She comes to the operating room today under informed consent.

DESCRIPTION OF PROCEDURE: The patient was brought to the operating room, induced under general anesthesia and nasally intubated with no difficulty. Calf pneumatic compression boots were used and pillows placed under her knees. A rolled towel under shoulders.

Mandibular subluxation: Dr. James Omlie of Maxillofacial Surgery then performed a very good subluxation of her mandible as dictated in his separate operative report to allow for appropriate exposure.

Neck exploration: Left neck was prepped and draped. Timeout was called again. A 4 cm incision was made from the mid posterior ear down towards the angle of the mandible. Dissection was carried with electrocautery. We identified a very generous brachial cutaneous nerve and this was mobilized, dissected free with minimal retraction. We then dissected down to the border of the sternocleidomastoid muscle.

Division posterior belly of the digastric muscle: We then identified the posterior belly of the digastric muscle. This did not appear to be overly enlarged. This was dissected free of the surrounding vessels including a small branch of the external carotid artery that was ligated between 4-0 silk suture. We identified the tendinous portion distally as it went into the anterior belly of the digastric. The digastric muscle was then removed off its attachment to the mastoid bone with electrocautery. We retracted this with a mosquito clamp and divided at the tendinous segment and removed this in entirety with absolute hemostasis.

Styloidectomy: With a light retraction, we identified the styloid bone along with adjacent tendons and muscles. We mobilized the external carotid artery and retracted this distally. This allowed us to divide the stylohyoid ligament. The bone measured at least 4 cm in length. It was very firm. With loupe magnification excellent visualization, we divided and excised segments of the styloglossus muscle and stylohyoid muscle. We then freed up the styloid bone with minimal retraction to its attachment off the skull. This was cut with a bone cutter, removed and a rongeur was used until it was flush with the bony attachment.

We had an excellent dry field. There was no evidence of any extrinsic compression remaining. We could see the internal jugular vein that was somewhat tender due to the turning of the head and set up position, but there was no evidence of any extrinsic compression. We did not mobilize the vein to help prevent scar tissue from developing.

Wounds were infiltrated with 0.5% Marcaine for post-analgesia along with Toradol 30 mg IV. Subcutaneous tissue was approximated with interrupted 3-0 Vicryl and the skin was closed with 4-0 Monocryl in subcuticular fashion followed by Exofin surgical adhesive.

At this time, Dr. James Omlie removed the mandibular fixation wires, allowing the mandible to return to its normal anatomical position. The patient was extubated without difficulty and returned to recovery room.

ESTIMATED BLOOD LOSS: Less than 2 mL

COMPLICATIONS: None.

Dr. James Omlie was involved in not only the mandibular subluxation but what the first assistant on this procedure to allow for safe completion of the operation. He was involved in the entire procedure from the start to finish.

William R. Omlie, MD

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I have had a good bit of pain - I’m still taking oxy, but not on any regular basis. Mainly I notice it if I swallow wrong or bite down. I’ve got vertigo still, but things are swollen enough that it’s not surprising.
I’ve been icing and that helps A LOT.
I’m still eating soft foods.

NOTE: my nurse friend Rachel said anytime one takes a narcotic, one should take a benedryl with it (at least at night). She said there have been studies done which indicate oxycodone can have a negative effect on REM sleep, so a benedryl counter-acts that. I have found it to be true.

I think my perception that my eyesight was better may have been wishful thinking- but I firmly believe that when the swelling goes down, my symptoms will improve.

My scar itches!! (This is a good thing, apparently things itch when they heal)

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Good thorough surgical report which is easily understandable. It’s good you’re still taking the Oxy. Pain w/ swallowing is not uncommon (due to the intubation during surgery) & biting, too, since they “subluxated” i.e dislocated your jaw in order to access the styloid. Both should feel better w/in a couple of weeks. You may actually have had improvement in your vision immediately post op because you’re given strong anti-inflammatory meds during surgery so the negative change in vision could have occurred as the post op swelling took over. This scenario does bode well for good vision recovery once your swelling goes down & as nerves heal.

Tell Rachel thx for info about Benedryl & oxycodone. Makes sense! I slept horribly post op but blamed it on the prednisone not the Percocet. Benedryl might have helped me sleep through both of those!

Please continue to update us as your healing progresses. :gift_heart:

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Happy healing❤️, looks like surgery went great, hopefully you will be feeling good results soon, keep icing

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With regards to the subluxated jaw, how long does that inflammation and pressure usually last?

I have intense deep pressure right by my TMJ that wraps around the front of my face occasionally.

Just wondering what you have noticed with regards to recovery for it. I’m now 12 days post op. I think I’m making very small progress with it each day but still feel the need to take Tylenol daily.

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I was told to take ibuprofen as if it were prescribed- 2 pills every 6 hours. I think it helps more with inflammation. I’m taking Tylenol too, when it hurts.
I’m icing almost constantly. It feels as if someone broke a bone in the side of my face ;). My left ear is also numb, like someone gave it a shot of novacaine
I’m avoiding solid foods still, although they told me I could try to chew.
It hurts the most where they removed the styloid process up by my ear, and my digastric muscle- if I move my tongue wrong it’s awful.
Rachel helped me pick out this awesome smoothie maker for, like, $20. Another friend thought I should get a Nutribullet- those are over $100!!
I’m attaching pic of my last smoothie. :slight_smile:

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I think it took me about a month but I was 58 when I had my first surgery so you’ll most likely heal much more quickly because you have the advantage of “youth”. It did get better gradually so you won’t be feeling as bad as you do now in even another few days to a week.

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Looks YUMMY! @tokenegret! Can I come share the next one w/ you?! :stuck_out_tongue_winking_eye:

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I sure hope so. Today feels worse than yesterday. And yesterday worse then the day before. Tomorrow is my two week point from surgery, I know it’s super early and I am trying to be as patient as I can.

I’m just limited in my pain meds because I can only take Tylenol (I’m on eliquis) and I have bad side effects from oxy and unfortunately medical marijuana only works if I get really high which I am not always in the mood of doing.

I’m pretty sure the pain is surgical pain. It’s most intense right by my ears and TMJ and radiates to the front of my face and nose.

Definitely sounds like Trigeminal nerve. I’ve had pain in my nose from that nerve as well. Funny story…I mentioned it to my ENT when I was in for an appt. awhile ago, & he said, “How do you know it’s the TN?” I told him I know where the TN lies in my face. I pointed to the place in my nose where it hurt, & he shone his little light up my nose & said, “You’re right!” I guess he could see the nerve. I felt rather smug after that. :joy:

Try icing the side of your face & not just your neck. If ice makes it worse, try heat. I’ve found when icing a painful nerve, initially it increases the pain but as the cold sets in, things get kind of numb & after 15-20 min when I take the ice off, the pain is gone. Always make sure to put a cloth between your skin & the ice pack.

If your eating regular food, you might try going on a soft diet for a few days so you don’t need to chew much. Chewing could also be exacerbating the TN w/ the swelling that’s going on.

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Hmm, I was not thinking of TN for the nose pain because it’s more of a pressure like pain that feels like it’s coming from my ears, but if it doesn’t go away in due time I’ll definitely look into TN as the cause.