Surgery questions - intra-oral

I finally saw the doctor today. He couldn’t stop saying how impressive my styloids were. They are calcified on both sides plus both ligaments and the left one is very thick. The left side is the one I’m noticing almost all of my symptoms on.

He said he’d recommend the intra-oral approach. He said he’s leaning a bit more towards just doing it on the left side. He said with Eagle’s you can never guarantee it will relieve the symptoms so it may be good to start with just one side.

Question: What have you guys had done? Is it an easier recovery with just one side than 2? He said he would only take my tonsils if he had to. I wish I knew if he did need to take the tonsils or not. I have a 9 month old and a shorter recovery is preferred.

He also said the biggest risk is the carotid artery. He checked the CT and he said it looks like it’s in a good place. I know it’s close to the styloid, how big of a risk is that? He said overall he thinks the surgery will be safe and relieve a lot of my symptoms.

He said he has done about 20 styloid surgeries both intra-oral and external. Is that considered experienced? He said there’s no real great expert I’ll find on google, which is true. I’m in the Chicago area. He seemed really caring and knowledgeable.

The other big caveat is that I’m a teacher. I’ll need to have the surgery in the summer if I’m going to have it. However I want to breastfeed until he’s a year on July 24th. Any advice would be appreciated. I’m petrified!

Hi Agordon

Welcome to the flock! I too am a teacher [High School Chemistry] and had my surgeries during post- Winter break and Spring break missing 3 weeks this year, I’ve always put my students first but on this- I had to come first! One of my former students subbed for me for the first surgery! Yes, I am old enough for that :wink:

I was wondering if you have seen a surgeon who does External Surgery? The thing is many people on here [research it yourself by reading many posts] have had good symptom results by having the whole bone removed. I myself, have had both fully removed since they were pressing on my GP nerve and my Carotid and Jugular fully on my fight side and at times on my left when I turned my head down to the left. While this is a surgery with risks [as you mentioned], the question is if doing nothing may result in long term damage? As for the 1 side or 2 sides question, my surgeon would only do one side at a time because of concern about swelling throat. I healed so well from my first surgery that I was able to have my second 3 months later [about 3 weeks ago].

I think there are some people on here who were the first Eagles surgery for their doctor; the surgeon I saw, said he had done over 80 surgeries in about 4 years. People fly in from other countries to see him = I’m on the West coast.

Look at the doctor list here on the site…there is a highly touted doctor near you I think, Dr Cognetti

I found reading as much as possible of the posts on this site and researching on-line to help me feel more in knowledgeable when I was panicked. We have all had some level of it , so hang in there.

Ah, the age old question of intraoral vs. external approach for ES surgery. The answer is both can be effective in alleviating ES symptoms, however, the external approach is believed to be slightly safer as it is easier for the surgeon to monitor nerve & vascular locations so as to avoid damaging something important. It also provides better access to the styloids & ligaments so they can be fully removed. The intraoral approach allows for a shorter length of styloid to be removed, & I’m not sure what access to the ligaments is like. There are some Youtube videos of the intraoral approach being done but none for the external approach.

Several people on this forum have had both sides done at once w/o a problem. I preferred erring on the side of caution & having mine removed by 2 different surgeries w/ healing time in between.

You should also be aware that when one elongated styloid/ligament is removed, the remaining one often becomes more symptomatic. Because of this there are people on this site whose surgeons refused to do a second surgery because they believed the continuation of pain indicated the surgery was ineffective. We don’t know why the second side tends to flare up when the first side is taken care of.

If your pain isn’t debilitating, I vote for nursing your baby till he’s a year old. Enjoy that time and take care of yourself after that. If your symptoms are keeping you from being a good mom (other than nursing), you might want to take care of yourself sooner and just be thankful for the nursing time you’ve already had.

I strongly encourage you not to be petrified. If you like your doctor and feel confident in his ability to take care of you, approach your potential surgery with a positive mindset. Be communicative about your concerns. Our bodies are made so they heal. Most people get some to complete symptom relief from ES surgery. Only the first week post op is truly uncomfy/difficult. Things improve from there.

I don’t want to add any more to the intra/ external debate as that’s been well covered, thanks everyone!
I had external, so can’t comment on the healing from an intra-oral surgery, although I would think that some healing is the same- all I would say is that I wouldn’t have been wanting to lift a one year old about too much for the first couple of weeks. I was working (voluntary though) with 3 year olds with disabilities and I took 4 weeks off as to lift them would’ve been too painful. So you might want to make sure you’ve got help about afterwards, if possible. And also obviously you’d have to ask your doctor about medication being okay with breastfeeding if you did decide to go for surgery before weaning.
I don’t know to be fair about whether 20 surgeries is an ‘experienced’ amount; that’s a good question. We always suggest seeing an experienced surgeon, but haven’t actually thought about how many would qualify them for that!! 20 sounds a decent amount, I’d have thought. If you feel confident and comfortable with your doctor, that’s important too!
Also I always thought that they had to remove the tonsils to get to the styloid behind it, but maybe I’m wrong with that. Did he say why he would prefer to do yours intra-orally?
As for the carotid artery, it’s a small, cramped space with lots of nerves and major blood vessels, so there is always that risk for this surgery, but with a good surgeon it shouldn’t be a major problem. With the surgery, they’ll only remove as much as is safe to do so; if to remove it higher would be to near a blood vessel or a nerve then they won’t, regardless of whether it’s internal or external, but usually external gives them a better view.
I hope that you can get a date sorted that helps you balance time with your little one and your students. Let us know how you get on!

Thank you. That was helpful. He recommended intra-oral with my case. He said most of the time he would have to remove the tonsil but sometimes it can be done without the tonsil removed. I am preparing myself that the tonsil will most likely be removed.

Only know that my surgeon has said that the carotid is one risk factor but , almost dismissively , said it was a sturdier structure than most people imagine and didn’t seem to consider it high on his list of risk factors albeit he is going the external approach as his preference.