Hi all, I just thought I’d start a post to track my symptom recovery (fingers crossed for some) and any unusual recovery symptoms that might arise post-op. I had surgery yesterday in Wellington with Dr Charles Davis. He has done two ES surgeries in the past though not vES like I have. He works alongside a very knowledgeable Anaesthesiologist, Kevin O’Connor. Though they don’t have huge experience with this surgery, anatomically they are extremely knowledgeable.
Charles is a plastic surgeon with Maxilio and craniofacial speciality and thus his technique for the surgery which involved the removal of ossification of my left stylohyoid ligament was to go in at the tip of the calcified ligament and work his way up under the jaw to the styloid process, removing the calcified portion of the ligament and the styloid process (leaving about 1cm at the skull base).
Post-surgery he noted that the calcified ligament was very much compressing most of the anatomy in the left neck up under the jaw including the IJV though they did also mention the EJV (which I will confirm in a follow up appt) with the tip of the ligament quite pointy and sitting at the carotid sinus level. They think this may have given rise to my tachycardia symptoms but yet to see. The calcified ligament was running very horizontally so they imagine every time I moved my head, most structures were being compressed or rubbed up against.
My surgery started around 1.30pm and was expected to take about 90mins, however was a bit faster than that. I was back in my room around 4pm. Post-surgery I was pretty drowsy and nauseous (which they put down to my slim build from the anaesthesia) but by 10.30pm after having Tramodol and some anti-nausea I was able to sleep through the night, head on an angle and cuddling a pillow so that the top end was up protecting my head from shifting.
I was woken twice in the night to check obs and have more pain relief.
In the morning around 7am I woke and felt really good. Though still lying down and resisting moving my head and neck too much. Moving it to the left still gives me an immediate headache. The muscles in my neck at the incision are sore and so are the muscles at the back of my head on the left when I stand. I wasn’t able to eat the night before due to the nausea/dizziness and had jaw restriction when eating my breakfast in the morning. I just had some pears chopped up, cup of tea, the soft part of my toast and a poached egg. So relatively decent. The neck pain is probably a 5 out of 10 and I have a bit of a sore throat, almost like a swollen gland feeling, but also about a 5 out of 10 pain rating.
Will wait to see what happens with my symptoms over the coming days. Just happy to have it out!
I was discharged at 10am the day after surgery and felt good leaving. I used a memory-form neck pillow during transit to help give support to my neck which really helped. I was able to have a conversation standing up for about 30mins, catching up with family by using this. In bed now resting and just put an ice pack on the neck, though I don’t actually see any swelling at this point. I’ve been told to keep the tape on for 2-3weeks so won’t see the size of the incision for a while yet.
Will update again in a few days. To all those who have been through this and provided information on their surgeries and tips for getting through it, thank you. I feel like I was very prepared going into this because of you all.
Thank you for your update so soon after surgery, @BraveKat. Dr. Davis sounds like he did a truly amazing & thorough job considering this isn’t a typical surgery he does. It makes sense that this type of surgery would be well within his range of experience though being a maxillofacial surgeon.
It sounds like you’re doing all the right things so far to take care of yourself. You may want to ice every couple of hours even if you don’t see swelling because there will be some even if not right away. Try to do gentle full range movements of your head & neck within your comfort zone several times/day starting now as that will help keep your neck muscles from getting tight & restricted. Taking short (10-15 min) walks 2-3x/day is also important to help keep good circulation in your legs & throughout your body.
Your sore throat is most likely from the breathing tube used during surgery & should subside w/in the first week. Sucking on ice chips or popsicles &/or sipping ice water can help soothe your throat. Your stiff jaw may last a bit longer but should resolve in 2-3 weeks or less so you can eat more normally. Overall, I’d say you’re doing very well so soon after surgery. Do remember that you may feel extra tired for a month or two post op. This is normal. Also symptoms can come & go as the nerves heal which is annoying but it seems to be the way recovery goes.
I’ll be praying for your recovery to progress consistently complete healing.
So glad that you’re through surgery, it looks like they were able to remove a fair amount of the styloid, that’s great! Hopefully getting that removed will vastly improve your symptoms if it was compressing the IJV & irritating the carotid sinus too!
Make sure you keep propped up a bit when you’re resting to help with any swelling, and take care of yourself…been praying for good results for you & sending you a hug too
Thank you for the styloid/ligament picture. The ligament looks like a twig from a tree branch, plus its curve would definitely have made it more problematic. I forgot to comment on your note that it had grown almost horizontally. That’s alarming & definitely would enable it to wreak havoc in your neck. The bit of styloid looks very thick. Good thing that’s gone now, too!
Hi @Isaiah_40_31 thanks for the tips. I tried to ice my neck but the pressure is too much - causes a lot of pain. Did you find that?
Dr Davis also advised the small head movements so that’s great to have reinforced. And the walks, I tend to forget this part of the recovery and enjoy the curling up in bed part too much - at least in the first week
It’s been nice today having little sleeps though the day. Will try to keep this up as much as I can. It’s hard with a young family to ever feel like you’ve had enough sleep haha.
I didn’t notice the curve of the ligament until I read your comment. Yes can see how it would have been sitting in there now. Thank you
Thank you @Jules. I bought a wedge pillow along with me on the adventure (based on your advice) which has been a game-changer. So grateful for the support from you all.
Definitely make the most of any opportunity you get to have naps then if you have little ones Take care of yourself, are you back at home, or staying away for surgery?
Thanks for the reminder. Will stay down in Wellington for at least a few more days, perhaps until my follow up on Monday.
Pain has been setting in a bit more over the last day so regularly taking tramadol and Panadol now, as prescribed. Mostly felt on the outside of the neck at the incision.Head/neck rotation improving with small exercise. Headache that I felt turning left on discharge has now disappeared. The throat has settled down, just a bit of discomfort at the base of the throat from something I cant clear as my cough is not super strong just yet.
My lower neck vertebrae are continuing to crack (as they did pre-surgery) with movement but the left arm and shoulder pain and pressure near the clavicle felt pre-surgery has reduced at this point, though I’m hardly using it right now. Still very much have tinnitus and blurred vision. No cranial head pressure though right now.
No new symptoms at this stage aside from the pain from the surgery itself.
Thank you for another update, @BraveKat. I’m really glad you’ve already noticed some positive improvements from your surgery. The pain during the first week post op can intensify over days 3-5 or 6 then it begins settling down during the second week. Just a reminder that the remaining symptoms can come & go for several months after surgery. Taking it easier on days where you feel more tired & uncomfortable will help the pain flares to leave more quickly than pushing through them though I also acknowledge that is a difficult challenge with young children at home. I’m glad you’re able to have a bit of time away for initial recovery. That will help your body get off to a good start recovering.
Hopefully the blurred vision & tinnitus will reduce/resolve over the next few weeks to a couple of months. I hope by Christmas you’ll be feeling substantially better!
Brilliant account of your experience. Hope very much things continue to go to plan and a full recovery with banished symptoms! Well done and thanks for posting.
Hi all, I’m wondering if someone might be able to help. I’m day 3 post surgery and I know it’s just early days but I’ve been feeling generally well aside from pain after icing my neck. I felt pain the first time I tried, so stopped. And have tried once a day since day one. Today I tried it for a bit longer as my general incision pain has gone but I had pain generally after moving something. Unfortunately I now have sharp pain at one area of the incision as well as in line just below it. It appears to me to be the line of the carotid artery - I was told that my ligament was at the level of my carotid sinus post surgery and so imagine my pre-surgery heart related symptoms of uncontrollable tachycardia, chest pain, feeling like my chest is erratic like arrhythmia (though never diagnosed) could have been due to this.
I’m just wondering how long it has taken for those with more carotid/heart symptoms to recover from these? Is it normal for these to ramp back up post-surgery from say pressure of an ice pack or a little exertion like having a shower and moving arms?
Thank you
@BraveKat - Days 3-5 or 6 post op are when swelling reaches its climax so it’s best to really take it easy during those days & keep on your pain medication schedule. You should do no lifting until after 2 weeks post op other than lifting your arms to wash your hair or very light lifting like moving your food to the table, dressing yourself, etc. It is normal for pain to ramp up on days 3-5 or 6 when the swelling peaks but as it starts going down again during week 2 post op, some of those symptoms should decrease & gradually disappear. Your carotid symptoms could take several months to fully disappear, but hopefully it will be quicker than that.
If ice is causing pain, you can try heat. I believe @Jules found ice was not helpful but heat was so that was her go to post op. Ice helps reduce swelling because of the cold, but in the end, it stimulates circulation just as heat does. As the cooled area “thaws” extra blood flows to it to rewarm it.
Thank you @Isaiah_40_31 for your support and reassurance. Yes big mistake lifting something, I definitely learnt my lesson.
The thing is, I’ve been questioning (based on a gut instinct) what is causing this pain, cos to me, it seems weird that just a specific area of my neck is sore and that it is bringing with it the tachycardia symptoms - almost like a nightmare come true post-surgery. I decided it was time I put my scans into RadiAnt and was surprised to see that what I thought had been going on pre-op possibly wasn’t correct. It looks more like a nerve (or small vein) is compressing the IJV (not the Styloid) and the calcified ligament was sitting hard up against the side of my ECA.
Not sure if these images will be legible but does anyone else see that?
It also appears that the hyoid bone was being very tightly pulled by the calcified ligament, holding it above the right side ever so slightly and when compared to the right side, there is no gap between where the greater horn of hyoid sits horizontally on the left and the ECA. Effectively they are either touching each other or 1 or so millimetres from touching. With the calcified ligament removed, could there be any chance of the hyoid settling into a different position or am I potentially looking at an additional surgery?
I am 100% happy to have my calcified ligament removed of course and know my chances of finding anyone more qualified than DR Davis in this area/field is likely not possible in nz.
Has anyone had a similar experience with the hyoid rubbing the ECA due to a calcified ligament?
Compression of the IJV can cause collateral veins to swell and take over with blood flow, it could be another small vein has done that, and hopefully if your IJV returns to normal then the collateral veins will go back down, so it could be a vein which will shrink? I’m not knowledgeable enough to comment on what else it could be, although I do agree it looks a bit of a tangle in there…
The styloid, stylo-hyoid ligament, hyoid, & back round to the other side is all a long chain, so if you’re ligament was calcified & tugging the hyoid it could be pulling it out of balance & position, hopefully with surgery it will loosen the tension on the hyoid, & it’ll move away from the ECA
Take care & hope that the surgery does work
@BraveKat - First off, your styloid looks very gnarly & it’s no wonder you were having such awful symptoms.
I’ve spent a lot of time looking at the pictures you’ve sent, & I believe the small vein you see which you think might be/have been compressing your IJV is the occipital artery which branches off the ECA. It looks to me more like the transverse process of your C1 is what is/was causing compression of your IJV. It does look like your elongated styloid was sitting on your ECA so it’s good that spike has been mostly removed from your neck.
You need to be able see the whole left greater horn of the hyoid to determine whether or not it’s as close to the ECA as it appears. The angle of the image only really shows the full right greater horn. The left carotid bifurcation is blocking part of the left greater horn making it impossible to know whether what you think you’re seeing is accurate or not.
You’re in super early recovery, @BraveKat, so it’s best to be patient & give your body a few months to heal before being concerned that something was missed. You’ve had 10 years of symptoms & that means your irritated nerves may take a bit longer to recover. Most of my worst symptoms were gone 6 months post op but some took a year to really go away. The recovery from nerve injury is slow & requires much patience.
Thank you @Jules and @Isaiah_40_31 for your thoughts on my previous queries. It’s taken me a while to come back as I like to think over my thoughts as this stuff is too far over my head to be able to find an immediate response
Very interesting that you think the vein wrapping the LIJV is the occipital vein. I will keep that in mind should I need to investigate further in the future.
I managed to slice through the 3d at the level just above the hyoid and it does seem like, at least with my head straight, there is 1-1.5mm between the left greater horn of the hyoid and the ECA branch. It’s possibly closest to that Occipital vein. The right greater horn is about 3-4mm to the ECA branch so not sure if this is something or nothing at this stage.
It’s funny, going into the surgery I knew this would take months if not years to heal but I’ve realised I wasn’t prepared for that to also be the case for my tachycardia/heart related symptoms. I want those gone now and it’s hard to think I might have to wait a few months to a year to understand if the surgery has resolved them or not. My sleep is still very much being affected too by my head position as it compressions the are during the night as my chin drops creating the same crazy heart rates I was having before - somewhere in the 150-180 range. It’s horrible. [feeling sorry for myself :(]
I also got a chest infection, I think from either the breathing tube or aircon in the hotel room I stayed in/plane as I traveled for the op, which I have had pain and achy body symptoms from including an extremely sore throat (like strep throat feeling) since day 3 but intensified around day 7. I’m on a course of antibiotics which have already started to reduce symptoms from that thankfully.
Day 11 post op. I took my bandage off today. My doctor had advised to wait 2-3 weeks but I felt like it may have been creating a bit of pressure on the area as it was stuck down before the swelling started. My neck is feeling a bit more relaxed which is good. The incision is very tender and it’s swollen still.
The incision is right in the join of my neck and jaw, and have been wondering if this could also be why I’m having such trouble still at night with the position of my chin. Could this be why surgeons typically position the incision further down the neck? To avoid swelling and scar tissue in the same area as the bone was positioned.
If it weren’t for the tachycardia (and in turn poor sleeping) I’d say things are progressing well. Bits of pain in different areas that come and go - examples are strange pain at the back side of my tongue on the left like the muscles have been affected, pain in deep behind the jaw near the ear, pain at the jawline on the left and a bit of the chin, nerve pain when I have the slightest bit of wind on my jawline and ear, pain at the incision but avoiding touching anywhere near there but it’s all pretty bearable. I’m just taking the antibiotics at the moment and some ibuprofen every now and then.
It looks like it’s healing well! I see what you mean about the position of the incision; alot of surgeons use different methods, mine was mainly behind my ear, the skin is quite tight there anyway, so I do still have to massage the area 8+ years later, but it’s way worth it!
If the styloid was irritating your vagus nerve & that was the cause of the tachycardia, then it could well take a while to settle down. It’s frustrating to have to wait, I know! But the chest infection complicates healing as well; I find even now that if I have any sort of virus etc the ES symptoms in my neck can flare a bit, it’s like the inflammation from a virus flares those nerves up again too, like they find a weak spot, so the infection you have could be causing something similar?
Also the random pains you’re getting in your jaw etc are probably nerves healing, that’s quite common, tingling or itching can happen too, hopefully a good sign that your body is getting fixed!
Sorry if I’ve mentioned this discussion before, but @GrnyAny posted this helpful discussion about vagus nerve effects & how long it took for healing, it might be helpful & certainly shows how patient we have to be with healing! Successful Surgery for severe Vagus Nerve Compression - General / Eagle Syndrome Stories - Living with Eagle
Praying that you see some improvements in your heart rate soon
I don’t have anything to add to @Jules comments regarding recovery, but I can suggest that a U or V shaped pillow placed under your chin before you go to sleep at night could help your chin not to drop when you sleep. I actually had a different problem when my chin would drop while sleeping. I would wake up feeling like my throat had closed, & I couldn’t breathe. I still have that problem to some extent so if I sleep on my back, I roll my down pillow up under my neck so it puts my neck in extension i.e. my head is tilted slightly backwards. That helps keep my throat open & avoids the choking sensation. Since your incision is still so tender, you might try rolling up a soft towel or large washcloth to tuck under your chin as a U or V pillow might touch your incision & cause pain.
I’m sorry about your crazy heart rate. If your symptoms persist, you may want to go back to Dr. Smith to discuss the proximity of the left greater hyoid horn to your ECA as that might indirectly stimulate heart rate by affecting your blood pressure. Alternatively it could also be affecting the vagus nerve. I had issues w/ my heart racing when I’d exercise, & it turned out that happened because my blood pressure would drop instead of elevating. My heart would race to try to oxygenate my blood to accommodate my activity level. It was very uncomfy & left me breathless & light headed. I wonder if your blood pressure is dropping & that’s what’s stimulating your heart to race? Carotid artery irritation can affect BP for sure.
Take care of yourself, are you back at home, or staying away for surgery? 
