Hi all! Thanks for accepting me in the group.
I have been offered trans-oral robotic surgery for my left side which is causing problems. The surgeon is planning to remove my tonsil first and then look for the styloid process. My left styloid process is poking my tonsil so it shouldn’t be too difficult to get it. Has anyone had trans-oral robotic surgery? This will be done by a consultant ENT which is a leading TORS surgeon in my region and he often operates head and neck cancers. How are you feeling after having the surgery? And what do you think about TORS for Eagle’s syndrome? I know a couple of other members had successful stories having the same surgery. My main worry is major bleeding but hopefully that won’t be the case as the anatomy of the neck is healthy and everything is where it should be. I know that the robotic surgery gives a much better view compared to the traditional oral method. What are your thoughts? Thanks!
One of the well known American surgeons, Dr Hackman, used to do robotic transoral surgeries, but from what I know, he now rarely does it if at all (for Eagle’s syndrome). I don’t know the exact reasons but anecdotes are that a) it takes much longer, b) costs way more, c) healing is more painful with higher risks of infection as there are a few larger holes cut inside of the throat (though they heal very quickly in that area), d) access is still more complicated if some small bits and pieces need to be fished out from deep levels.
From what I know, he now mostly does these surgeries using external approach.
We’re proponents of the transcervical approach on our forum for the reasons @vdm mentioned: better styloid access, if there are fragments (which robotic surgery can create) robotic surgery cannot remove them so they have to be manually removed in a second surgery. Tonsillectomy is often necessary additionally. Risk of post op infection is higher in oral surgery cases.
Other arguments for transcervical surgery are the tonsils can stay intact so you don’t have to recover from 2 painful surgeries in your throat at once, finding the styloids doesn’t require blindly looking for them once the incision has been made as they can be seen fairly easily once the neck is incised, the styloids can be removed close to the skull base which is difficult w/ intraoral surgery, calcified stylohyoid ligaments can be removed, nerves are monitored to help prevent injury, quicker recovery.
It’s very critical that you find out how many styloidectomies your surgeon has done. We’ve heard that sometimes a styloid has to be removed during a cancer surgery to better access the cancerous area, but that is different than removing the styloid because it is the problem. In cases of ES the styloid can’t merely be shortened. It needs to be removed as thoroughly as possible (near the skull base), & the remaining stub needs to be smoothed off to help prevent further irritation.
After saying all this, if you feel confident that your surgeon has the experience & expertise to do your styloidectomy then it’s probably worthwhile considering having him do your surgery. You just need to weigh the pros & cons & decide what’s best for you.
@Isaiah_40_31 & @vdm have covered everything really; if it was me I would ask if your surgeon has had to remove SPs to access cancers before & I would ask how high he can remove the styloid as if it’s going to just be shortened a bit it might not help alleviate your symptoms. Unfortunately there are very few surgeons in the UK who do this surgery that we know of, so options are limited! If they regularly remove styloids & can shorten it a decent amount, it might be a better option rather than waiting for ages for another surgeon…