Update-Surgery with Dr. Costantino

Hello everyone! I am now post-op Day 11 and this is my update…

Dr. C’s office situation: I went for my first post-op appointment yesterday. I arrived and was pleased to actually have an appointment in the system (some of you know what I am talking about here)! He was behind but everything seemed to be running much smoother. He has a new PA that started about two weeks ago. I was told by other staff that she seems to be working out well. I believe her name is Laura Dorn, but don’t quote me on that! She was in the office when I was there, but I did not get to see her with my own eyes. I set up my follow-up for four weeks on my way out the door. Fingers crossed that all will be back on track.

Progress at home post-op: I went home after two nights in the hospital. I have some other medical issues that came into play or I surely would have been out after one night. I was very comfortable, all things considered. They sent me home with some pain meds which I used very sparingly. I needed one occasionally to help with pain/pressure from swelling at the skull base. I found it initially a challenge to sleep semi-upright but it was the only way for the first few days. I had purchased a wedge pillow at walmart. I actually slept with it and a cervical pillow my husband had the night before surgery so I knew what it would be like. I took full advantage of rest and did not push it in any way-which for me is difficult. At this point, my left cheek, jaw and ear are all still completely numb. This is allowing me to be able to eat freely and is a surprise because of other people’s accounts of not being able to eat solid food, etc. (more on this later) As the days pass, I notice my pulsatile(which is only on surgical side) is greatly diminished. It is still constant, but sometimes hardly noticeable. I did notice, if I get riled up, it also gets amped up. I had bilateral ringing which is now only on the non-surgical side. In the past day or so, I have noticed it has disappeared for periods of time. My husband is most impressed with the brain fog aspect. I was having delays in responding to questions (processing please wait) and now I answer immediately and clearly. I have noticed that I am talking faster and not searching for words nearly as much. I had severe pressure gradients and it was thought that the brain fog may be the most demonstrable improvement, and it very well may be so! It was one of my most worrisome symptoms. My visual issues are greatly improved. I was having disturbances multiple times a day and I can count on one hand how many I have had since surgery. I thought my vision was clearer initially, but now I am not sure. I have an eye appointment next week so maybe I can see if this is indeed the case. Although I am trying to minimize activity, I was able to do a round of errands with my husband with little difficulty. I have noticed that bending forward does still give me some wooziness. As long as I stay upright, I am good. I can now turn my head somewhat to either side without any pain, but still only about 45 or 60 degrees in either direction. My incision looks amazing. I got the clearance yesterday to get it wet and I look forward to a full body shower experience today! He told me to go ahead and put a warm compress on it for 20 minutes and pick off any yuckiness. It should be looking pretty great after that. I don’t know how long it will take for the stitches to dissolve but most of my incision is glued as far as I can tell. I was very hands off of the wound which is probably due to the area being completely numb for so long (more on that). So, I am very pleased with where I am at today. I cannot wait to see where this leads!

Pain Management: So, this was a weird scenario. I am hoping to help someone else who is as naive as I was. At my appointment yesterday, I learned that Dr. C. used a newer technique(for him, at least) to try to minimize post-operative pain. He said he lightly cauterized several nerves during the surgery (I am assuming this is similar to or the same as the ablation another poster was talking about for pre-operative pain control). I woke up with no jaw pain at all. My jaw opened freely. I could eat, drink, talk with no pain whatsover. I was numb from the top of my ear, across my cheekbone, all the way to my jawline and slightly down my neck on the surgical side. Today, 11 days out, the bottom third of my ear down to the underside of my jawbone running under my chin on that side is still numb. This definitely made for an improved experience. Since the incision area has still been numb, I was rarely tempted to scratch or mess with it. Once in awhile I would get an odd itch which was buried beneath the numbness so it was impossible to scratch. It took about a week to get feeling in the upper part of my ear and most of my cheek area. Definitely a good pain management tool in my eyes, Because I had no jaw pain, I was able to minimize the amount of pain meds required. In my case, that’s a good thing because even with minimal pain meds, I had a complete debacle.

The double-edged sword: So, here I am-happy as can be that I can eat and have no jaw pain or restriction of movement at all! It turned out to be a curse! I was eating everything and anything! I am a little person, but the meds must have given me the appetite of a giant! I also had the procedure at Stamford Hospital which has very good food (highly recommend the cheesecake). The night of surgery I had a street taco party in my room (brought in from outside) and indulged in several pork belly tacos. I ate like this for days. I had everything from pork ribs with kraut to a porterhouse steak when I got home. I am not bragging because…disaster struck. The whole time, I was taking senna and colace and probiotics. I am not a daily pooper (sorry) by nature, so I didn’t think much of it. I only wish my nurses would have advised me to reel it in when they saw what I was consuming before they sent me on my way. I was naive. I have taken opioids only a handful of times and had general anesthesia for short procedures even fewer. I did not know what I did not know! What a disaster! I thought I was going to the ER. I have never been in so much pain in my life! It was like a powder keg in my body and it took alot to get it under control. All that food was piled in my colon which was still asleep, top it with the massive amounts of liquids I consumed (because hydrate, hydrate, hydrate), and top it off with a huge balloon of air. It was such a shame that everything went so amazingly and then this happened because I am an idiot! It was three days of absolute torture followed by several days of misery. Today is the first day in a week that I feel almost back to normal. I share this tale because I do not want anyone else to go through this! If you are blessed to have a pain free jaw when you wake up-treat your diet like your jaw hurts like the dickens! Make sure you are pooping within a day or two from surgery. Like I said, I am not a daily kind of girl, so I did not think anything of it. I eat pretty high protein, low carb most of the time and my body uses most of what I eat for fuel. I am sure the change in my diet also played a part. Just please don’t be lured in by the joy of feeling no pain in your jaw and celebrate like I did. Save yourself days of agony. This would have been a walk in the park if I knew more about how pain meds/anesthesia affect digestion and motility. I know now and I will never make that mistake again!

Badges Earned: Longest Styloid 2023 11.43 cm
First patient to gorge themselves after styloidectomy
Most naive surgical patient

And you, my Eagle friend, get a badge for actually reading this far! I thank you!


Wow, 11cms! That definitely wins an award :flushed: :trophy: :1st_place_medal:
So pleased that you’re seeing some improvements already and not in too much pain with your jaw, but so sorry that you had such a terrible time afterwards, definitely a good idea to take something for constipation, thank you for sharing your experience…
Very glad too that hopefully problems in Dr C’s office are being sorted out!
Praying that you keep healing well and seeing more improvements :hugs: :bouquet: :pray:


It was a monstrous styloid for sure! I have seen several doctors through this journey and received reactions from quiet giggles and a gasp of awe so I was very curious just how big these suckers are! He had to cut it in half to get it out. I saw the picture of the little bugger. It was gnarly. I hope to get the other one out in six months or so.
Thank you for the well wishes!


Was the styloid & stylo-hyoid ligament all calcified together right to your hyoid, or was it all styloid do you know? Just curious…

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Both had calcifications, but he only removed the styloid and I believe he cut the ligament. That was a question. I failed to get clarification on when I met with him yesterday because another doctor had said that they would remove the ligament and its entirety but I know Dr. C had said, due to location and some other issues he would not be removing the ligament he would be cutting it. I saw the picture of the styloid, and it had nothing else attached to it.

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I’d wondered how you made out, I’m super glad you had an appointment and surgery, GI issues not withstanding! Glad to hear things are going well by all accounts. No jaw pain would be so amazing, that alone sounds like fantastic!!


Loved your update & chuckled through your constipation story. Been there & done that but went to the ER. Someplace on this forum is my explanation about the “atomic enema” you get in the ER. It was NOT FUN, but it was VERY EFFECTIVE!! (My issue wasn’t the result of ES surgery, but it was caused by a pain med I didn’t realize was an opioid :crazy_face:).

11+ cm is an unbelievably long styloid!! I think our previous forum record was 8 or 8.5 cm. I’m so glad for the positive difference you’ve already noticed. That’s so great!! I like that Dr. Costantino is trying new methods to help recovery be less painful. I would have loved to be able to eat regular food after my first surgery but couldn’t open my mouth very wide or chew for several weeks post op. Second surgery was a skate in the park in comparison w/ no sore throat or stiff jaw. Interesting how that works!

Thank you so much for your update and may your recovery continue speedily forward!


Oh my! I will have to look for your post regarding your experience! I was so close to going to the ER several times. Our wait times locally are 8 hours or more and I could not bear the thought of enduring that. I probably would have gotten much better relief more expeditiously if I had gone, even with the wait. This took six days to get to a bearable level.

I asked if I could have the styloid so I could make earrings, but Dr. C. said the pieces had to be sent to pathology. I don’t have pierced ears, but since I can’t feel my ear right now, I thought it was the perfect opportunity to put a hole in it🤣 Oh well! My earlobe will remain naked for now!


Oh I am so sorry for your mishap! That must have been scary and miserable! I am very pleased and happy for you that you are doing well though after surgery. It’s encouraging to hear that you are a pioneer in a new technique to help with pain. Thank you and Dr C. Did that. I’m excited to hear all of your progress. Please keep in touch- wishing and hoping for your continued healing and sending positive recovery thoughts!


I am very curious myself! So you know all what was done on your procedure? Was there any hyoid, carotid involvement?

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Thank you so very much for such a thorough and beautiful to read update. I am SO happy for you that your post op experience (bar one) has been so good. What an excellent idea to do that to the nerves. I sincerely hope that he is sharing with peers and this starts spreading (I am booked but only in April next year for surgery and not with Dr C).
Your constipation story! Oh yes oh yes oh yes I know that SO well!!! I was right there with you (not literally… that would be… well… weird :rofl:) But I ended up going about a week without pooping and oh my oh my oh my… I tried everything I could think of and it only got worse (as you well know). And then I called a nurse via my health insurance plan and she told me to get to a pharmacy and buy x and y and then…
So there I am in Walgreens in front of the suppository section and diuretics etc etc… and what do you know, I end up pretty much passed out and flat on the floor… An ambulance is called and every single person from staff to ambulance to ER is trying to work out if I am bulimic… I of course, delirious from being so faint and at the time at my sickest form all of this said (as if the paramedic were a friend who knew me) “I have lost a lot of weight but I cant help it, I just can’t eat”. That sure didn’t help the interrogation.
And go figure, while still in the throws of pain, the ER did not help me with my 'situation"… So back home I went, sent my husband to buy the goods (he came from work to the hospital) and finally I could follow the nurse’s protocol.
I hope I gave you a little giggle back…
And thank you again for sharing. I so hope that you continue to have a smooth low pain progression and look forward to hearing more when and as you can :blue_heart: :green_heart: :purple_heart:


Although I had received quite a bit of information and details about my procedure, I was not quite totally able to retain all of the details. I do know that I did not have a carotid involvement. As far as the hyoid, I do believe that was involved, but I am waiting patiently for the detailed surgical report to come out. That way I can make sure that I have all my details straight. I do know my IJV was being compressed three ways and he said it was a very difficult procedure. He said he had to go in as deep as his pointer finger to reach the area he needed to work on. I believe that required him to move some things and disconnect some things that may have not been originally planned, I am nearing two weeks from procedure date so I am hopeful that the report comes out soon because I would like to see all the details myself.


Thank you for sharing your tale! I feel so much better to know that I am not alone in this! Honestly, one of the things that kept me from the ER was that I was too embarrassed to call Dr. C. It was a horrible dilemma. The thought of walking myself into a pharmacy in that condition would have been the scariest thing imaginable. The nervous sweating and chills, wondering if I was going to make it out of the store without humiliating myself and having an accident. That must’ve been a very scary experience for you, though. And I can’t believe they did not help you at the hospital! I guess we can look back at it and chuckle, although I’m not quite out of the woods yet, but I’m getting there. It just stinks that I had to have an otherwise awesome outcome muddied up with this other circumstance.


YIKES! @akc! The passing out part is scary & I’m sure glad you didn’t end up w/ a head injury or some broken body part. Your story did make me laugh otherwise! :rofl:


I am guessing the difference was I knew there was no chance that I was going to have an accident. There was a clear pile up on the highway and no traffic would be going anywhere until the emergency crew could get in :rofl: :rofl: :rofl:.

And the thought of any assistance was for me the humiliating point so I did not push it at all when they did not offer to help at the ER

I am sorry though that you’re still on the rough side from that part of the experience. And indeed so sorry that you had to go through it at all. You are right, that really ought to be a part of the discharge instructions…

Take good care!


I definitely go with the humor part of it… I knew without doubt what was about to happen and so got down on the floor. Lucky

On the other hand, that was (is) my local Walgreens and it took me a LONG time before I went back in there (the whole people thinking I was bulimic thing for some reason was what was so embarrassing to me)


Crazy that you’d be asked about bulimia. Some people are naturally thin so that wouldn’t necessarily follow, but perhaps it was the fainting combined w/ your thinness & the aisle you were in at Walgreen’s that spurred those questions. I knew someone in college who used laxatives for weight control. She was thin, but I wondered if that would mess up her digestive tract &/or leave her nutrient deficient over time.

I can’t imagine it did any good when used for weight loss purposes. I gotta say in retrospect I did understand. Exactly for the reasons you point out… someone who is skinny, makes some comment about having lost weight due to food issues, standing in front of laxatives, and passes out (… easy to imagine passing out due to weakness). Even though I did tell every single person who asked the full story of having problems due to side effect of Aimovig and dial a nurse telling me what I needed to buy at Walgreens… So come to think of it, since I shared that just as openly, you’d have thought that they might have believed me. …or maybe they thought that was just my cover story… who knows…


@Mjrmunch - Congratulations on the surgery. Do you have any more information on the operative report and what was done?

I am especially curious to hear if the digastric muscle was removed or touched.

I think I might have digastric muscle compression issue since my pulsatile tinnitus disappears when I move my jaw far enough.

How is your brain fog now?