Three questions. Any answers would be appreciated
1 - Can someone please describe what it feels like to have your stylohyoid ligament released from the hyoid bone? A bit of an open ended question, but I’m curious to know what the before and after sensation is.
2 - Is it important that the entire ligament is removed? If only the bottom portion of the ligament is calcified, should only this portion be removed? Has anyone had problems with the rest of the stylohyoid ligament staying in the neck, while detached from the hyoid?
3 - Does the stylohyoid muscle stay when the ligament is removed? How is the muscle itself affected by this kind of surgery?
I haven’t had my ligaments removed, so not sure if this will help at all, but as my styloids were removed to skull base, the ligaments were all detached. I haven’t noticed any difference with the ligaments gone; we get asked this alot! Swallowing, talking, eating all the same, a bit uncomfortable eating after surgery, but it soon improved.
If only part of the styloid is calcified then often only that part is removed. One of our members, Sewmomma , had the same surgery, you could search for her posts as she gave quite detailed info about her recovery & experience.
Thanks for your reply Jules!
I’ve seen Sewmomma’s posts and they are very helpful.
In particular, I’m struggling with tightness and compacted space in the hyoid area. When your ligaments were detached, did you notice more space and release of tension in the area? I’m just trying to get a sense of imagining the sensation of what it would feel like.
I am not really sure how to answer
The styloid is a bone attached to the skull base. The stylohyoid ligament extends from the styloid to the hyoid. Other ligaments attach to the hyoid as well. There is a lot more going on in that area as well. These are the three things that compose eagles syndrome along with the many nerves that are affected.
Intraorallly, usually the surgeon goes in through the tonsil area and finds the calcified styloid and or stylohyoid ligament and removes some of it. They often leave a part of the styloid and a part of the stylohyoid. Effectively, the styloid and stylohyoid that are remaining just stay there. The stylohyoid for me felt like a part of a 3 jointed chicken wing had been removed and the rest snapped back near the hyoid and part of the styloid was gone. For me, this never really felt right. For most, it is enough to get rid if pain.
For me the styloid was very thick and pressing on a nerve. The stylohyoid remaining seemed hung up in my throat like a little stick.
Intraorallly, some doctors can now remove the entire styloid and stylohyoid, they say. That is very new I believe
Externally, doctors take several approaches, a cut in the lower neck or an “s” shaped incision from the mid front of the ear around and down to the mid back of the ear and down and back in a half heart to a crease in the neck. That incision looks terrifying, but it is a flap that makes everything more visible and it is a superficial incision to make a flap except that the earlobe is numb for a couple months after. The incision scar is almost invisible in a month or 2. Amazing work.
Then the surgeon can find the nerves and tissue that he needs to maneuver through and protect or cut to reach the styloid and stylohyoid.
The surgeon will remove what he deems necessary. .When they remove the stylohyoid completely from the hyoid, they dissect it from the hyoid and leave the hyoid intact. They may or may not leave a tiny bit of styloid at the skull. Sometimes they clip a tiny bit of muscle from the hyoid in order to remove the stylohyoid ligament.
When the stylohyoid is removed from the hyoid and everything is healed, you mostly do not feel any different The hyoid is not attached with a joint to any other bone, but there are other ligaments still attached to the hyoid that stabilize the hyoid.
You may notice a little more tenderness or weakness when you cough a lot, and sometimes swallowing water in a certain way will cause a cough like choking, but 99 % of the time, it feels normal as before.
Like you, I could not get a handle on what releasing the stylohyoid would do. Intraorally the classic way actually removes a middle chunck and leaves a bit of styloid hanging down and stylohyoid sticking up. The only problem with that, is if the nerves are still compressed by either of those pieces, you still have pain
If you have bilateral issues, I recommend a Physical therapist to help you relieve tight muscles after a 2 month healing process.
I had both these surgeries and this is my story as I felt and experienced it. Today is my one year anniversary of my last of 3 surgeries.
You should recover pretty well in a month, but the one year mark after you last surgery will be a milestone because all the little setbacks have passed. I am still unwinding and releasing neck back and shoulder muscles that were held hostage for many years, but I feel like I got back 4 years of my life
I recommend physical therapy after.
emma, thank you so much for the detailed response. This is very helpful
I have interrupted calcification, near the styloid and then near the hyoid. My surgeon wants to just remove the calcified portion near the hyoid, but optimally I would just rather remove the entire chain. The method you’ve laid out to remove the entire segment seems much more complicated than my previous understanding.
It does seem like leaving a portion of the ligament was causing you problems, so I’m still torn on whether I should advocate going for the full removal. It’s a bit of a challenge to figure out what the right balance is.
Good luck trying to figure out the balance. Seriously, I get it this is nothing to take lightly.
Do you gave a 3D CT scan. Even with a 3 D scan, I believe an interruption is not conclusive that there is no calcification of a ligament. I believe ligaments do not show up well on s CT unless the calcification is seriously bone like…
From NJ, you are in a food place to consult more than one surgeon.
Ultimately, I dealt with 5 surgeons before I finally got my external surgery… Dr Samji got my CT and gave me a phone consult , but he did not have a 3D version.Perhaps he was able to make his own. He did not want to redo my first surgery, but all my pain was on that side. my husband created a 3D version and we found the thickness of the 1st side to look dangerous. We saw no stylohyoid, yet it was about a centimeter in the final surgical report.
I sent all my data including my first intraoral and our crude 3D pic and the CD to a doc at U of Penn… He was willing to see me if I would go there. I was planning to go for am appt. when I hound a doc in LA. I got a referral to him from an ENT that I knew there. As soon as he saw me , he already knew he would operate and which side most concerned him. .
There is a lot to external surgery. If your problem is in the area of the hyoid and you are confident in your surgeon,it is very possible he is right I have heard of this partial fro near the hyoid.
Internal avoids damaging nerves, but it cannot show the surgeon nerves that are compressed…
I don’t know that I noticed tension, or a release- it was 5 years ago, you think you’ll never forget! For me it was vascular symptoms which were worst & more noticeable, & they’ve improved massively.
I do agree that you need to carefully consider the surgical options; it’s not always easy to get a second/ revision surgery if not enough is removed first time, so it’s worth perhaps having a look at the doctors list & getting a second opinion if you’re not sure. It’s also worth bearing in mind that if you have some calcification in your ligament, that won’t go away, & may worsen. If part of the ligament is removed from the hyoid end, & some calcified parts are left in the now free rest of the ligament, then I would imagine that they could rub and irritate structures still.
Hi sjayjay910 -
To add to what emma & Jules have said, since your s-h ligament has already shown a tendency toward calcification, leaving some in leaves a “seed”, as it were, which can also calcify later. I had both of my styloids & stylohyoid ligaments removed. I didn’t have the tension you feel because my ligament calcification looked like a dotted line extending from my hyoid bone toward my styloid thus my s-h ligament still had some flexibility. When even a small section of the ligament is a solid line of calcification, that section acts like a tether & anchors the hyoid bone so it can’t move properly during swallowing, talking, coughing, laughing, singing…that’s when the feeling of tension results. I would vote for having the whole s-h ligament removed. Dr. Samji, who did my surgeries, told me it plays a small role in helping w/ swallowing. I had swallowing issues before surgery which have not improved since surgery. I’m chalking them up to vagus nerve damage at this point.
I hope this makes sense.
On my tomography scan, my ligament showed up as interrupted. The radiologist who red the CT scan done also read it as interrupted. Dr. Samji read the scan in front of me and indicated that he doubts it is segmented. That the CT scans are essentially slices and the software interpolates (interprets) between the slices. From what I gather, more often than not the calcifications are continuous.