Where to cut?

Hi All! I’ve seen two doctors now and have gotten two different opinions on ES. For me, what it comes down to is a detail within the surgical procedure.
(A) One doctor is telling me that he will remove it at the base of the skull so that it does not regrow. He has a lot of experience and has seen regrowth, as such, he found the closer he cuts to the skull, the less likely to grow back. This doctor doesn’t discuss the neuro vascular symptoms, he has more of a straight forward approach, something along the lines of “overall no matter what the symptoms are, the removal will help.”
(B) A different doctor is telling me that it is too dangerous to remove it at the base of the skull, as he said, “no one knows what that will do to your body in 20 years.” When I brought up regrowth, he simply said it’s all part of the risk and no one really knows what’s best. He has less experience in ES but a ton of neuro vascular experience, which unfortunately is a large part of my ES, as its pushing down on my carardid artery.

These are two very different opinions within the surgery. Has anyone heard of these two points of discussion? What has your experience been or what have you been told? I’d like to consider myself young :stuck_out_tongue: so I am concerned about regrowth.

Hi!!! I love that you’ve seen two doctors - it’s nice to gather info then pull back and look at everything when selecting a surgeon.

My surgeon in Atlanta said for me (just calcification, no elongated styloid process) just “untethering” the ligament from the hyoid was all I needed. My hyoid got caught on something around it when I swallowed (larynx maybe because I couldn’t sing any high notes last year and now I can) so just taking out 3 cm at the hyoid going up was all I needed. He said he doesn’t like to encounter the jugular and carotid artery so I guess he’s in the camp with the “B” guy in your post. Who’s to say if one is right/wrong because our Eagle syndrome presentations can certainly vary. What does your scan indicate? I kind of like the “A” guy because he sounds confident and capable. What does your gut say?

Hi FlyAway,

I’ll start by saying I’m biased. I’m in the camp of the (A) doctor. Dr. Samji did my ES surgeries, & he’s of the same opinion - take the styloid back to the skull base & remove the stylohyoid ligament whether or not it’s calcified thus preventing an opportunity for further calcification or elongation & the need for another surgery. Dr. Samji uses specialized equipment to monitor the nerves during surgery, & because he uses the external approach, he is able to view the vascular tissues during surgery & protect them. He has done many complex but successful ES surgeries that involved impingement of either the jugular vein or carotid artery(ies). It all comes down to experience & the surgeon being confident in his abilities.

I will say that one of my styloids could only be cut back to the normal length (2.54 cm/1 inch) because my glossopharyngeal nerve was wrapped around it & he didn’t want to permanently damage it by moving it around too much. Even w/ that, I’ve had no problems & am 4.5 years post op. I give you this example to say that most experienced surgeons are generally careful & will do their best to produce a good outcome for you.

Since you’ve been on this forum for awhile, you must also be aware that healing takes quite awhile, & the way you feel 2 weeks post op is not an indication of the failure or success of an ES surgery.

I agree with what Isaiah says- I had bilateral compression of the jugular veins, & had surgery with a skull base surgeon. My styloids were removed back to the skull base as tgey wete compressing the jugulars most of their length.
An experienced surgeon will be aware of the risks to blood vessels so will obviously avoid them- external surgery gives the surgeon a better view- so I would say could do the surgery as safely as a neurovascular surgeon.
There’ve only been a few members who’ve come back on here with re-growth, it’s not common but can happen. But I think probably most of the doctors aren’t aware of any cases, so alot of doctors would probably say it can’t happen.

I’d go with A. I had a doctor do an intra-oral surgery to remove part of the SP. He was only able to remove a small portion of it due to it being in contact with the facial nerve and he was afraid of damaging it. After a couple more years of suffering I went to Dr Samji and he removed the SP to the skull base and the ligament extra-orally. I still have some issues with the scar tissue from the 1st surgery but I have had much improvement from the 2nd. We’re not doctors here so what we say is just educated opinion but we have had experience with this. In the end, you have to make the decision that’s best for you.
Good luck and may God bless you.

I’d go with A as well. Also had Samji remove mine. Closer to the base, there are a couple more ligaments that are attached. In his experience, releasing these as well, helps to more completely resolve symptoms beyond just snipping the end oF the styloid. I’m about 10 weeks out and it doesnt even cross my mind anymore. No pain, minimal scar. Could not have gone better.



Thank you for posting! So glad to read how well you’re doing. It seems that 6- 8 weeks post op is a turning point for many people. You’ve raced across that line & are back to enjoying life. So awesome! :sparkler: :sparkler:

Hi Flyaway. I would listen to my gut . I have regrowth at almost 60 years old. I knew I would because my gut told me I would. I had everything removed but my case was considered extremely rare. I’m sure you know whar best in your heart. I don’t regret getting my styloids removed. They are not as big as they were and I am pain free most of the time. Good Luck ans listen to your heart!!