Why do some doctor operate intraoral and extraoral

I am dizzy and sometimes have blurry vision. I have the surgery is less than two weeks so I guess we will see.


I developed eye pain, floppy eyelid and glaucoma in the last 3 years.Worse in the right eye. open angle and narrow angle glaucoma. My opthamalogists cared less about the Eagles. After laser iridotomy to stabilize the pressure from narrow angle and several eye drops, I still hurt. External surgery for Eagles revealed the facial nerve pressed on the styloid. Moving the nerve left me with temporary eyelid and mouth paralysis. It was scary, very scary, but the eyelid recovered within about 2 months and the mouth followed. Today 7 months later, my eye pressures are better, No More constant eye pain, and the floppy eyelid is gone. I will always have glaucoma,but my eyelid closes properly and I need much less dry eye care.
I really would love if you can find an opthamalogist to get interested. My surgeon told me of a case of Eagles causing someone a stroke and left her blind.
Research into opthamalogic effects from Eagles syndrome could get more serious attention in the medical community. I would be ecstatic to have my doctor researching my case.

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I am so happy to hear you have someone looking into all of this for you. As Jules mentioned above vascular compression from the styloid and resulting intracranial hypertension (too much pressure trapped in your skull) can definitely impact your optic nerve very dramatically. Sounds like you have some good people on your side. Please if you loose more vision go the the ER immediately! Praying nov 11th comes quickly for you.

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adriene61 - Your surgery date is on my calendar. I will be praying for you between now & especially on that day! I hope getting your styloids removed will make a world of difference for you.


Did you have your styloid process removed externally or internally? I’m glad you have had some improvement. Yeah I am hoping I have no more damage before my surgery. I have next to no optic nerve left on the left eye and they said if any more goes I will go blind in that eye. Chapel Hill is a teaching hospital so I was glad to hear so one in ophthalmology is working on the connection between Eagles and what symptoms may occur with the eyes. How long was your recovery?


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There’s lots of info about what to expect post-op in the past discussions, you can search for that using the magnifying glass icon. The recovery from intraoral is a bit different as your throat will be quite sore & there’s a bit more risk of infection. So swallowing & eating will be hard, get lots of stuff ready for smoothies or soups. Ice packs will be useful for swelling, & sleeping semi-upright will help with that too, so have a wedge pillow ready.
Recoveries do vary alot, but generally don’t expect immediately to feel better, the nerves get very irritated with surgery & can take weeks & ecen months to settle down. Some members have even noticed improvements after a year! And recovery can be quite up & down, especially if you overdo things, it can set you back.
Will be praying for you…

Recovery is in stages. I had external. It really depends on what is going on. Intraoral involves getting rid of
swelling so you can chew food and not have throat and jaw pain. 3 weeks at least to get beyond the stitches. Sometimes nerve pain remains a bit longer or not.
External, may be able to chew sooner and feel great after a couple weeks or have nerve pain or nerve paralysis. Recovery is always a roller coaster. You get better then you feel bad again, up and down.Gradually fewer shorter downs and you level off. All recovery actually takes a full 12 to 18 months, because nerves take a long time to heal. I am 7 months out from the right side and 13 out from the left side. Still improving. There is a roller coaster often after the first side is done and before the second side.
Be careful thinking that the surgery did not work. After surgery, the nerves and muscles are weak and cannot compete with the strength of the unoperated side and some members have decided agsinst the second surgery. I cannot imagine how terrible it is to never fix the second side as everything remains off balance and out of whack. True recovery, as I see it, and can definitely attest, requires both sides if you have bilateral eagles. After this period of 13 months, I am regaining my life and confidence, though I still have traumatic stress syndrome and panic at each pain that I feel. Prayers for you.


Thank you for the information. I do have bilateral. I hope I’m not taking on to much at one time. I am having both removed at the same time as well as my whole thyroid removed. I guess I was just hoping for immediate relief.

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adriene61 -

You may have immediate relief from some symptoms but surgery can also cause new symptoms to arise temporarily. The advice Emma has given is very accurate. My surgical recovery definitely followed the timeline she suggested. I had two separate surgeries so recovery occurred more or less over a three year period for me. Once you get over the hump at 6-9 months, it’s easier to be patient as the remaining symptoms gradually subside to whatever extent they will. Most of us have some small residual nerve pain the is ongoing, but it is not the debilitating problem that the pre-op symptoms cause. I can live my life fully w/ what I have left over.

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I am happy to report that I am nine days out of bilaterial styloid removal as well as having my right thyroid removed. I feel amazing. I wish everyone knew about my surgeon. He is a skull based surgeon. He uses robotics so he can take the styloid out to the skull using the robot internally down tot the skull. It will not come back and less risky for nerve damage and much less invasive. I had just about every symptom I can not believe how great I feel the major pain was the first 48 hours. My right styloid was 1.5 cm and my left was 3.2 cm and branched off. Funny thing was I only had symptoms on the right side though even though the left was twice the length. None of my friends or family can believe how well I am doing compared to how bad I was doing the previous 9 months. I was in bed for about 90 percent of the day for the last nine to 10 months in pain. I had the wild shooting, stabbing positional headaches. Doctors thought I had CSF leak, vasculitis. I had tinnitus,jaw pain, it felt like I had the mumps for months, whole rt side of my face would go numb sometimes, my scalp on my head would be tender and hurt, eye and vision problems, cervical problems, neck problems, rt arm pain, etc about the only pain I didn’t have is throat pain. After surgery I can say I am still very fatigued. I don’t every remember being this fatigued. I haven’t had a shooting pain in my head since surgery and previously there wasn’t a day in 9 months that I didn’t have that. Absolutely no nerve damage. I am just very blessed and damage and want people to know that you do not have to do extra oral that is much more risky and it is true if you don’t get an experienced surgeon that is trained in robotics you can’t do the same thing with intro oral. But if you do you can get it all with intro oral with robotics. Good Luck with everyone out there. I got a lot of support and information and I was truly blessed and lucky in this journey.


Hi adriene61 -

I’m so glad to read about your excellent results. You will likely feel tired for a couple of months, but your energy will come back. Do you mind sharing your surgeon’s name & location?

I need to say that there have been several forum members who recently had non-robotic intraoral ES surgery where the doctor was able to remove the styloid to the skull base & the stylohyoid ligament down to the hyoid bone. It seems that intraoral ES surgery is progressing in its scope & ability to take care of ES more completely.

Thanks. Dr. Trevor Hackman at UNC Chapel Hill.

Chapel Hill North Carolina. Robotics is so much less invasive and safer. I have no nerve damage.

No nerve damage is definitely a plus! I added Dr. Hackman to our US ES Doctors List. :blush:

Thanks for sharing your story & your surgeon’s name! So pleased for you that you’re feeling so good! To be tired is to be expected; you’ve had a major op, & perhaps because you’re feeling good maybe you’ve overdone it a bit?
I’d just like to correct what you said about extra-oral being more risky- it’s actually a less risky surgery than intraoral as there’s better visibility of blood vessels & nerves in the area.
It’s great that new surgical techniques are being used for ES surgery!
Keep healing! :bouquet:

Thank you for your support. I guess I need to clarify less risky. With intro oral robotics they have more access with the robotics and it is very precise. That is why it is less risky. I am not a surgeon but look at some articles on robotic surgeries. There are some out there even on Dr. Hackman. There are not a lot of doctors trained in robotics. Especially not a lot of skull based surgeons. If it were not for the robot I truly believe extra oral would be the way to go as they wouldn’t have the access needed or the precision. I know I’m basing this a lot from what I’ve read . Also it seems that I have had such better results than most people I am reading about there results on the support group. I just want everyone to have the best opportunities and results they can have.
Here are a few articles on Dr. Hackman. https://www.med.unc.edu/ent/hackman-is-latest-surgeon-to-complete-his-20th-trans-oral-robotic-surgery/

He’s been voted the Top doctor award, where other doctors vote on what doctor they would want to operate on them. https://www.castleconnolly.com/doctors/profiles/trevor-g-hackman-otolaryngology/

Totally agree that robotics seems the way to go, just wanted to clarify that the usual external surgery is less risky than the usual intraoral.

I guess I was trying to clarify that with robotics intro oral was less invasive and more precise making it less risky. Otherwise definitely you would need to do extro oral as they wouldn’t have the access.

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And I realize there are not many surgeons with this capability.

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Hi Adriene61, I am planning on having a consultation with Dr. Hackman in a few weeks. I am also meeting with Dr. Sanji in CA. I am glad to hear your surgery went well. I am praying that I have the same results. What was your before ES symptoms? and after surgery?