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Can Styloids Close To Spine Affect Nerves?

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Posted on Mon, 17 Nov 2014
Question: Dear Doctor,

you answered my query a few days ago. I'm attaching your answer below for your reference.

I have just been to see my ENT specialist, who suspects that I may have Eagle syndrome. I had a CT scan done, which didn't prove or disprove it. My ENT specialist didn't, however, use a 3D reconstruction, as you suggested, because he doesn't have the knowledge of the software to do so.

I have two questions:

1) I was wondering if there's any way I could send the pictures to someone online and they could put it in the software to reconstruct the images. That would be extremely helpful.

2) I was told that my styloids are close to the spine (based on the CT scan). Could they somehow affect some nerves or blood vessels?

Thanks!



==========================

Detailed Answer:
Hi

Thanks for writing back

1. The TMJ dysfunction is on the right side, while the sensation of foreign body in the throat on the left side is because of LPR, the clicking sound is due to opening and closing of the Eustachian tube (the tube connecting nose and the ear)

2. When the acid from the stomach regurgitates into the throat, it will burn the mucosa of the throat causing inflammation of the mucosa. The inflamed mucosa thus gives the sensation of foreign body in the throat. Most of the times, the sensation is unilateral.

3. Eagle syndrome can be confirmed by the reconstruction of the CT scan images or with Ortho-pantomography. In these sections, it is difficult to identify the elongated styloid process.

4. I have examined the images thoroughly and I feel there is some osseous inflammation with the reduction in the joint space on the right side. MRI will be helpful in clearing all the doubts.

Hope I have cleared your doubts. I wish you good luck and good health.

Regards
Dr. XXXXXXX XXXXXXX N.
ENT and Head & Neck Surgeon
doctor
Answered by Dr. Naveen Kumar Nanjasetty (11 hours later)
Brief Answer:
Please consult any other radiology centre...

Detailed Answer:
Hi

Thanks for writing back

Online 3D reconstruction is a tedious procedure and the results may not be encouraging. It requires a special software for the reconstruction. Only radiologists can help you in the reconstruction of the images. I would suggest you to find out any other radiology centers in your locality and request the radiologist over there to help you in reconstruction of the images.

The elongated styloid process can cause compression of adjacent nerves, eg, the glossopharyngeal, the lower branch of the trigeminal, or the chorda tympani.
There can be impingement of the carotid vessels with irritation of the sympathetic nerves in the arterial sheath.

Hope this clarifies your doubts. Kindly revert back to me if you have any follow up queries.

Regards
Dr. Naveen Kumar N
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Naveen Kumar Nanjasetty (10 hours later)
Thanks for your quick answer!

In fact, I just managed to do a reconstruction myself, albeit not perfect. I'm enclosing some pictures for you to take a look if you want. In my humble opinion, I don't think the styloid is elongated.

Despite that, the styloid seems to be somewhat curved towards the spine so it might cause some carotid compression (or at least that's what my doctor said). But it seems less likely now. If there were to be impingement of the carotid vessels, what kind of symptoms would that have?

Thanks again and best wishes,
XXXXXXX
doctor
Answered by Dr. Naveen Kumar Nanjasetty (42 minutes later)
Brief Answer:
Could you please repost the images..,

Detailed Answer:
Hi

Thanks for writing back.

Could you kindly repost the images, I am not able to see them on my portal.

Secondly, patients with compression of the styloid process over the carotid may experience pain in the neck that radiates to the eye, ear, mandible, soft palate and nose, parietal headaches and pain along the distribution of the ophthalmic artery.

Regards
Dr. Naveen Kumar N
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Naveen Kumar Nanjasetty (46 minutes later)
Thanks. I uploaded them in a format that was rejected by the server. Now they're in pdf so it should work.

Best,
XXXXXXX
doctor
Answered by Dr. Naveen Kumar Nanjasetty (11 hours later)
Brief Answer:
Could you please send me the link...

Detailed Answer:
Hi XXXXXXX

I am sorry! I am unable to find the report. Could you please resend the link to me like how you did it before or you can mail the images to YYYY@YYYY with subject as ATTN: Dr Naveen Kumar N.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
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Follow up: Dr. Naveen Kumar Nanjasetty (2 hours later)
Hi, I have provided some attachments. Please review them.
doctor
Answered by Dr. Naveen Kumar Nanjasetty (5 hours later)
Brief Answer:
Styloid process seems to be normal (< 25mm)...

Detailed Answer:
Hi XXXXXXX

"Hats off to you"! You have done a wonderful job by reconstructing the images, it's near to perfection.

I have examined the images thoroughly and I could see a normal styloid. The styloid should be longer than 25 mm to be termed as elongated. I could not appreciate the deflection of the same towards the carotids. Hence, I strongly feel, we need to stick on to the previous diagnosis of TMJ dysfunction with myofascial dysfunction syndrome.

Hope this clarifies your doubts. I sincerely apologize for the delay in answering your queries because of my busy schedule.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.

Above answer was peer-reviewed by : Dr. Prasad
doctor
Answered by
Dr.
Dr. Naveen Kumar Nanjasetty

Otolaryngologist / ENT Specialist

Practicing since :2001

Answered : 2540 Questions

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Can Styloids Close To Spine Affect Nerves?

Brief Answer: Please consult any other radiology centre... Detailed Answer: Hi Thanks for writing back Online 3D reconstruction is a tedious procedure and the results may not be encouraging. It requires a special software for the reconstruction. Only radiologists can help you in the reconstruction of the images. I would suggest you to find out any other radiology centers in your locality and request the radiologist over there to help you in reconstruction of the images. The elongated styloid process can cause compression of adjacent nerves, eg, the glossopharyngeal, the lower branch of the trigeminal, or the chorda tympani. There can be impingement of the carotid vessels with irritation of the sympathetic nerves in the arterial sheath. Hope this clarifies your doubts. Kindly revert back to me if you have any follow up queries. Regards Dr. Naveen Kumar N ENT and Head & Neck Surgeon