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Dr. Andrew Rynne

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Swelling and pain in jaw with headache. CT scan clear. What am I suffering from?

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Dr. Naveen Kumar

ENT Specialist

Practicing since :2001

Answered : 2356 Questions

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Posted on Thu, 17 Jan 2013 in Ear, Nose and Throat Problems
Question: I have the following symptoms -

Dull pain at jaw hinge, left side. Dull pain along upper and lower jaw on left side. Slight but noticeable amount of external swelling and tenderness starting at jaw hinge descending about 1 inch along the side of the esophagus. Headache behind left eye, and left temple. Headache symptoms increase with physical exertion (I run a lot). Been to 3 doctors - had CT scan. Neurologist says there is nothing neurolgoically wrong with me. ENT stuck a camera down my throat, and looked at my ears. Nothing significant. ENT looked at CT scans and noted nothing significant. CT scan not yet looked at by a radiologist. Been on Amoxycillin for 10 days with no noticeable change. Nothing dentally wrong.
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Answered by Dr. Naveen Kumar 22 hours later
Hi

Thanks for posting the query

Your symptoms seem to be of a condition known as 'Elongated styloid process syndrome'.

There are two variations of this syndrome:
1. Eagle's syndrome
2. Stylocarotid syndrome

I feel you are having the second variety of this elongated styloid process. This is characterized by the compression of either of the branches of the carotid artery by the elongated styloid process. Pain is noticed on rotation and compression of the neck. There can be supraorbital or infraorbital pain (above or below the orbital socket) and parietal headache (over the temples and above). Also, occasionally, there will be discomfort while swallowing.

Many of the cases do respond to the anti-inflammatory and analgesic medicines. Only severe cases, which do not respond to the above medications, require surgery.

You will require an orthopantomogram (OPG) or 3 D reconstructed CT scan to identify the length of the styloid process or CT scan of the skull base and neck is best for diagnosis.

Hope I have answered your query; I will be available for the follow-up queries.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Naveen Kumar 4 hours later
Thank you Dr. XXXXXXX

That information is very helpful. I received an orthopantomogram, and have had a CT scan of the skull base and neck. I will ask my doctor to take another look. Is the pain casued by a reduced blood flow, or compression of the nerve or some other process? If there is reduced blood flow through the carotid will this be likely to be visible on the CT scan? Also, I forgot to mention one symptom in case this it matters, which is minor pain along the left side on the rear of my tongue (this is where it started and why I initially went to a dentist).

Regards,
XXXXXXX
doctor
Answered by Dr. Naveen Kumar 16 minutes later
Hi

Thanks for writing back

1. The compression of carotid and the neural tissue surrounding the vessel gives rise to the above symptoms. This increases with the head movements.
2. Request your doctor to get a 3D reconstruction of the CT images, it will be very helpful in identifying the cause.
3. It is bit difficult to identify the vessel compression on the CT scan, angiogram will be an ideal investigative procedure.
4. The actual pain pertaining to this syndrome starts from the tosillar fossa or the rear of the tongue as you mentioned. This area also corresponds to the level of the styloid process.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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