John's Story

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My History

 

1st Parotidectomy
 

2nd Parotidectomy

 

CT Scan Report

 

What Should I Ask My Surgeon?

 

Tumor Statistics

 

Diagram Of Facial Nerve

 

Do List - Before surgery

 

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Pre-Op Survey

170 people have provided answers to pre-op questions.  Bench mark yourself against them. Age, gender, health, etc.
 

Post-Op Survey

Read what they have to say after the operation.

 

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Questions Regarding a Tumor of the Parotid Gland

 

While I was learning as much as I could about the parotidectomy procedure, I developed the following list of questions for the doctor that would eventually do my surgery. 

Testing Prior to Diagnosis

   Family Drís exam and MRI.  There is no pain associated with the lump. 

  1. What does my MRI indicate Ė what were the findings (obstruction or tumor)?

  1. Iím not experiencing any pain.  Is that a good sign or not?

  1. What other test would you recommend?  Fine needle aspiration (FNA), CT scan?

  1. If a CAT scan, why when MRI is already done?  Whatís the additional benefit?

  1. If FNA, what about the cells left in the needle tract?

  1. How accurate/reliable is the FNA results you get (% correct)? 

  1. What are the chances that this causes re-growth of the tumor in the same area?

  1. I would like to review the findings.  May I read them?

 

My Diagnosis

 

  1. What is your level of certainty of diagnosis from the tests conducted?

  1. Could it possibly be anything else (Cyst of Infection)?  If yes, what else could it be?

  1. How common or rare is this disorder?  (Number of occurrences in US/yr)

  1. What, if any, symptoms should I be experiencing?

  1. Is it benign (only if FNA biopsy is performed)?

  1. What is the percentage of these tumors that are benign (if 5 not ans.)?

 

Recommended Treatment

 

  1. What is the best course of treatment for this situation?

  1. What are the various risks involved with this procedure?

  1. Is it facial nerve damage only, or are there others?

  1. Will you use a nerve monitor and or stimulator to reduce/avoid nerve damage?

  1. Do you have access to such devices?  If yes to #5 and no to #4 why not use them?

  1. Are there any alternative treatments (list all)?

  1. What are the risks compared with best course (list all)?

  1. What are the risks of waiting 4-8 weeks before surgery?  

 

The Parotidectomy Procedure

1.      Will the procedure be outpatient or will I need to be hospitalized?

2.      If hospitalized, how long would you expect me to be in?

3.      How long would you expect the operation to take given what you know now?

4.      Will I be under general anesthesia, twilight or local?

5.      What side effects might I experience from the general anesthesia?

6.      Will you be assisted by another surgeon? 

7.      If yes, their level of experience with this procedure?

8.      Will the procedure be performed under a microscope or magnifying glasses?

9.      Is there any reason you would cut or remove part of any facial nerve? (Since you are going to be asleep during the procedure you need to establish what youíre expectations are now.)

10.  If yes to 9, can this nerve be restored or re-grafted to minimize facial droop or paralysis?

11.  Given what you know of my tumor size and location, what do you think the chances are of permanent nerve damage?

12.  What type of temporary nerve damage (numbness) should I expect?  (What wonít I have feeling in?)

13.  How long is this numbness expected to last?

14.  What type of permanent nerve damage (numbness) is expected and to what part of the face?

15.  What are the chances of scar tissue causing nerve irritation or damage?

16.  How long will I be in recovery?

17.  How much pain should I expect after surgery?

18.  How will the pain be managed?

19.  How much bruising and swelling should I expect?

20.  How is the swelling managed? (ice, other)

21.  Can you show me what the incision will look like (modified Blair or other)?

22.  Can you show me where the incision will start and end?

23.  Will you be closing the incision or someone else (if not him, why not)?

24.  How will you close the incision: sutures, staples, Dermabond or combination?

25.  Will a drain be required?

26.  How much of the parotid gland will likely have to be removed?

27.  What procedure will you use to remove it? 

28.  How much bleeding is expected and will I need blood?

29.  What are the chances Iíll experience Freyís syndrome (cheek sweating)?

30.  How can/will you minimize chances of this occurring?

31.  Is there anything I can do if I do incur Freyís syndrome?

32.  Will I have noticeable saliva loss or not and is that a problem?

33.  Will I experience any eye dysfunction (unable to blink) and how severe?

34.  Will it correct itself with time and how long will it take?

35.  If not, what treatment options can be considered?

36.  Will there be any effect (Loss) on my hearing?

37.  How will my facial uniformity look left to right side after complete healing?

38.  Will there be a dent left by the removal of the gland (if gland is removed)?

39.  How can you fill in the dent if one will be left?

40.  Would a muscle overlap be appropriate? 

41.  What are the risks of this procedure?

42.  How much scaring on my face will there be?

43.  Being concerned about what the scar will look like, do you think plastic surgery will be needed afterwards? 

44.  How many IV lines will be required and why?

45.  Are they all necessary or are some "just in case?"

46.  Will they be applied in the operating room or hours ahead of time?

47.  When will they be removed?

Post Operative Questions

1.      How long will I be off my feet at home after leaving the hospital?

2.      How long after leaving the hospital before I can start doing household chores?

3.      How long should I plan to be out of work?

4.      I have to travel for my job.  Will my driving/flying be restricted when I go back to work and for how long?

5.      How much pain should I expect to experience at home and for how long?

6.      What kind of medications will be prescribed and can I have those prescriptions ahead of surgery so, I have them at home when I get there?

7.      When will the stitches be removed?

8.      Can the stitches be removed by my family physician or do I have to come back here?

9.      Will I have any neck pain/stiffness in the first few weeks due to head position for surgery?

10.  Are there any head/neck/facial exercises for me to do to help recovery?

11.  How difficult will it be to eat/chew and how long will that last?

12.  Is it better to avoid extensive/hard chewing and for how long?

13.  How long before I can lay/sleep on that side of my face?

14.  How long before I can get back to jogging, exercising, volleyball, swimming?

15.  Will I have any difficulty/interference with the incision when wearing my glasses?

16.  What sensitivity will I have to temperature extremes in the surgical area?

17.  How many post-operative visits will be necessary?

18.  How long will it take for the scar to fade as much as itís going to?

19.  At my age, what are the chances of tumor re-occurring at the same site after surgery?

 

 

 Regarding The Doctor

1.      Are you board certified?

2.      Where did you go to medical school? 

3.      Where did you conduct your residency?

4.      What did you study during residency?  (It should be head and neck and he/she should have performed some parotidectomies during that time.)

5.      How many parotidectomies did you perform during your residency?

6.      How long have you been practicing, not including your residency?

7.      How may parotidectomies have you performed and how often after residency?

8.      Have you ever had patients experience permanent facial nerve damage due to the removal of a benign parotid gland tumor?

9.      How many and how long has it been since that has happened?

10.  Do you have any certification in plastic surgery?

11.  Do you have any former patients that you performed this surgery on that would be willing to discuss their experience with me?

12.  If you had this condition, what doctor in the US would you seek to perform your surgery?

13.  Is he/she the best in the country in your opinion?  If not, who is?