Pre-op Questions

I’m finally in the homestretch for my first surgery with Dr. Nakaji. My pre-op is on Tuesday, 7/9. I would appreciate some help formulating my list of pre-op questions as my brain is pretty foggy. Especially for those who have had the surgery, any questions you wish you would have asked ahead of time but didn’t?

We do have a list of questions we suggest members ask their doctor, although it’s more aimed at those doctors we’re not sure of, to check whether their surgical technique is the best…as Dr Nakaji is experienced is doesn’t really apply, but some of them might be useful:
Questions To Ask Your Doctor:

  1. How many ES surgeries have they done and what was the success rate?
  2. Whether they’re going to operate externally, or intraoral- through the mouth. Whilst some members have had successful surgeries with intraoral, external is better for seeing all the structures, to be able to remove more of the styloids, & also there’s less chance of infection.
  3. You need to ask how much of the styloid he’ll remove- as much as possible is best- & anything left needs to be smoothed off. The piece needs to be removed too- some doctors have snapped it off & left it in! If the styloid is only shortened a bit it can still cause symptoms.
  4. If your stylohyoid ligaments are calcified, then any calcified section needs to be removed too.
  5. There’s usually swelling after surgery; you could ask if a drain’s put in to reduce swelling, or if steroids are prescribed. It’s not essential, but can help with recovery a bit.
  6. Will it be a day case surgery or will you need to stay in?
  7. Obviously ask the risks- we know from experience on here that temporary damage to the facial nerve is quite common, and also the hypoglossal nerve and the accessory nerve. These usually recovery very quickly but in some cases members have needed physiotherapy. There is also the risk of catching a blood vessel or having a stroke, but these are very rare.
  8. Ask if the surgeon monitors the nerves- this should be done to see if there’s stress on the nerves to avoid damage as mentioned above.
  9. What painkillers will be prescribed afterwards.
  10. Ask about recovery- most doctors either down play it or are genuinely unaware of how long the recovery can take!

I guess as you have vascular ES there’s extra to ask about whether a C1 shave will be necessary, will he free the IJV from any other structures, scar tissue…
I can’t think of anything else, but others might have ideas!

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It’s exciting, but can also be anxiety producing to be getting ready for surgery. You can ask him if they plan to use opioids for pain relief. If they do, then you’d want to be prepared with a laxative/stool softener. Also, you can ask him what the likelihood would be of the spinal accessory nerve being involved. I had no idea that there would be an issue with that; however, mine was really part of the problem, so it was significantly involved. You can also ask him how long he recommends you sleep in an elevated position. I had the styloidectomy & C1 shave along with a few other things. I’m assuming that since he is an experienced surgeon that he answer a lot of your questions before you even ask them.


Thanks so much. I am definitely having a lot of anxiety.

@Chrickychricky - It’s hard not to be anxious about the unknown. Reassure yourself that you’re seeing the best surgeon for you & that you feel confident in his ability to help you or you wouldn’t have chosen him.

Don’t fear recovery. Go into surgery knowing that you will need some months for full recovery but you can start very gradually easing back into your daily routine after about 2 weeks. Prior to that, you need to take life S-L-O-W-L-Y. A big key to recovery is listening to your body & not pushing yourself i.e. rest when it asks, stop an activity if it’s stirring up pain or other symptoms, allow family/friends to help you do things you usually do for yourself for a week or two.

You’re in good hands w/ Dr. Nakaji. I’m excited that your surgery day is coming soon! I’ll be praying for you now & on 7/10. :hugs: :pray:

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Thank you so much @Isaiah_40_31 @vap @Jules for sharing your wisdom and experience. Slowly and with support are not the norm for me but I know you learned this from experience and I am going to learn from your experience rather than the hard way!

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