Pre-op surgery questions

I have my second appointment with Dr. Costantino tomorrow (Wednesday) to discuss surgical specifics and planning (styloidectomy/vascular ES w/ IJV compression). I have a long list of questions that I’m refining/prioritizing and I’d love to hear from you, the brain trust.

What are the top questions you would ask a prospective surgeon? Questions you didn’t ask but wished you had?

On my list:

  • surgical approach + post surgical care/management of swelling (drains, steroids, hospital stay vs outpatient) + confirm
  • that he is doing the entire surgery himself (not a fellow)
  • continuous nerve monitoring
  • removal of complete styloid to skull base + stylohyoid ligament
  • plan for IJV compression if removing the styloid doesn’t provoke rebound
  • his approach to scar tissue if he encounters it (excise with scalpel or does he use electrocautery)
  • accessibility of his team if I have post op concerns
  • recommendations/limitations for at home recovering

I have some more granular questions about internal sutures and methods of access that I will ask if I have time.

Would love any and all suggestions from you. Thank you!

I’ve thought about the pros and cons of telling him that I may be the first patient reporting on a surgical experience with him in an ES forum but I’m not sure if that’s appropriate.


I also plan on asking about first bite syndrome in his patient population…

@KimberlyNYC -

I think you have done a remarkable & thorough job of thinking through your questions. To my mind, you’ve covered the topics we generally recommend for discussion in an appt. prior to committing to surgery.

As far regards First Bite Syndrome, I’m very interested in what he says. Since it’s caused by irritation/injury to the glossopharyngeal nerve, which is sometimes in the way during styloidectomy & needs to be move thus irritating it, that outcome is sometimes unavoidable. It’s not an uncommon post op problem for surgeries in the throat & neck. I believe that on our forum, many less people end of w/ FBS than get it, & in most cases, it subsides w/in 3-4 mos post op. The intensity of the pain it causes & frequency of occurence do decrease as time passes.

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Thanks so much for taking the time to read and respond!

I agree about First Bite Syndrome. In a small way I wonder if I might be using that question as a test. If he glosses over such a common outcome (I expect to experience it post op and will be pleasantly surprised if I don’t) it would probably make me wonder … on the other hand, if he says his patients don’t tend to experience it as much and has an explanation about how his surgical technique minimizes that outcome … count me in.

I live alone and am chronically ill, so for me one of the essentials is having a realistic expectation of the range of recovery rates/time periods. It’s not all hip hip hooray after all!


Very thorough list of questions! You could just ask if he does external surgery if where the incision will be- we see quite a variety in techniques, most doctors try to use a crease of the neck so the scar won’t show but not all do, you might not be too worried about that?
Might be best not to mention about reporting the experience on here- not all doctors have been happy to be on our list, & some have read the forum & don’t always agree with things members’ have discussed on here- no reviews, but symptoms we’ve experienced etc.
I hope your appt goes well & looking forward to hearing about it!


Thanks, Jules. I’ve already confirmed he does external and I believe it’s a transcervical approach but that’s definitely on my list. I’m less concerned about scar location and more concerned about a successful surgery!

Got it re not mentioning anything about the forum. I didn’t plan on naming it - was going to refer to it as a support group - but I absolutely see your point about why best not to mention at all. Confirmed!