Surgeon consultation questions

[Moose.]

I'm due to have a procedure next week to remove one of my submandibular salivary glands after a failed attempt to remove a stone that has become stuck in the gland. I'm meeting the surgeon on Monday to discuss the whole procedure, the risks and recovery time, and was wondering if the great PH collective might have some things I really should be asking? Also, is there a way to check their credentials, success rates etc?

I'm having the op done privately, as it's covered by my insurance thankfully, but it's not something that one should take lightly I don't think, so I want to be sure I'm fully prepared and informed.

Cheers

[Revisitph]

Fairly common and straightforward operation; less potential problems than, for example removal of the superficial part of the parotid (the other major gland). The surgeon should go though them all with you as part of fully informed consent.

Dr Foster may have data on your surgeon or you could see if there is any other source. However, a lot of the data only relates to cancer (not the issue for you) and a lot of it is very flawed. For example this http://www.nhs.uk/choiceintheNHS/Yourchoices/consu... report has data on one of my surgical ENT colleagues which I know is incorrect - it says that none of his cases was discussed at the multidisciplinary meeting (which looks bad) when all of them were. For lung cancer the big national data report is poor because different regions have different cancer registries and the database fields don't map properly - so it is often recorded centrally as "incomplete". The GP who referred you should have chosen someone they know is well-regarded.

ETA The basic check of their credentials (whether currently licensed to practise, whether on the specialist register for the field they are working in) can be done on the GMC website - see the "check a doctor's registration status" if this shortcut doesn't work. http://webcache.gmc-uk.org/gmclrmp_enu/start.swe?S...

Edited by Revisitph on Saturday 10th May 18:12

[Moose.]

Thanks for the link Revisitph, he is listed on that site and as an ENT surgeon, so that's good. Glad to hear it's considered a straightforward op, although I can't believe it's that common. It's the first time in my life I've ever had any health concerns, so it's all new to me and hence has me a little worried having read up on what's involved and the various risks to nerves etc. I'd love to just ignore the problem but the discomfort when eating is just too much now and I can't have the risk of infection hanging over me where I work with its lack of medial facilities.

[Revisitph]

Moose. said:

Thanks for the link Revisitph, he is listed on that site and as an ENT surgeon, so that's good. Glad to hear it's considered a straightforward op, although I can't believe it's that common. It's the first time in my life I've ever had any health concerns, so it's all new to me and hence has me a little worried having read up on what's involved and the various risks to nerves etc. I'd love to just ignore the problem but the discomfort when eating is just too much now and I can't have the risk of infection hanging over me where I work with its lack of medial facilities.

Yes, fairly straightforward (for an ENT surgeon) - as you say nerve damage is the biggest risk with the potential for numbness in the area supplied by the nerves which pass close by the gland. If it happens this is usually temporary ("bruising" of the nerves), rarely, if the nerves were cut it is permanent. The surgeon will take a great deal of care to identify and preserve the nerves as they dissect / part the overlying and nearby tissues and if, as in your case the gland is being removed for recurrent sialadenitis or stone it is usually quite easy to "shell out" once that has been done. The nerves can be more difficult to preserve if there is a malignant tumour in the gland, especially if it has escaped into surrounding tissues. However as you say, sialadenectomy for recurrent infection / stone, though not uncommon in ENT practice, is not that commonly needed in the population as a whole. We see, I suppose, less than 50 a year for a population of 500,000 ~ <1/10,000 people a year; cancers of the submandibular gland are far rarer and would be highly unlikely to present with pain and swelling on eating - they are usually painless slow-growing masses. The classic test for SMG stone was to give the patient a slice of lemon which would induce the signs and symptoms - impressive but rather cruel! They will probably (should) send the gland off for histopathological examination which takes a few days to check that it is just a stone / chronic sialadenitis - it would be exceedingly rare to find an unexpected tumour in there though.

The other potential complications are those common to any operation, not unexpectedly, pain and bruising, infection of the wound, scarring (inconspicuous scar for SMG removal) and the risks of anaesthesia.

I'm sure it will go smoothly.

[numtumfutunch]

I too am sure it will go well, however am intrigued by how you found the surgeon
As you're a private patient you have the choice of anyone - why this one?

What you describe is a commonly performed op but if it were me and I had choice I would want somebody operating who did it frequently

Its a bit late tomorrow but I would want to know how many this individual does and their complication rates
Id also want to know how many you have to do to be considered good - not sure if I can help you with that

Best of luck

[Moose.]

I'm with AXA international and they found me one close to where I'm staying whilst back in back in the UK (I work abroad). He's a member of a team of ENT consultants and operates in two different private hospitals, all of which are approved by AXA. I'll certainly be asking those sort of questions tomorrow though