What should I bring with me when I come for a scheduled appointment?

We would highly recommend that the following items are brought with you for your appointment.

  • Your insurance information
  • A referral letter from your GP or family doctor
  • All x-ray reports and test results from your primary care or referring GP
  • A complete list of all medications that you are currently taking
  • A list of any known drug allergies and the symptoms you may have from taking these medicines
  • If you have had surgery anywhere else, please bring a copy of your operation report.

What should I expect during first visit?

During your first visit, Mr Clarke will review any medical information you bring with you, ask you questions and may do a physical examination.  He may discuss the requirement for further investigations which he will explain to you.

Do I need a referral to make an appointment?

Most medical specialists will accept only referred patients. This is partly to try to ensure that the specialist you are seeing is appropriate for you and your condition.

Can I fly after my surgery?

Yes after your post operative check.

What is a Head & Neck MDT?

This is the team of surgeons, oncologists, radiologists, pathologists, speech therapists, dieticians, nurses etc who meet weekly to discuss all cases of head and neck cancers and suggest treatment options.

I have already had a scan and biopsy. Why might this need to be repeated?

The quality of scans can vary widely. All areas of interest may also not be included in the initial scan. Sometimes a different (CT, ultrasound, MRI, PET) scan is required in addition to gain all the appropriate information. Prior to surgery an examination under anaesthetic may be needed to fully assess a tumour.

Can I drive after head and neck surgery?

Usually this is not a problem. Occasionally neck stiffness means that you may feel that turning your head is difficult and so you should be cautious if this is so.

What is globus pharyngeus?

This is an extremely common throat symptom. It can manifest as a feeling of a lump or mucus or obstruction in the throat. It is often associated with discomfort and causes anxiety about its cause. Food and drink goes down the gullet without getting stuck and the sensation is worse between meals/when swallowing saliva.

If the symptoms are associated with pain while swallowing food, food sticking in the throat or coughing up blood then further investigation will be required.

Globus is more common in people who are run down, stressed or anxious and addressing these issues often improves the symptoms. A dry throat makes saliva and mucus thicker and makes the sensation worse so drinking plenty of fluids and sometimes douching the nose if dry can help.

I have a parotid tumour. What is the risk to my facial nerve and why?

The facial nerve travels through the parotid salivary gland. Tumours almost always sit on or next to the nerve so the tumour needs to be dissected free from the nerve. This can result in some minor bruising of the nerve so that its function is reduced.

The risk of the whole nerve being permanently or even temporarily damaged is extremely small with benign tumours (Mr Clarke has never had a complete facial nerve palsy post operatively in 20 years as a consultant surgeon). One branch of the facial nerve to muscles of the lower lip and chin is sometimes particularly thin and susceptible to minor bruising and can have some temporary weakness which very occasionally (less than 5%) is permanent.

Malignant tumours are more likely to have invaded the nerve and the requirement to remove a cuff of normal tissue around a malignant tumour significantly increases the risk of nerve weakness.

What is a PET scan?

This is a scan that shows active cells. The brain and heart show up brightly as they are constantly active. Infection, inflammation and many tumours are also active and show up on this scan. Any such area can then be further investigated.

What is a Nasoendoscopy?

This is an outpatient procedure in which a lubricated flexible light emitting tube with a camera (endoscope) is used to examine the nose and the upper airways including: the nasal passages, the back of the nose over the soft palate, the upper part of the back of the throat behind the nose, the mouth and back of the tongue and down into the voice box (larynx) to look at the vocal cords. The procedure does not require an anaesthetic and is carried out by the surgeon after an explanation of the procedure. The scope is passed into the nostril as the patient breathes normally through the nose. This assists the passage over the narrowest part of the back of the nose and is the only point where the procedure may be a little uncomfortable. The discomfort quickly settles as the scope is passed further backwards and lasts only a few seconds. The complete examination takes only a few minutes in total and once the scope is removed any irritation of the inside of the nose quickly settles.

What is Microsuction of the Ears?

This outpatient procedure is carried out to remove wax from the ear canal and to allow a detailed inspection of the canal and eardrum (tympanic membrane). A small hollow cone is inserted into the ear canal as the surgeon manipulates a fine suction tube with their other hand whilst inspecting the narrow channel of the ear canal under a microscope. The skin on the inside of the ear canal is very sensitive to touch and so patients may find the process uncomfortable and it may stimulate a desire to cough. The procedure is also very noisy as the suction noise is very close to the eardrum.

If you know that you have wax build up in the ear canal and are seeing the doctor for its removal it is very important to use wax softening ear drops which are readily available from a commercial chemist for 4 to 5 days before your appointment. This will make the process much easier, less uncomfortable and will allow the surgeon to remove more of the compacted wax so that the eardrum can be inspected. Please read the instructions which come with the ear drops carefully for any contraindications.

What is Nasal Cautery?

Persistent nose bleeds are sometimes treated with nasal cautery in outpatients when a prominent blood vessel has been identified by the surgeon on examination of the inside of the nose. The surgeon dilates the nostril with a metal speculum to see the surface of the septum of the nose between the two nostrils. Cotton wool soaked with local anaesthetic is then applied to the area of bleeding for a few minutes. The surgeon then uses a cautery stick which looks like a matchstick to apply silver nitrate causing a chemical burn which scars the bleeding vessel closed. After the procedure it is common to have a little bleeding continue for 12 to 24 hours after cautery until the blood vessel fully contracts.

If you do experience bleeding squeeze the soft part of the nose gently closed for 10 minutes whilst leaning forward. It is important to understand that a normal clotting time is up to 9 minutes and therefore releasing the pressure before 10 minutes will mean that the bleeding will not be stopped adequately and is likely to start up again.

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