Just had a consult with Dr. Hackman

Hi Everyone!
I just drove to NC and met with Dr. Hackman. I really liked him. He told me he could do either the external surgery or the internal robotic one. He said that for him it didn’t make a difference on outcome but that the internal one was a very painful recovery. He also said that he would not remove the styloid all the way to the skull as it was not necessary and that he said it would not grow back as if the ligament is not there there would be not reason for it to. What do you all think about that? Also anyone used Dr. Hackman and did the external surgery? He said he has done about 25 of these surgeries total including both internal and external.

Glad that you liked him, but he’s wrong about the styloid not growing back, we’ve had members come back with re-growth. But not everyone has them grow back, it’s rare.
From what we’ve seen on here, I’d agree that intra-oral surgery is more painful & a trickier recovery, you’re more likely to get infections too. It’s good that he was honest about that, as often doctors aren’t really aware of what recovery from surgery is really like!
If you use the search function & look for Dr Hackman robotic surgery, it’ll come up with quite a few mentions in discussions.
Hopefully others with experience of surgery by Dr Hackman will chip in!

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Thanks Jules! I am also meeting with Dr. Samjii tonight. So I will let you know how that goes.

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Please do let us know how your meeting w/ Dr. Samji goes, Priscilla. I’m a bit biased since he did my surgeries. I think he’s the best of the best!

I had bilateral styloid removal by Dr. Hackman on 11-11-19. I can not say enough about him. I am surprised he said he doesn’t go to the skull as he did on me. I just had a CT scan the other day and the ENT asked who did mine and said he had never seen a better job. He is trained in so many areas. He is called into a lot of surgeries when they have vascular issues. He works a lot on cancer patients. He does reconstructive surgery. The robot surgery which goes intra orally was very easy for me. I was surprised. It is less invasive and less risky. Read about the Davicini Robot. Where ever you choose to go I hope you have relief soon!

Best of Luck,

Adriene

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Adriene, Thank you so much for writing to me. Did Hackman remove both ligaments? Did you have both sides done at the same time? I talked with Dr. Samji last night and he said that when doing orally you can not get both tendons. Also Hackman made it seem like externally has the same risks but that internally is so much pain during recovery. Why did he suggest the robotic over the external for you? I really liked Hackman and he is a lot closer to me, but Samji has done 400 of these and hackman only 25. Now I am confused.

I really liked him, but now confused as there were some discrepancies with Hackman and Samji. Mostly in regards to the ligaments being calcified or not. Can someone explain it to me. I feel confused. Samji seemed to be saying that it has nothing to do with the ligaments calcifying and Hackman seemed to say it had everything to do with the ligaments being calcified. I think I was so nervous and tiered that I may not have heard either of them correctly.

Adriene, Thank you so much for writing to me. Did Hackman remove both ligaments? Did you have both sides done at the same time? I talked with Dr. Samji last night and he said that when doing orally you can not get both tendons. Also Hackman made it seem like externally has the same risks but that internally is so much pain during recovery. Why did he suggest the robotic over the external for you? I really liked Hackman and he is a lot closer to me, but Samji has done 400 of these and hackman only 25. Now I am confused.

Yes he removed both at the same time.and my ligaments. He also took out my right thyroid at the same time. He would not have been able to do it intraorally without the robot… It gives them a lot more access and vision. Dr. Hackman is very experienced. Ask how many surgeries he’s done totally. Not just ES. He does head and neck surgeries for cancer patients, Vascular ,and I know he does reconstructive also (like cleft palate) and many more types of surgery. I’ll have to ask him how many ES surgeries are external or with the robot.

ES is so rare and that is such a small part of what he does. From what I have heard Samji would be a good choice too. I am partial to Dr Hackman as he was amazing. I really felt confident when I found out that he received an award that physicians voted on (whom they would want to operate on them). That sold me as there would be no higher honor than your colleagues voting that if they had to have surgery he is the one they would want to perform it.

The only negative thing I could say is he gets called into other surgeries to help with major problems and sometimes you have to wait a little longer. But that has not been a major issue for me.I don’t think Samji is trained on the Davinci robot. It takes a lot of training and an entire team to have that surgery.

You may not be a candidate for the robot, I know some are not.

You have two great surgeons so I would just go with your gut. I hope you do well and get relief soon.

Let me know how your surgery goes.

Best of Luck

Dr. Hackman said that he was happy to do either internal or external for me. He warned me that the recovery from the internal was painful. What did you think? How painful was it and how long did it last. I would be so happy if I could get both out at the same time!

Honestly I only took
One pain killer. Read up on the Davinci robot… the mouth heals fast. It was so much easier than I expected. Less chance of nerve damage or vascular.
It’s just less invasive. Reading others experience it seems like they have a lot of swelling externally. My son is a head neck
Surgeon in Brazil and he happened rnn in be at John hopkins for training when I had my surgery. He said he wished he was trained on it.

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Others can give you more in depth information on pros and cons of everything. This is where it comes down to opinions and weighing your comfort levels. There are many surgeons that will not do both sides at the same time for a variety of reasons which others can share in more detail. Dr. Samji is one of them. I see generally those that get both out at same time, tend to be with surgeons who do the intra-oral approach. Having had my tonsils out at age 17, I remember how painful it was and opted for the external approach. Im older and I didnt care about scars from incision. Most people dont even see the scar from my 1st surgery unless I point it out. Intra-oral you will be struggling with more pain as well as challenges with eating and swallowing due to the incisions. I chose not to deal with that challenge. I was eating pretty well within a couple days although I stuck with soft foods. Adriene has had a good experience with someone who has training and experience on Davinci robot. Although as she pointed out, not all patients cases make a good candidate for that and you may not have that option. Others who have had intra-oral can share their experiences with the pain and how they chose which do do. Often it has to do with the surgeon they go to.
I live on the west coast so Dr. Samji was an easy choice for me given his experience. I flew in for a consult and a friend in medicine in SF attended. She knew some of his past associates on the east coast. She gave him the thumbs up and I had a good rapor with him. I had no doubt I would be in good hands with him. Ive flown for surgeries before but have stuck to the end of the country I live. I did travel east coast for consults for my daughter and inpatient at Vanderbilt for her because that is where the foremost experts were for her medical condition. Going with your gut and where you are most comfortable is good advice. Just take them time to ask alot of questions here and have full undrstand of pros and cons of each approach. Good luck on your decision and surgery.

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My full recovery was about six weeks. I haven’t had external si I really can’t speak to that but based on the comments I have read.

Hi Priscilla,

The whole styloid vs. s-h ligament issue is a “Which came first the chicken or the egg?” question. The stylohyoid ligament runs from the tip of the styloid process to the lesser horn (cornu) of the hyoid bone. In some cases, the stylohyoid ligament begins to calcify at the hyoid end & calcification moves up toward the styloid w/o the styloid process ever becoming elongated. This renders the s-h ligament inflexible/tethered, so it can’t move as it should which in turn locks down the hyoid bone so it can’t move as it should which in turn causes pain. These structures need flexibility to move during talking, singing, breathing, swallowing, coughing, hiccupping, sneezing, etc.

The other side of this equation is when the styloids elongate. Now here’s the puzzler…does the styloid itself elongate, or is it the stylohyoid ligament calcifying from the tip of the styloid (rather than from the hyoid bone end) which makes the styloid appear to be elongated? I don’t think anyone knows for sure. The discrepancy about ligament vs styloid calcification that you felt you heard between the two doctors may just be a matter of definition of terms & not actually a disagreement about your diagnosis. If you have a 3D image of your CT scan & are willing to post it (you can send it to me & Jules privately, if you don’t want it on the forum at large, by clicking on my screen name above this post) & we can give you our non-medical opinion & perhaps help you understand whether you have just elongated styloids or if your s-h ligaments are also calcified.

I do know that if there is any calcification on your stylohyoid ligament, Dr. Samji will remove it along w/ the styloid process. I am living proof of that. At the time I had my ES surgeries w/ him, I understood him to say he always removes the stylohyoid ligament along w/ the styloid to help prevent further opportunities the ligament to calcify post op. Perhaps it’s only when there’s already calcification there that is his policy & if there is none then he leaves the ligament. I also know that Dr. Hackman will remove the styloid(s) at the skullbase in some cases as Adriene61 pointed out so I would certainly have a follow-up conversation w/ him about that. He told another member that he can only remove the stylohyoid ligaments by external surgery so Adriene61’s case seems to be somewhat unique. Perhpas what he does is on a case by case basis.

I hope I haven’t totally confused you & that this info is helpful.

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I am leaning towards getting the robotic intraoral with Hackman. 1. I have 7 children and live on the east coast so getting to NC is much easier for me. 2. I am worried about nerve damage with the external. 3. I would love to be able to get both sides done at the same time.

I really liked Dr. Samji too and am still not sure who I will use. I like how much experience he has. Just not keen on getting my neck cut into. Ugg. Planning on making my decision this weekend as living in the unknown is so stressful.

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Sorry about all the mistakes. I was typing on the phone and didn’t have my glasses on.

Best of Luck

Thank you! I am such a visual person that every time I talk with doctors I truly wish they had a picture or model to show me exactly what they are talking about doing. I really did think Dr. Samji was great. I know he know what he is doing but if I feel can feel confidant with Dr. Hackman, he is closer to me. I will try and send you my scans. Thank you so much!

I interviewed 7! Surgeons and would be happy to speak with you. I had surgery w Cognetti mid August. Very much liked Hackman. I can explain the 1 cm reasoning. The facial nerve is at risk if taken back to skull. But samjii nerve monitors. Would be happy to speak by phone as so many were generous w me! I am also a retired oncologist so have general knowledge…

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Hi Priscilla,

Proximity to home can be a critical factor in deciding on surgery. I think if Dr. Hackman is willing to take your styloids back to the skullbase, he is an excellent choice. He certainly doesn’t lack experience. I think nerve monitoring is used in both types of ES surgeries now. The facial nerve exits the skull near the base of the styloid, & because of its location, some doctors are more conservative in the way they do styloidectomies erring on the side of caution to protect the facial nerve. Even doctor Samji has been known to leave a bit of styloid behind if he felt there could be a permanent impact on a nerve or nerves. That is to say, a surgeon can tell you what his/her surgical intention is but the reality can be different once the surgeon sees “how you’re put together”.

Why did you choose Cognetti instead of Hackman? Did you have Internal robotic?