Problems after mouth and oropharyngeal cancer surgery

There is a risk of problems or complications after any operation.

Possible problems after mouth and oropharyngeal cancer surgery include changes in eating, talking, and appearance. Other risks include infection, blood clots and bleeding.

Many problems are minor but some can be life threatening. Treating them as soon as possible is important.

Infections

You are at risk of getting an infection after an operation. This includes a wound, chest or urine infection. You will have antibiotics to reduce the risk of developing an infection after surgery. Tell your doctor or nurse if you have any symptoms of infection.

They include:

• a high temperature
• shivering
• feeling hot and cold
• feeling generally unwell
• cough
• feeling sick
• swelling or redness around your wound and your wound might feel hot
• a strong smell or liquid oozing from your wound
• loss of appetite

Rarely for an infection in your wound, you may need another operation.

Occasionally for an infection in your wound you may need another operation.

Bleeding from the wound

You may have a small amount of blood on your wound dressing after surgery, which is normal. Your nurse will regularly check your dressing after the operation. Tell your doctor or nurse straight away if there is more bleeding.

Blood clots

Blood clots (deep vein thrombosis, DVT) are a possible complication of having surgery because you might not move about as much as usual. Clots can block the normal flow of blood through the veins. Let your doctor or nurse know if you have an area in your leg that is swollen, hot, red or sore.

There is a risk that a blood clot can become loose and travel through the bloodstream to the lungs, causing a blockage there (a pulmonary embolism). Symptoms include:

• shortness of breath

• chest pain

• coughing up blood

• feeling dizzy or lightheaded

To prevent clots it's important to do the leg exercises that your nurse or physiotherapist taught you. Your nurse might also give you an injection just under the skin to help lower the risk whilst you are in hospital. You might need to carry on having these injections for 4 weeks, even after you go home. This depends on the type of operation you had.

Your nurse might teach you to do these injections yourself before you go home. Or a district nurse might come to your home to do them.

It's important to continue wearing compression stockings if you have been told to by your doctor.

Flap failure

Rarely one of the blood vessels can become blocked with a clot. This means the flap doesn’t get a blood supply. This usually happens within the first 48 hours after surgery. If this happens, you will need to go back to the operating theatre to try to save the flap. Sometimes the flap cannot be saved and the surgeon has to remove it. If your flap fails, your surgeon will usually replace it within a week to 10 days. 

You can usually have another reconstruction later date.

Numbness

Parts of your face and neck might be numb after surgery. The numb areas might include the tip and side of your nose, cheek, upper lip or gums. The sensation usually comes back after a few weeks. But sometimes it can take several months or might be permanent. Not being able to feel parts of your nose, cheek or mouth can be difficult to cope with.

Swelling

After surgery, the area can be swollen. This should begin to settle soon after your surgery, but it can take longer.

If you have some or all of the lymph nodes in your neck removed, the swelling might be due to lymphoedema.

You should let your doctor or nurse know of any swelling you have.

Lymphoedema (swelling)

Lymphoedema means a build up of lymph fluid that causes swelling in a part of the body.

The lymph nodes are part of your body's drainage system. Removing them can affect the natural circulation and drainage of tissue fluid.

After surgery to remove some or all of the lymph nodes from your neck, you are at risk of getting lymphoedema in your neck or face.

Lymphoedema in the head or neck can also cause symptoms inside your mouth and throat. This may include swelling of your tongue and other parts of your mouth.

Tell your doctor or nurse straight away if you have:

• any swelling or a feeling of fullness or pressure

• find it difficult to swallow

• have changes in your voice

They will refer you to a lymphoedema specialist if they think you might have lymphoedema. It’s important to start treatment early to stop the swelling from getting worse.

Exercises

Using your head, neck and shoulder muscles may help to reduce swelling. Your physiotherapist or specialist nurse will usually go through these exercises with you. 

These exercises shouldn't be painful. You might have a feeling of stretching as you do them, this is normal. Stop doing the exercises if you have any pain and if it doesn't get better contact your doctor.

Do the exercises slowly and gently, don't rush them. You can rest between exercises. It might help to do them in front of the mirror so you can check that your shoulders are back and relaxed. 

Scarring

Your scar may look red soon after surgery. Over time this fades and becomes less noticeable. After a few months, you may only have a thin white line. Some people may develop a thicker looking scar called keloid scarring. It might take a year or longer for this to improve.

Your nurse might give you advice about applying sunblock for the first 6 months after your operation. They will also show you how to massage the scar. It can help to flatten the scar and keep the tissue supple.

Changes to your appearance

Surgery for mouth and oropharyngeal cancer can change the way you look. How you look is an important part of your self esteem. It can be very hard to accept sudden changes in your looks.

It can sometimes be hard to look at yourself in the mirror at first. You might feel very angry, confused and upset for some time afterwards. Before your operation you will see your specialist head and neck nurse. They will discuss all the possible changes to your appearance and how these might make you feel. 

It can be very upsetting to go through a cancer diagnosis and then a big operation that changes how you look. You are likely to have times when you feel very down. Try to take time to recover fully from the operation. You’ll need a lot of support from your doctors and nurses, and your family and friends.

Changes to speech, chewing and swallowing

Your surgeon will always try to minimise changes to your speech, chewing or swallowing as much as they can. Sometimes this isn't possible, and you will need to adapt to changes after the surgery. This can be very hard to deal with, but there are things that can help.

You may see a speech and language therapist (SLT) before you start treatment if this is likely to affect your speech and swallowing. An SLT can assess these functions during and after treatment. They can provide rehabilitation, which may include mouth and throat exercises, a range of adaptations and emotional support. They work closely with a dietitian if you are finding it difficult to eat.

Blue or green pee and poo

After a sentinel node biopsy, your pee and poo might be blue or green because of the dye used during sentinel biopsy. This usually lasts for a couple of days. Not all hospitals use the dye.

Rarely some people are allergic to the blue dye, so it is important to let your surgeon know if you have any allergies beforehand.

Shoulder stiffness and arm weakness

The accessory nerve controls shoulder movement. So if the surgeon removes it during a neck dissection, your shoulder will become stiffer and more difficult to move. Raising your arm over your head on that side can also become more difficult.

After a selective neck dissection, the weakness in your arm usually lasts only for a few months. But if the surgeon completely removes your accessory nerve, the damage is permanent. Usually, you see a physiotherapist, who teaches you exercises to help improve the movement in your neck and shoulder. It is important to do these exercises regularly.

Some people still have problems with pain and movement a year after surgery, despite doing their exercises. If this happens, your surgeon may refer you to a shoulder surgery specialist.

Other possible effects of nerve damage

The cranial and spinal nerves supply the head and neck area. A neck dissection can damage some of these nerves. If this happens you might have:

• numbness in the ear on the same side as the operation

• loss of movement in the lower lip

• loss of movement on one side of the tongue

• loss of feeling on one side of the tongue

Pain

You may also have some pain. Taking painkillers can help. Physiotherapy exercises can also reduce pain. Your doctor can refer you to a pain clinic if the pain continues or is not controlled with painkillers.

Stiff neck

You may have a stiff neck after a neck dissection. Your physiotherapist will show you some exercises that will help improve this. It can take a few weeks or longer for your neck to be less stiff. You may need to continue the exercises after you go home.

Chyle leak

Chyle is milky fluid carried around the body by the lymphatic system. Rarely one of the lymph channels (called the thoracic duct) leaks after a neck dissection. This may cause chyle to collect under the skin. You are usually on bed rest in hospital until it stops.

Some people may have to go back to the operating theatre if the leak continues. You will be asked to follow a fat free diet. You might be given a medicine too, but this will depend on the amount of chyle leak.

Changes to the appearance of your neck

Removing the muscle during a neck dissection at the side of your neck doesn't usually cause a problem. But it does make your neck look slimmer and sunken on that side.

You might have a neck dissection on both sides, this means removing both muscles. Afterwards, you are likely to have some difficulty bending your head forward. Physiotherapy can help to improve movement and prevent stiffness. 

More support and information

You can get in touch with organisations for people with head and neck cancer.

You can contact a local counsellor through your hospital or through one of the counselling organisations.