After nasal and paranasal sinus cancer surgery
It takes a few weeks for you to recover after your operation. You will need to spend a few days in the hospital and then give yourself time to recover once you are home.
When you wake up after your operation
After the operation, you wake up in the recovery room. You will have one to one nursing care. The nurse looks after you until you are awake and well enough to go back to the ward.
Everybody is different when they are waking up after an operation. It takes some people longer than others to wake up. Some people remain very sleepy for a while afterwards. You may be in the recovery room for hours before you are ready to go back to the ward.
Back on the ward your doctor will see you regularly. Specialist nurses may visit you. They look after people who have had major surgery but do not need to be in the intensive care or high dependency unit.
Sometimes you may wake up in the
(ICU) or (HDU) after your operation. This is so your doctors can keep a closer eye on you. This may happen if:
- your general health is poor
- the operation took longer than planned
- the operation was more complicated than the doctors thought it would be
In the ICU you have one to one nursing care. In the HDU you have very close nursing care.
The staff in the ICU or HDU will speak to a member of your family or friends about visitors. But, you usually move back to the ward within a day or so.
Tubes and drains
You might have several different tubes in place. This can be a bit frightening. It helps if you know what they are all for.
You might have:
- drips to give you fluids, painkillers and antibiotics until you are eating and drinking again, and a blood transfusion if you need one
- a thin tube into your stomach to drain fluids and give liquid foods
- one or more wound drains coming out of your neck or near your wound
- a tube into your bladder (catheter) to collect and measure your urine
The thin tube is to drain fluid from your stomach and stop you feeling sick. Later it might be used as a feeding tube. The tube might go up in your nose and down your throat into your stomach. Or you might have a tube that goes directly into your stomach through your tummy (abdomen). This is called a gastrostomy or PEG tube.
Your surgeon might suggest a PEG tube if the operation is likely to cause problems with swallowing while you are recovering.
The wound drains stop blood and fluid collecting in the area of the operation. This helps your wound to heal and prevents infection. The wound drains connect to suction bottles, which help to draw out the fluid gently. Your nurses will change the bottles attached to them every day. When the fluid stops coming out, your nurse takes the drains out. This is usually a few days after the operation.
Pain control
You will almost certainly have some pain and discomfort for the first week or so. But it is possible to control your pain. There are many different painkillers you can have.
Tell your doctor or nurse as soon as you feel any pain. They need your help to find the right type and dose of painkiller for you. Painkillers work best when you take them regularly.
You might have an electric pump called a PCA pump (patient controlled analgesia). It is a way of giving painkillers after surgery. It attaches to your drip. You have a hand control with a button to press to give yourself extra painkillers when you need them. Use it whenever you need to.
You can’t overdose because the machine is set to prevent giving too high a dose. But tell your nurse if you need to press the button very often. You might need a higher dose in the pump.
Your wound
You might have a dressing over your wound. Or you might have a clear protective covering sprayed on or an antibiotic ointment. If you have a dressing, your doctor will leave it on for a couple of days before removing it.
Stitches or clips
Your stitches or clips will stay in for up to 10 days. But they might come out before you go home. If your wound hasn't healed and you feel otherwise well, you might go home with your stitches. You can go back to the hospital to have the stitches taken out. Or a district nurse will visit you at home and take them out there.
If you had a skin graft
Sometimes your doctor has to remove a large area of tissue during your operation. They will repair the area with a skin graft or flap. While the skin graft or flap is healing, it will be very delicate. You must be very careful not to knock it. And your doctors and nurses will be very careful to protect your wound from infection. Your doctor might prescribe a course of antibiotics.
After a flap repair, your nurses and doctors will regularly check your wound site. They make sure it is getting a good supply of blood to bring oxygen and nutrients to the healing tissues. Skin grafts are usually covered with a tight dressing to keep the pressure on the wound.
If you have a skin graft or flap repair you will have 2 wounds:
- a wound caused by the surgery to remove the cancer
- a wound where the surgeon took the tissue for the flap or graft, also called the donor site
If you had part of your upper jaw removed
Some people might have a temporary replacement part (prosthesis). This is after removal of part of your upper jaw. The prosthesis is called an obturator. It is a bit like an upper denture. It fills the space left by the removal of the cancer.
A nose pack
You might have gauze packs or cotton wedges inside your nostrils. These packs help to control bleeding.
You might have tape at the end of your nose to keep the packs in place. How long you have the packs depends on the type of surgery you've had. They are often taken out after 24 to 48 hours. But might stay in longer to help with healing.
Having the packs taken out isn’t usually painful, but it can feel a bit strange. Once they are out, you shouldn't blow your nose for a couple of days.
If you have packs in both nostrils, you will need to breathe through your mouth until the packs come out. This can make your mouth feel very dry and uncomfortable. Your nurses will give you ice to suck and regular mouth care. This will make it more comfortable.
Talking after your operation
If you've had surgery to your mouth or jaw you will have problems talking to the doctors and nurses. This can be very frustrating and might make you feel as though you have no control over things. Staff will be aware of this and will visit you often to see if you need anything.
You will have a call bell close by so that you can call for help whenever you need it. Your nurse will also give you a pen and paper or an electronic device to write down or type anything you want to say.
Getting up
This might seem impossible at first. Moving about helps you to get better, but you will need to start very gradually.
Your physiotherapist will visit you every day after your operation. They will help you with your breathing and leg exercises. Your nurses will encourage you to get out of bed and sit in a chair 1 or 2 days after your surgery. They will help you with all the drips and drains.
Over the next couple of days, your nurse will take out most of the tubes, bottles and bags. Then, it will be much easier to get around.
Eating and drinking
When you can eat and drink after your operation depends on the type of surgery you had. For example, if your surgery involved parts of your mouth, you might not be able to eat or drink anything for a few days. This lets the area heal and helps to prevent infection. You will have fluids through your drip and can wet your mouth with ice or small sips of water.
Feeding tubes
If you had major surgery you might not be able to eat or drink for some time after your surgery. During your surgery your surgeon may have put a soft plastic tube into your nose and down into your stomach. This is called a nasogastric tube. Or you might have a tube put directly into your stomach through your tummy (abdomen). This is called a PEG tube.
Your nurse puts liquid food put down the tube to keep you nourished. The hospital dietitian will visit you regularly over the next week. The dietitian decides when to increase the amount of feed you are having through the tube. They build it up slowly until you are having the same number of calories as you would have in your normal diet.
Starting to eat and drink
Once your wound has healed, you can gradually increase the amount you can drink. And then you start to eat a light, soft diet. This usually means foods like soup and jelly.
Swallowing
You might have some problems swallowing at first after surgery to your mouth. This is for example after a maxillectomy. A speech therapist will check that you can swallow properly. You can then start drinking or eating. As you start eating more, you can cut down the liquid tube feeds. Your dietitian will guide you on this.
Once you are eating a normal diet, your nasogastric or PEG tube will come out. The nurses and dietitian will continue to check your progress. They can answer any questions that you might have.
Once you have recovered from your operation, you can usually eat and drink normally again.
Maintaining your weight
Your dietitian can help if you have lost a lot of weight and find it hard to put the weight back on. They can give you high calorie liquid supplements. These drinks have vitamins, protein and carbohydrates. They provide you with what you need for a balanced diet. You can sip them during the day as well as having regular meals.
Your dietitian can also give you powdered protein or carbohydrate supplements. You sprinkle it on foods and add them to drinks.
Helping you to breathe
Some operations might cause a lot of swelling in the neck area. In these cases, your surgeon might make an opening in your neck for you to breathe through. This is called a stoma or tracheostomy. You usually only have this for a few days until the swelling goes down.
Going home
You’ll need some help when you first go home. The dietitian will talk to you and your family about what to eat. It might take some time to find what works for you.
You’re likely to feel very tired for several weeks or a few months after your surgery. It helps to do a bit more every day.
Try:
- sitting for less time each day
- walking around the house a bit more each day
- building up to walking outside
What you can do depends on how fit you were before your surgery and any problems you have afterwards. Talk to the physiotherapist or your doctor if you’re unsure about what you should be doing.
Contact your doctor or specialist nurse if you have any problems or symptoms you’re unsure about.
Possible problems after surgery
Nasal and sinus cancer operations can be big operations and can change your appearance. They can also have other effects.
