Problems after nasal and paranasal sinus cancer surgery

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

Possible problems after nasal and paranasal sinus cancer surgery include changes to:

• how you breathe
• how you chew and swallow
• how you see
• how you hear
• how you speak
• your sense of smell

How you might be affected will depend on the position of your cancer and the type of operation you have.

Other risks include infection, blood clots and blood collecting under the skin and forming a clot (haematoma).

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.

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.

Blood collecting around the operation site (haematoma)

Sometimes the drainage tubes, which are put in at the time of surgery, become blocked. This can cause blood to collect under the skin and form a clot (haematoma). This can cause pain and swelling. The area might also feel hard.

The haematoma normally goes away on its own, but it can take a few months. Your doctor or nurse can drain the swelling if needed.

Tell your doctor or nurse if you have any swelling around the wound.

Changes to your appearance

Surgery for nasal cavity or paranasal sinus 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 that you are not happy with.

If you have had facial surgery, it might 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. So lean on them for help as often as you need to.

Temporary changes in how you breathe

Some surgery can temporarily affect how you breathe. The airflow through the nose can change after removal of the tumour. This can lead to build up of mucus or crust in the cavity. Daily washing of the nose with salt water can help to reduce this but sometimes the crust may need to be removed by your doctor in the clinic. Usually, the crusting gets better with time.

You might have a reconstruction of part of your face with a tissue flap. This means that you might need to breathe through a tube in a hole in your neck. You do this until the wound has healed. The hole in your neck is called a temporary breathing stoma or tracheostomy.

Changes to speech, chewing and swallowing

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

Loss of sense of smell and taste

Your sense of smell will decrease after some types of surgery. This is especially noticeable if your nose is packed after the surgery. Once the pack comes out, it might improve. But it can take up to 3 months for your sense of smell to come back.

Sometimes, the lining at the top of the nose containing the smell receptors is involved in the cancer. Your surgeon might have to remove this area. This will lead to permanent loss of smell. Loss of smell will also affect your ability to appreciate the flavour of food and drink. Basic tastes such as salty, sour, bitter and sweet will not be affected.

It can be difficult to cope with not being able to smell.

Numbness

Parts of your face 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.

Changes to your eyesight

If your surgery affects the eye socket, you might have swelling and bruising around the eye. This is usually only a temporary problem.

Sometimes you may have double vision after surgery if it is done close to the eye. This is often temporary but if it persists, you may need treatment.

You may also get watering of the eye after sinus surgery as the tear duct runs close to the nose and sinuses. Again this is often temporary but if it persists, it can be treated.

Rarely, the surgeon needs to remove the eyeball if it is affected by the cancer. This will cause changes in your eyesight which can be hard to cope with. 

Changes to your hearing

Sometimes the swelling at the back of the nose caused by surgery can reduce your hearing, due to fluid collecting in the middle ear space. This is usually only a temporary problem while you recover. Your hearing should get back to normal when the swelling goes down but can be treated if it persists.

Lymphoedema (swelling)

After surgery to remove 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 if you have:

• any swelling or a feeling of fullness or pressure
• find it difficult to swallow
• have changes in your voice

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 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. 

More support and information

If you would like to talk to someone outside your own friends and family, you can phone the Cancer Research UK information nurses on freephone 0808 800 4040. The lines are open from 9am to 5pm, Monday to Friday.

You can also 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.