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After surgery

Find out what happens after your surgery and how you might feel.

Waking up after your operation

Waking up after an operation can feel quite strange. You might feel very confused or disorientated. You'll feel drowsy because of the anaesthetic and painkillers. This is normal. But knowing what to expect can help.

You might wake up in the recovery room close to the operating theatre. A nurse will look after you and monitor you closely. When you first wake up, you will have a little clip on your finger called a pulse oximeter. This measures your pulse and blood oxygen levels. You might also have an oxygen mask on for a while.

Your nurse will measure your pulse and blood pressure often during the first few hours.

If you've had a big operation, you might wake up in intensive care or a high dependency recovery unit. These are places where you can have one to one nursing care. And your surgeon and anaesthetist can keep a close eye on your progress. As soon as your doctors are sure you are recovering well, you will go back to the ward.

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 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 gently draw out the fluid. 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 about 3 to 7 days after the operation.

Talking after your operation

If you 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 very 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 for you to write down or type anything that you want to say. 

A nose pack

You might have gauze packs or cotton wedges inside your nostrils. These packs help to control bleeding. They also support the soft division between the two nostrils (the septum).

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 had. They are often taken out about after 24 to 48 hours. But they might be left in longer, to help with healing.

Having the packs taken out isn’t usually painful but it can feel a bit strange. Once the packs are taken out you shouldn't blow your nose for a couple of days.

If both sides of your nose are packed you will need to breathe through your mouth until the packs are taken out. This can make your mouth feel very dry and uncomfortable. Your nurses will give you ice to suck and regular mouth care to help you feel more comfortable.

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 painkilling drugs you can have.

It is very important to 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), to give painkillers after surgery. These attach to your drip. You have a hand control with a button to press to give yourself extra painkillers when you need them. Do 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 protective clear 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. You will probably have them taken out before you go home. But if your wound isn't completely healed and you feel otherwise well, you might be able to go home with your stitches still in. 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

If you had a large area of tissue removed during your operation, you will have had the area repaired 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 pressure on the wound.

If you have a skin graft or flap repair you will have 2 wounds. As well as the wound caused by the surgery to remove the tumour, you have a wound where the surgeon took the tissue for the flap or graft. This area is called the donor site.

If you had part of your upper jaw removed

If you had part of your upper jaw removed you might have a temporary replacement part (prosthesis) fixed in place. 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.

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 to 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. So when you were in the operating theatre, 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 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

If your surgery involved your mouth (for example, a maxillectomy) you might have some problems swallowing at first. A speech therapist will check that you can swallow properly before you start drinking or eating. As you are able to eat more, you can cut down the liquid tube feeds. Your dietitian will monitor this.

Once you are eating a normal diet, your nasogastric or PEG tube will be taken out. The nurses and dietitian will continue to check your progress and answer any questions that you have.

Once you have fully recovered from your operation, you can usually eat and drink normally again.

Maintaining your weight

If you lost a lot of weight and find it hard to put the weight back on, your dietitian will give you some high calorie liquid supplements. These drinks have all the vitamins, protein and carbohydrate that 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 to sprinkle on foods and add to drinks. 

Helping you to breathe

If your operation is likely to cause a lot of swelling in the neck area your surgeon might make a hole in your neck for you to breathe through. You usually only have this for a few days until the swelling goes down.

Making progress

After a few days you will be up and about more. Gradually you will start to feel better. Soon you will be able to eat. At first you will find it easier to have lots of very small meals rather than 3 large meals a day. The hospital dietitian will give you help and advice with managing your diet.

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.

Follow up appointments

You’ll have follow up appointments to check your recovery and sort out any problems. They‘re also your opportunity to raise any concerns you have about your progress.

After effects of surgery

Nasal and sinus cancer operations can be big operations and can change your appearance. They can also have other effects.

Information and help

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