After your operation for nasal and sinus cancer
This page tells you what to expect after your operation. You can find the following information
After your operation for nasal and sinus cancer
When you wake up, you may have several different tubes in place. These may include a drip in your arm, drains from your wound, and a fine tube into your stomach to give you liquid food. The feeding tube may go down your nose, or you may have one put in through the wall of your abdomen (a gastrostomy tube). You may have gauze packs or cotton wedges inside your nostrils. If both sides of your nose are packed you will have to breathe through your mouth.
Coping with pain
You will almost certainly have some discomfort for the first week or so. It is 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.
Eating and drinking
If your surgery has involved your mouth, you may not be allowed to eat or drink for a few days. You will have fluids through your drip. If you have had major surgery you may not be able to eat or drink for some time. You will need to have liquid food through a tube. Your surgeon will put the tube up your nose and into your stomach during surgery.
Seeing yourself for the first time
If the surgery has changed the way you look, it may be very difficult to look in the mirror at first. You may feel very angry, confused and upset for some time. Your doctors and nurses will help support you during this time.
You can view and print the quick guides for all the pages in the treating nasal cancer section.
Waking up after an operation can feel quite strange. You may feel a bit confused or disorientated. This is very normal. But knowing what to expect can help. If you've had a big operation, you may wake up in intensive care or a high dependency recovery unit. This is nothing to worry about. 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.
When you wake up, you may have several different tubes in place. This can be a bit frightening. It helps if you know what they are all for. You may have
- Drips (intravenous infusions) to give you fluids, painkillers and antibiotics until you are eating and drinking again, and a blood transfusion if you need it
- A fine tube into your stomach for drainage and for liquid foods
- One or more wound drains coming out of your neck or near your wound
- Nose packs
- A tube into your bladder (catheter) so that your urine can be collected and measured
The fine tube is to drain your stomach and stop you feeling sick. Later it may be used as a feeding tube. The tube may go up your nose and down your throat into your stomach. Or you may have a tube that goes directly into your stomach through your abdomen. This is called a gastrostomy or PEG tube. Your surgeon may 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 around the site of the operation. This helps your wound to heal and to stop infection. The wound drains connect to suction bottles, which help to gently draw out the fluid. When the fluid stops coming out, your nurse will take the drains out. It usually takes a few days for the wound to stop draining.
After your operation you may have gauze packs or cotton wedges inside your nostrils. These packs are used to help control bleeding. They also provide support for the soft bone between the two nostrils (septum) after surgery. Sometimes the packing is coated with an antibiotic cream to help prevent infection or a petroleum jelly to prevent it becoming stuck to the tissue that is healing.
Your doctor may tape up the end of your nose to keep the packs in place. How long you have the pack will depend on the type of surgery you have had. They are often taken out about 24 to 48 hours after surgery. But it may be left in longer, to help promote healing. Having the packs taken out isn’t usually painful, but it can feel a bit strange. Once the packs are taken out you should not blow your nose for a couple of days.
If both sides of your nose are packed you will have 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 with this problem.
When you first wake up, you will have a little clip on your finger called a pulse oximeter. This is to measure your pulse and blood oxygen levels. You may also have an oxygen mask on for a while. Your nurse will measure your blood pressure often during the first few hours after you come round from the anaesthetic. They will also measure the amount of urine you produce. This will help the medical staff make sure you are neither dehydrated nor have too much fluid in your body.
You may have a couple of electronic pumps attached to your drips. These give you a constant, measured dose of painkillers or other drugs you might have through your drip.
If you have had surgery to your mouth or jaw you will have problems talking to the doctors and nurses. This can be very frustrating and may make you feel as if 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 for you to write down anything you wish to say. If you need a temporary breathing stoma, you won’t be able to talk until the tube is removed.
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. So 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.
Many hospitals now use electric pumps, called PCA pumps (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 as you need them. Do use it whenever you need to. You can’t overdose because the machine is set to prevent that. But do tell your nurse if you need to press the button very often. You may need a higher dose in the pump.
This may 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.
Some surgeons cover wounds with a dressing after surgery. Others just spray them with a protective clear spray or use an antibiotic ointment so that they can see them clearly. If you have a dressing, your doctor will leave it on for a couple of days before removing it.
If you have had part of your upper jaw removed you may have a temporary replacement part (prosthesis) fixed in place. Your doctor or nurse might call this an obturator. It is a bit like an upper denture. It fills the space left by the removal of the cancer, and closes off communication between your mouth and nose.
Your doctor will want your wound drains to stay in until they stop draining fluid. This is usually about 3 to 7 days after the operation. Your nurses will change the bottles attached to them every day.
Your stitches or clips will have to stay in for up to 10 days. You will probably have them taken out before you go home. But if your wound is not completely healed and you feel otherwise well, your doctor may let you go home with your stitches still in. You can go back to the hospital to have them taken out. Or a district nurse will visit you at home and take them out there.
If you have a large area of tissue removed during your operation, you will need to have the area repaired. This can be done using a skin graft or flap. This is most likely with large tumours of the nasal cavity and paranasal sinuses. While the skin graft or flap is healing, it will be very delicate. You must be very careful not to knock it. And your doctor and nurses will be very careful that your wound does not become infected. Your doctor may prescribe a course of antibiotics to help prevent infection.
After flap repair, your nurses and doctors will regularly check on your wound site to 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 which keeps 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 will have a wound where the surgeon took the tissue for the flap or graft. This area is called the donor site.
Having a skin graft or flap can change the way you look. This can be quite difficult to cope with. There is information on coping with changes in your appearance in the living with nasal cavity and paranasal sinus cancer section.
Whether or not you can eat and drink after your operation depends on what operation you had. For example, if your surgery has involved parts of your mouth, your doctors and nurses may not allow you 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 you may be allowed to wet your mouth with ice or small sips of water.
If you have had major surgery you may not be able to eat or drink for sometime 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 a nasogastric tube. Or you may have a tube put directly into your stomach through your abdomen. This is called a PEG tube.
You will have liquid food put down these tubes to keep you nourished. The hospital dietician will visit you regularly over the next week. The dietician decides when to increase the amount of feed you are having through your nasogastric or PEG tube. They will build it up slowly until you are having the same number of calories as you would have in your normal diet.
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 starting with things like soup and jelly. If your surgery involved your mouth, for example, a maxillectomy, your swallowing may be affected. 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 your liquid tube feeds. Your dietician will monitor this. Once you are eating a normal diet, your nasogastric or PEG tube can come out. The nurses and dietician will continue to check your progress and answer your questions.
Once you have fully recovered from your operation, there are usually no restrictions on what you can eat and drink. But people have often lost quite a bit of weight by the time they are diagnosed with a cancer of the head or neck. If this is the case and you have not managed to put the weight back on, you need to build yourself up again with some high calorie liquid supplements.
There is detailed information on coping with eating and drinking after nasal cavity and paranasal sinus cancer in the living with nasal cavity and paranasal sinus cancer section.
Your sense of smell will decrease after some types of surgery to treat nasal cavity and paranasal sinus cancers, especially if you had your nose packed after the surgery. Once the pack is removed it may improve. But it can take up to 3 months for your sense of smell to return. If you had little or no sense of smell before your operation, losing your sense of smell may be permanent.
As well as loss of your sense of smell, the tip and side of your nose, cheek, upper lip and gums may be numb after surgery. The sensation usually returns after a few weeks. But sometimes it can take several months or might be permanent. Not being able to smell or feel parts of your nose, cheek and mouth can be difficult to cope with. There is more about changes to your sense of smell in the living with nasal cavity and paranasal sinus cancer section.
If your surgery only affects the eye socket you may have swelling and bruising around the eye. This is usually only a temporary problem. But if your surgery involves removing your eyeball then you will have to cope with changes in how well you see and how you look. This can be very difficult to cope with. There is information on coping with changes in your sight in the living with nasal cavity and paranasal sinus cancer section.
Sometimes the swelling caused by your surgery can affect your hearing. This is usually only a temporary problem whilst you recover from your surgery. Your hearing should get back to normal after the swelling has gone down. There is more about changes to your hearing in the living with nasal cavity and paranasal sinus cancer section.
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 dietician will give you help and advice with managing your diet.
If you have lost quite a lot of weight, your doctor or dietician will probably recommend that you try and boost your calorie intake with some high calorie liquid supplements. These drinks have all the vitamins, protein and carbohydrate that you need for a balanced diet. If you are trying to put weight on, you can sip these through the day as well as eating meals. They come in many flavours these days, both savoury and sweet. Available brands include Ensure, Fresubin, Complan and Build Up.
You can also get powdered protein or carbohydrate supplements to sprinkle on foods and drinks. A dietician will be able to help you plan a suitable diet and advise on supplements. There are also some tips for adding hidden calories to your diet in the managing diet problems section.
Surgery to treat 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 is not unusual to find it very difficult to look in the mirror at first. You may feel very angry, confused and upset for some time after surgery. Before your operation your specialist head and neck nurse will discuss all the possible changes to your appearance and how these might make you feel. There is a detailed section on how to cope with changes in your appearance in the living with nasal cavity and paranasal sinus cancer section.
You have been through a lot of distress already. First you’ve had your cancer diagnosis to come to terms with. And now you’ve been through a big operation. You are likely to have times when you’ll feel very down. Try to be patient with yourself while you fully recover from this operation. You’ll need a lot of support from your doctors and nurses, family and friends. So don’t be afraid to lean on them for help as often as you need it.
There is more about living with cancer of the nasal cavity and paranasal sinuses in this section.
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 look at our general cancer organisations page for organisations that can offer support or put you in touch with a support group. You can find details of counselling organisations in our counselling section.
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