What happens after surgery for head and neck cancer?

How long you are in hospital for depends on the operation you have. With reconstructive surgery, you may need to be in for a few weeks. After a bigger operation, you may be in intensive care for a few days. You usually have some drips, drains and tubes attached to you. The nurses remove these as you begin to recover.

These may include:

  • Drips – a tube going into a vein in your arm or neck to give you fluids.
  • Drains – thin tubes that collect fluid from your wound.
  • A feeding tube – that goes into your stomach to give you liquid food. The nurses remove it when you can eat and swallow.
  • A temporary tracheostomy tube – a small opening into your windpipe held open by a tube you breathe through. Your surgeon will tell you before the surgery if you are likely to need a tracheostomy.

As you recover, you may have pain, changes in sensation or numbness, speech and swallowing changes, stiffness in the jaw and possible changes to your appearance. You will have help to manage any of these.

After the operation

Some people have surgery as a day patient, but surgery often involves a stay in hospital. This may be for several days or up to a few weeks. How long you stay depends on the type of surgery you have and whether or not you have reconstructive surgery.

After your operation, you will be encouraged to start moving around as soon as possible. This is an important part of your recovery. If you have to stay in bed, it is important to do regular leg movements and deep-breathing exercises. A physiotherapist will explain these to you.

If you have had a bigger operation, you may spend some time in intensive care immediately after the operation. This is a ward where you have one-to-one nursing care for as long as necessary to help you recover.

After the operation, it is likely that you will wake up with a number of drips, drains and tubes attached to you. These are gradually removed as you recover.

Drips

Operations to the mouth and throat area usually cause quite a lot of swelling. This can make eating and drinking uncomfortable for a time. Because of this, you will probably wake up from the operation with a tube going into a vein in your arm or neck (an intravenous drip). The nurses will give you fluids through this tube for a few days. They remove the drip when you are able to drink fluids again.

Drains and dressings

Depending on the extent of your surgery, you may have 1 or 2 thin, plastic drainage tubes coming from the operation area. The tubes have bottles attached to them to collect fluid from the wound. This helps the wound to heal. Drains usually stay in place for 2 to 7 days.

If you have had reconstructive surgery using tissue taken from another part of your body, you may also have stitches, a drain and a dressing on this area.

When you go home, a district nurse can check and dress your wound and drain (if it is still in) if necessary. Or you may be asked to go back to the hospital every few days to have it checked. If you do not have dissolvable stitches, you usually have your stitches or staples removed about 7 days after your operation.

Feeding tube

You may not be able to eat for a short time while your tissue heals. This means you may have to get the food and nutrition you need through a feeding tube that goes into your stomach. This may be put in before or during the operation.

If you need a feeding tube, your cancer specialist will talk to you about this before your operation. Your dietitian will also talk to you and provide support afterwards. They will prescribe high-protein, high-calorie, liquid food, which is given through the tube.

Once your mouth and throat have healed, your surgeon may arrange for you to have a swallowing assessment by your speech and language therapist (SLT). This is to check whether you have any swallowing difficulties. When you can eat and swallow safely, the feeding tube is removed.

If you are going to have radiotherapy after your surgery, you may need a feeding tube until all your treatment is completed. This is because radiotherapy can give you a sore mouth and throat, which can make it difficult for you to eat.

If you need to go home with a feeding tube, your dietician, SLT or a nurse in the hospital can teach you and your family members or friends how to use and to look after it safely. You can also have daily home visits from community nutritional care nurses. They can help with feeding tube care and setting up the feeds.

Passing urine

You may have a small tube (catheter) to drain pee (urine) from your bladder into a collecting bag. This stops you having to get up to pee (pass urine). It also helps the doctors monitor how well your kidneys are working. It is usually removed after a couple of days.

Temporary tracheostomy tube

Sometimes surgery to the mouth or throat can cause temporary swelling around the throat. This can narrow the airway and make it difficult for you to breathe. If the type of surgery you are having is likely to cause this problem, the surgeon creates a small opening into the windpipe for you to breathe through. This is called a tracheostomy or stoma.

The opening is made in the lower part of the front of the neck. It is held open by a small plastic tube that is a few centimetres long. When the swelling from your operation goes down (after about 5 to 7 days) and you can breathe easily, the tube is taken out. The opening will then be left to heal over naturally.

Position of a tracheostomy tube
Position of a tracheostomy tube

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A tracheostomy tube
A tracheostomy tube

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If you have a tracheostomy, you cannot usually speak with the tube in place. But you can use a pen and paper, or a mobile phone, laptop or tablet to communicate with other people.

If you are likely to have a temporary tracheostomy after your operation, your surgeon will explain this to you before your operation. You will also have time to ask the specialist nurse or SLT questions about it before you have your surgery.


Recovery after surgery for head and neck cancer

Pain

You may have some pain or discomfort for a few days or weeks after your operation. Your doctor or nurse will explain how to manage the pain. It is important to let the staff caring for you know if you are still in pain. If the painkillers are not relieving your pain, they may be able to increase the dose or change the painkillers.

We have more information about managing pain.

Changes in sensation or numbness

Surgery may affect the sensation or feeling in your mouth, face, neck or shoulders. Some areas may feel numb. This can happen if nerves are bruised during the operation. It may take several months for the nerves to heal and for normal sensation to come back.

If you have a scar on the surface of your skin after the operation, it is common for the skin around the area to feel numb. It may take several months for normal sensation to come back.

Sometimes, if a cancer is growing very close to a nerve, the only way to remove all of the cancer is by cutting the nerve. If this happens, the changes in sensation can be permanent.

We have more information about numbness and changes in sensation.

Speech

Some operations to the mouth and throat can affect the way you speak. The throat, nose, mouth, tongue, teeth, lips and soft palate are all involved in producing speech. Any operation that changes one of these parts of the head and neck may affect your speech or voice, or both.

For some people, this is hardly noticeable. But for others, their speech or voice is temporarily or permanently changed. A speech and language therapist (SLT) can help you adapt to any changes, and help improve your communication.

We have more information about managing changes to speech and voice.

Swallowing

When you are ready to start taking fluids and food by mouth, you will see a speech and language therapist (SLT). If chewing or swallowing is difficult, they will give you advice on foods that are easy to swallow. You may cough when you eat and drink. This can sometimes be sign that food is going down the wrong way (into the airway). Your SLT can teach you exercises to help with swallowing and stop this from happening.

We have more information about help with swallowing.

Difficulty opening your mouth due to a stiff jaw (trismus)

Some operations to the back of the mouth and throat can lead to a stiff jaw. This can make it difficult to open your mouth (trismus). It is usually temporary. There are exercises you can do to help prevent this from becoming a permanent problem.

Changes to your appearance

Before your operation, your surgeons and specialist nurse can talk to you about the possible changes in your appearance. It is important to have a good idea of what to expect.

Operations that are done in the mouth or throat can often cause swelling, so your face and neck may look very swollen immediately after the operation. This slowly gets better over a few months.

Whenever possible, your surgeon plans the operation so that if you have scars, they are in less noticeable places. For example, they could be in skin creases on your face or a fold in your neck. Scars are usually red or dark to begin with, but slowly fade over time.

It can take some time to adjust to changes in how you look. It is important to know that support is available.

We have more information about coping with changes in your appearance.

Preparing to go home

Before you leave hospital, you will be given an appointment for a check-up or to plan further treatment, such as radiotherapy. You will also be given appointments if you need to see any other members of the team, such as your SLT, specialist nurse or dietitian.

If it is needed, the ward nurses can arrange for district nurses to visit you at home and look at any wounds and dressings.

Back to Surgery for head and neck cancer

Who might I meet?

A team of specialists will plan your surgery. This will include a surgeon who specialises in your type of cancer.