About Your Mandibulectomy and Fibula Free Flap Reconstruction

This guide will help you get ready for your mandibulectomy (MAN-dih-bul-EK-toh-mee) at Memorial Sloan Kettering (MSK). It will also help you understand what to expect during your recovery.

Use this guide as a source of information in the days leading up to your surgery. Bring it with you every time you come to MSK, including the day of your surgery. You and your healthcare team will refer to it throughout your care.

About Your Surgery

Mandibulectomy and free-flap reconstruction

A mandibulectomy is a surgery to remove all or part of your jaw (mandible). You may have a mandibulectomy if you have a tumor involving your jaw.

Your jaw may be rebuilt using bone from another part of your body (the donor site). The bone may be taken from your fibula, which is the smaller of the 2 bones in your lower leg. An artery, vein, and soft tissue will also be removed with the bone. This is called a fibula free flap (see Figure 1).

Most jaw reconstructions use the leg as the donor site. Some surgeries rebuild your jaw using a bone from a different donor site or don’t use bone in your reconstruction. Your plastic surgeon will talk with you about how they’ll rebuild your jaw.

You may also need a skin graft to cover your donor site. A skin graft is made by taking the top layer of skin from one part of your body and moving it to the surgical site that needs to be covered. If a skin graft is needed, it will be removed from another area, usually the buttock or thigh. Your plastic surgeon will talk with you about the plan for your surgery.

Before your surgery

You’ll meet with your head and neck surgeon, your plastic surgeon, and your dentist. They’ll make sure it’s safe for you to have surgery. They’ll also take computed tomography (CT) scan(s) and x-rays to assess the amount of tumor in your jaw. These will be used to make a model of your new jaw before surgery.

You may also have:

• Photographs taken of your face that will be used during the reconstruction.
• Scans that use special dye (angiograms), such as magnetic resonance (MR) or CT, of your donor site to evaluate the blood vessels in your donor site.

During your surgery

Your surgery will be done by 3 surgical teams: a head and neck team, a plastics team, and dental team.

Your head and neck surgeon will remove the tumor from your jaw and the soft tissue around it. At the same time, your plastic surgeon will remove the bone, tissue, and skin from your donor site. This will take 3 to 4 hours. Your head and neck surgeon will send the tumor and surrounding tissue to the Pathology Department for testing. Once your head and neck surgeon has completed their part of the surgery, the reconstruction can be done.

Your plastic surgeon will transfer the tissue from your donor site to reconstruct your jaw. The bone from your donor site will be shaped to match, as closely as possible, the piece of your jaw that was removed. Once this is complete, your plastic surgeon will attach the artery and vein from the donor site to an artery and vein in your head and neck area. This is done under a microscope. They’ll fix the new jaw bone in place with plates and screws and cover it with the soft tissue. Your plastic surgeon will then place stitches in your face and neck to connect them to the soft tissue. The reconstructive part of the surgery usually takes 6 to 8 hours.

During your reconstruction, your dentist may place temporary arch bars and rubber bands in your mouth (see Figure 2). These will keep your teeth and jaw correctly aligned. Your dentist will remove the rubber bands 5 to 7 days after your surgery and the arch bars 14 days after your surgery.

Mandibulectomy can cause swelling and difficulty breathing. To prevent this, a tracheostomy tube will be put into your trachea (windpipe) through an incision (surgical cut) in your neck while you’re still asleep. This will keep your airway open and make it easier for you to breathe.

Your surgery will also cause facial swelling, which will affect the way you eat, drink, and speak. This will slowly decrease as the area heals over several months. To help you get your nutrition, a nasogastric (NG) tube will be put through your nose into your stomach during your surgery. The NG tube will give you nutrients for the first 1 to 2 weeks while your jaw is healing. After your jaw has healed, the NG tube will be removed and you’ll gradually start to eat and drink again. Your doctor will decide when it’s safe to do so. How long this takes varies from person to person. It also depends on the extent of your surgery. Tell your healthcare team if you have any questions or concerns.

Getting Ready for Your Surgery

This section will help you get ready for your surgery. Read it when your surgery is scheduled. Refer to it as your surgery gets closer. It has important information about what to do to get ready.

As you read through this section, write down questions to ask your healthcare provider.

Getting ready for surgery

You and your care team will work together to get ready for your surgery. Help us keep you safe by telling us if any of these things apply to you, even if you’re not sure.

• I take a anticoagulant (blood thinner), such as:
  These are examples of medications. There are others.
  
  Be sure your healthcare provider knows all the medications you’re taking.
  • Aspirin
  • Heparin
  • Warfarin (Jantoven®, Coumadin®)
  • Clopidogrel (Plavix®)
  • Enoxaparin (Lovenox®)
  • Dabigatran (Pradaxa®)
  • Apixaban (Eliquis®)
  • Rivaroxaban (Xarelto®)
• I take an SGLT2 inhibitor, such as:
  • Canagliflozin (Invokana®)
  • Dapagliflozin (Farxiga®)
  • Empagliflozin (Jardiance®)
  • Ertugliflozin (Steglatro®)
• I take prescription medications (medications my healthcare provider prescribes), including patches and creams.
• I take over-the-counter medications (medications I buy without a prescription), including patches and creams.
• I take dietary supplements, such as herbs, vitamins, minerals, or natural or home remedies.
• I have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device.
• I have sleep apnea.
• I have had a problem with anesthesia (medication to make me sleep during surgery) in the past.
• I’m allergic to certain medication(s) or materials, including latex.
• I’m not willing to receive a blood transfusion.
• I drink alcohol.
• I smoke or use an electronic smoking device, such as a vape pen or e-cigarette.
• I use recreational drugs, such as marijuana.

About drinking alcohol

It’s important to talk with your healthcare providers about how much alcohol you drink. This will help us plan your care.

If you drink alcohol regularly, you may be at risk for problems during and after your surgery. These include bleeding, infections, heart problems, and a longer hospital stay.

If you drink alcohol regularly and stop suddenly, it can cause seizures, delirium, and death. If we know you’re at risk for these problems, we can prescribe medications to help prevent them.

Here are things you can do before your surgery to keep from having problems.

• Be honest with your healthcare providers about how much alcohol you drink.
• Try to stop drinking alcohol once your surgery is planned. Tell your healthcare provider right away if you:
  • Get a headache.
  • Feel nauseous (like you’re going to throw up).
  • Feel more anxious (nervous or worried) than usual.
  • Cannot sleep.
  These are early signs of alcohol withdrawal and can be treated.
• Tell your healthcare provider if you cannot stop drinking.
• Ask your healthcare provider questions about drinking and surgery. All your medical information will be kept private, as always.

About smoking

If you smoke, you can have breathing problems when you have surgery. Stopping for even a few days before your surgery can help.

Your healthcare provider will refer you to our Tobacco Treatment Program if you smoke. You can also reach the program by calling 212-610-0507.

About sleep apnea

Sleep apnea is a common breathing problem. If you have sleep apnea, you stop breathing for short lengths of time while you’re asleep. The most common type is obstructive sleep apnea (OSA). With OSA, your airway becomes fully blocked during sleep.

OSA can cause serious problems during and after surgery. Tell us if you have or think you might have sleep apnea. If you use a breathing device, such as a CPAP machine, bring it on the day of your surgery.

Using MyMSK

MyMSK (my.mskcc.org) is your MSK patient portal. You can use it to send and read messages from your care team, view your test results, see your appointment dates and times, and more. You can also invite your caregiver to make their own account so they can see information about your care.

If you do not have a MyMSK account, you can sign up at my.mskcc.org. You can get an enrollment ID by calling 646-227-2593 or your doctor’s office.

Watch How to Enroll in MyMSK: Memorial Sloan Kettering's Patient Portal to learn more. You can also contact the MyMSK Help Desk by emailing [email protected] or calling 800-248-0593.

Within 30 days of your surgery

Presurgical Testing (PST)

You’ll have a PST appointment before your surgery. You’ll get a reminder from your surgeon’s office with the appointment date, time, and location.

You can eat and take your usual medications the day of your PST appointment.

It’s helpful to bring these things to your appointment:

• A list of all the medications you’re taking, including prescription and over-the-counter medications, patches, and creams.
• Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram, or carotid doppler study.
• The names and telephone numbers of your healthcare providers.

You’ll meet with a nurse practitioner (NP) during your PST appointment. They work closely with anesthesiology staff (specialized healthcare providers who will give you anesthesia during your surgery). Your NP will review your medical and surgical history with you. You may have tests to plan your care, such as:

• An electrocardiogram (EKG) to check your heart rhythm.
• A chest X-ray.
• Blood tests.

Your NP may recommend you see other healthcare providers. They’ll also talk with you about which medications to take the morning of your surgery.

Identify your caregiver

Your caregiver plays an important role in your care. Before your surgery, you and your caregiver will learn about your surgery from your healthcare providers. After your surgery, your caregiver will take you home when you’re discharged. They’ll also help you care for yourself at home.

For caregivers

‌  Caring for a person going through cancer treatment comes with many responsibilities. We offer resources and support to help you manage them. Visit www.msk.org/caregivers or read A Guide for Caregivers to learn more.

Fill out a Health Care Proxy form

If you have not already filled out a Health Care Proxy form, we recommend you do now. If you already filled one out or have any other advance directives, bring them to your next appointment.

A health care proxy is a legal document. It says who will speak for you if you cannot communicate for yourself. This person is called your health care agent.

• To learn about health care proxies and other advance directives, read Advance Care Planning.
• To learn about being a health care agent, read How to Be a Health Care Agent.

Talk with a member of your care team if you have questions about filling out a Health Care Proxy form.

Do physical activity

Doing physical activity will help your body get into its best condition for your surgery. It will also make your recovery faster and easier.

Try to do physical activity every day. Any activity that makes your heart beat faster, such as walking, swimming, or biking, is a good choice. If it’s cold outside, use stairs in your home or go to a mall or shopping center.

Follow a healthy diet

Follow a well-balanced, healthy diet before your surgery. If you need help with your diet, talk with your healthcare provider about meeting with a clinical dietitian nutritionist.

Buy a 4% chlorhexidine gluconate (CHG) solution antiseptic skin cleanser, such as Hibiclens®

4% CHG solution is a skin cleanser that kills germs for 24 hours after you use it. Showering with it before your surgery will help lower your risk of infection after surgery. You can buy a 4% CHG solution antiseptic skin cleanser at your local pharmacy without a prescription.

7 days before your surgery

Follow your healthcare provider’s instructions for taking aspirin

Aspirin can cause bleeding. If you take aspirin or a medication that has aspirin, you may need to change your dose or stop taking it 7 days before your surgery. Follow your healthcare provider’s instructions. Do not stop taking aspirin unless they tell you to.

To learn more, read Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E.

Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements

Vitamin E, multivitamins, herbal remedies, and other dietary supplements can cause bleeding. Stop taking them 7 days before your surgery. If your healthcare provider gives you other instructions, follow those instead.

To learn more, read Herbal Remedies and Cancer Treatment.

2 days before your surgery

Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs, such as ibuprofen (Advil^® and Motrin^®) and naproxen (Aleve^®), can cause bleeding. Stop taking them 2 days before your surgery. If your healthcare provider gives you other instructions, follow those instead.

To learn more, read Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E.

1 day before your surgery

Note the time of your surgery

A staff member will call you after 2 p.m. the day before your surgery. If your surgery is scheduled for a Monday, they’ll call you the Friday before. If you do not get a call by 7 p.m., call 212-639-5014.

The staff member will tell you what time to get to the hospital for your surgery. They’ll also remind you where to go.

This will be the following location:

Presurgical Center (PSC) on the 6^th floor
1275 York Avenue (between East 67^th and East 68^th Streets)
New York, NY 10065
Take the B elevator to the 6^th floor.

Shower with a 4% CHG solution antiseptic skin cleanser, such as Hibiclens

Shower with a 4% CHG solution antiseptic skin cleanser before you go to bed the night before your surgery.

Do not use any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.

Instructions for eating before your surgery

‌  
Do not eat anything after midnight (12 a.m.) the night before your surgery. This includes hard candy and gum.



 

The morning of your surgery

Instructions for drinking before your surgery

‌  You can drink a total of 12 ounces of water between midnight (12 a.m.) and 2 hours before your scheduled arrival time. Do not drink anything else.

Do not drink anything starting 2 hours before your scheduled arrival time. This includes water.

Take your medications as instructed

A member of your care team will tell you which medications to take the morning of your surgery. Take only those medications with a sip of water. Depending on what medications you take, this may be all, some, or none of your usual morning medications.

Shower with a 4% CHG solution antiseptic skin cleanser, such as Hibiclens

Shower with a 4% CHG solution antiseptic skin cleanser before you leave for the hospital. Use it the same way you did the night before.

Do not put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.

Things to remember

• Wear something comfortable and loose-fitting.
• If you wear contact lenses, wear your glasses instead. Wearing contact lenses during surgery can damage your eyes.
• Don’t wear any metal objects. Remove all jewelry, including body piercings. The tools used during your surgery can cause burns if they touch metal.
• Leave valuable items at home.
• If you’re menstruating (have your monthly period), use a sanitary pad, not a tampon. You’ll get disposable underwear, as well as a pad if needed.

What to bring

• Your breathing device for sleep apnea (such as your CPAP device), if you have one.
• Your Health Care Proxy form and other advance directives, if you completed them.
• Your cell phone and charger.
• Only the money you may want for small purchases (such as a newspaper).
• A case for your personal items (such as eyeglasses, hearing aid(s), dentures, prosthetic device(s), wig, and religious articles), if you have one.
• This guide. Your healthcare team will use it to teach you how to care for yourself after surgery.

Where to park

MSK’s parking garage is on East 66^th Street between York and 1^st avenues. If you have questions about prices, call 212-639-2338.

To get to the garage, turn onto East 66^th Street from York Avenue. The garage is about a quarter of a block in from York Avenue. It’s on the right (north) side of the street. There’s a tunnel you can walk through that connects the garage to the hospital.

There are other parking garages on:

• East 69th Street between 1st and 2nd avenues.
• East 67th Street between York and 1st avenues.
• East 65th Street between 1st and 2nd avenues.

Once you’re in the hospital

When you get to the hospital, take the B elevator to the 6^th floor. Check in at the desk in the PSC waiting room.

You’ll be asked to say and spell your name and birth date many times. This is for your safety. People with the same or a similar name may be having surgery on the same day.

When it’s time to change for surgery, you’ll get a hospital gown, robe, and nonskid socks to wear.

Meet with a nurse

You’ll meet with a nurse before surgery. Tell them the dose of any medications you took after midnight (12 a.m.) and the time you took them. Make sure to include prescription and over-the-counter medications, patches, and creams.

Your nurse may place an intravenous (IV) line in one of your veins, usually in your arm or hand. If your nurse does not place the IV, your anesthesiologist will do it in the operating room.

Meet with an anesthesiologist

You’ll also meet with an anesthesiologist before surgery. They will:

• Review your medical history with you.
• Ask you if you’ve had any problems with anesthesia in the past, such as nausea or pain.
• Talk with you about your comfort and safety during your surgery.
• Talk with you about the kind of anesthesia you’ll get.
• Answer your questions about your anesthesia.

Get ready for surgery

When it’s time for your surgery, you’ll take off your eyeglasses, hearing aids, dentures, prosthetic devices, wig, and religious articles.

You’ll either walk into the operating room or a staff member will bring you there on a stretcher. A member of the operating room team will help you onto the operating bed. They’ll put compression boots on your lower legs. These gently inflate and deflate to help blood flow in your legs.

Once you’re comfortable, your anesthesiologist will give you anesthesia through your IV line and you’ll fall asleep. You’ll also get fluids through your IV line during and after your surgery.

Recovering after your surgery

This section will help you know what to expect after your surgery. You’ll learn how to safely recover from your surgery both in the hospital and at home.

As you read through this section, write down questions to ask your healthcare provider.

What to expect

When you wake up after your surgery, you’ll be in the Post Anesthesia Recovery Unit (PACU). You’ll stay in the PACU overnight so your nurses can closely monitor your flap for 12 hours after your surgery.

You may not be able to open your mouth because of the rubber bands. You won’t be able to talk because a tracheostomy tube will be in your windpipe. Your nurses will ask you “yes” or “no” questions about how you feel. You’ll be given an iPad to help you answer these questions. A dry erase board will also be available for you to write down what you need.

You’ll have tubes, drains, catheters (thin, flexible tubes), and other medical devices, including:

• A humidifier collar placed over your tracheostomy tube. It will provide moist air to your lungs.
• An IV line through which you’ll receive fluids, antibiotics, pain medication, and anticoagulants to prevent blood clots.
• A urinary (Foley®) catheter to drain urine from your bladder. It will be removed 2 or 3 days after your surgery.
• Drains (small tubes) in your neck and your donor site to let fluid drain. They’ll be removed when the drainage is less than 1 ounce in 24 hours.
• A feeding tube that goes through your nose into your stomach. This is called a nasogastric (NG) tube. You’ll get high-protein liquid feedings and some of your medications through this tube. You won’t be able to eat and drink until the swelling from the surgery goes down.
• A cast, splint, sling, or wound VAC (a special dressing that applies suction to your wound to improve healing) may be placed on the donor site. It will be removed 5 to 7 days after your surgery. If you have a cast, splint, or sling, a dressing will be placed underneath it.
• Compression boots on 1 or both legs to help circulate blood to prevent blood clots. If your donor site was on one of your legs, that leg won’t have a boot on it.

For the first week after your surgery, your doctors and nurses will monitor the blood supply to your jaw and nearby tissue. They’ll use a machine called a Doppler^®. It’s noisy, but painless. It will be used every hour for the first 2 days after your surgery. After 2 days, your doctor will decide how often the Doppler will be used. Your doctor and nurse will check that the flap feels warm to touch and appears similar in color to your surrounding skin.

It’s very important to avoid pressure to your newly reconstructed jaw. You won’t be able to use a pillow while in the hospital.

Your nurses and nursing assistants will care for your drains, tubes, and tracheostomy. As you start to feel better, they’ll teach you how to do some of this care yourself.

Suctioning the tracheostomy tube

When you cough and breathe deeply, mucus from your lungs and the back of your throat will come through your tracheostomy tube. This mucus will have to be suctioned. Your nurse will do this often during the first few days after your surgery. They’ll then teach you how to do it yourself. For more information, read the resource Caring for Your Tracheostomy.

Once the swelling has decreased, you’ll have less mucus and the opening of the tracheostomy tube will be capped so you can breathe through your nose. If you’re able to breathe normally and cough up mucus comfortably with the tracheostomy tube capped, the tracheostomy tube will be removed. If you go home with the tracheostomy tube in place, your nurse will teach you how to care for it. We’ll order a portable suctioning machine for you.

Nasogastric (NG) tube feedings

Your nurse will give you tube feedings through your NG tube for the first 1 to 2 weeks. Once the swelling starts to go down, your NG tube will be removed and you’ll be given clear liquids to drink and then soft foods to eat. How quickly this happens will depend on your healing.

Caring for your donor site

The leg is the most common donor site for jaw reconstructions. If your jaw is being rebuilt using tissue from a different donor site, your nurse will tell you how to care for it.

You’ll stay in bed for the first 2 days after your surgery to help your leg heal. After 2 days, you can get out of bed and sit in a chair with your leg raised. It’s important to keep your leg raised as much as possible for the first 3 weeks. This will help with the swelling and promote healing. Your doctor will tell you when you can start walking again. You’ll need to use a walker at first, but you’ll be able to walk on your own over time.

During your hospital stay, your nurse will tell you how to care for your leg and skin graft, if you have one. When it’s time to go home, they’ll give you specific instructions if you still need them.

Irrigating your mouth

Starting 5 days after your surgery or as soon as your rubber bands are removed, your nurse will start irrigating (wetting) your mouth with salt water and baking soda. This helps keep your mouth clean and moist.

You’ll keep irrigating your mouth after you leave the hospital. Do this 3 to 4 times a day, in the morning, after meals, and at bedtime. Your nurse will give you an irrigation kit to take home with you.

Preventing trismus (lockjaw)

Trismus is when you have trouble opening your mouth. It can develop after surgery or radiation therapy. It’s caused by soft tissue scarring or changes in the muscles around the jaw. You must do jaw exercises to prevent trismus. As soon as you’re ready, your doctor or nurse will tell you how often to do them.

For more information, read the resource Managing Trismus After Treatment for Head and Neck Cancer.

Following a puréed diet

Most people will need to follow a puréed diet after they’re discharged. This means that foods have to be put through a blender or food processor. Your dietitian will go over this diet with you. Your diet will progress as healing takes place.

For more information, read Eating Guide for Puréed Food and Mechanical Soft Food Diets.

Commonly asked questions

How long will I be in the hospital?

The length of time you are in hospital depends on the extent of the surgery and how quickly you recover. On average, most people stay for 10 to 14 days.

Will I have pain?

You’ll have some pain after your surgery. Your healthcare providers will ask you about your pain often and give you medication as needed. If your pain isn’t relieved, tell one of your healthcare providers.

You’ll get a prescription for pain medication before you leave the hospital. Talk with your healthcare provider about possible side effects and when to start switching to over-the-counter pain medications.

Will I have pain when I’m home?

The length of time each person has pain or discomfort varies.

Follow these guidelines to help manage your pain at home.

• Take your medications as directed and as needed.
• Call your healthcare provider if the medication prescribed for you does not help your pain.
• Do not drive or drink alcohol while you’re taking prescription pain medication. Some prescription pain medications can make you drowsy (very sleepy). Alcohol can make the drowsiness worse.
• You’ll have less pain and need less pain medication as your incision heals. An over-the-counter pain reliever will help with aches and discomfort. Acetaminophen (Tylenol®) and ibuprofen (Advil® or Motrin®) are examples of over-the-counter pain relievers.
  • Follow your healthcare provider’s instructions for stopping your prescription pain medication.
  • Do not take too much of any medication. Follow the instructions on the label or from your healthcare provider.
  • Read the labels on all the medications you’re taking. This is very important if you’re taking acetaminophen. Acetaminophen is an ingredient in many over-the-counter and prescription medications. Taking too much can harm your liver. Do not take more than one medication that has acetaminophen without talking with a member of your care team.
• Pain medication should help you get back to your normal activities. Take enough medication to do your activities and exercises comfortably. You may have a little more pain as you start to be more active.
• Keep track of when you take your pain medication. It works best 30 to 45 minutes after you take it. Taking it when you first have pain is better than waiting for the pain to get worse.

What’s my Recovery Tracker?

We want to know how you’re feeling after you leave the hospital. To help us care for you, we’ll send questions to your MyMSK account. We’ll send them every day for 10 days after you’re discharged. These questions are known as your Recovery Tracker.

Fill out your Recovery Tracker every day before midnight (12 a.m.). It only takes 2 to 3 minutes to complete. Your answers to these questions will help us understand how you’re feeling and what you need.

Based on your answers, we may reach out to you for more information. Sometimes, we may ask you to call your surgeon’s office. You can always contact your surgeon’s office if you have any questions.

To learn more, read About Your Recovery Tracker.

How can I prevent constipation?

Some prescription pain medications (such as opioids) may cause constipation (having fewer bowel movements than usual). There are steps you can take to prevent constipation, including exercising if you can. Walking is an excellent form of exercise. Drink plenty of water.

If these methods don’t help, talk with your doctor or nurse. They may recommend over-the-counter or prescription medication.

When will my stitches be removed?

If you have stitches inside of your mouth, they’ll dissolve on their own and don’t need to be removed.

Your doctor will remove the stitches in your face and neck about 2 weeks after your surgery. If you’ve had radiation therapy to your face or neck, the stitches may stay in place for 3 to 4 weeks.

How do I care for my incisions?

• Don’t apply direct heat or cold to your incisions. They may be numb and you can easily burn yourself.
• Don’t use hot water bottles or heating pads. You should also avoid saunas and steam rooms.
• Don’t shave over your incisions while your stitches are in place. If you shave your face or neck, use an electric shaver.
• Don’t use perfume, cologne, after-shave, or perfumed moisturizers until your incisions are completely healed.
• Avoid sun exposure. Once your head and neck surgeon determines that your incisions are completely healed, you can use a PABA-free sunscreen with an SPF of 30 or higher on your incisions.

When can I shower?

Your doctor or nurse will give you instructions on when you can shower.

When can I swim?

You can swim when you’ve been told that your incisions are completely healed. Avoid hot tubs, baths and swimming pools until then.

When can I start doing my usual activities?

Your doctor or nurse will tell you when you can start doing your usual activities again. This depends on the extent of your surgery and how quickly you recover.

When is it safe for me to drive?

Your doctor or nurse will tell you when you can start driving again. This will depend on the extent of your surgery and how quickly you recover.

When can I exercise?

Don’t do strenuous exercise or lift any objects heavier than 5 pounds (2.3 kilograms) for 6 weeks. Talk with your doctor or nurse before resuming activities such as lifting and exercise.

When can I resume sexual activity?

Your doctor will tell you when you can start sexual activity again.

What type of follow-up care will I receive after I leave the hospital?

Both your head and neck surgeon and your plastic surgeon will need to see you after discharge. Call each surgeon’s office to schedule your follow-up appointment. Write down any questions you have and bring them with you.

When will I get my test results?

Your test results should be available 10 to 14 days after surgery. Your doctor will discuss them with you at your first follow-up appointment after your surgery.

How can I cope with my feelings?

After surgery for a serious illness, you may have new and upsetting feelings. Many people say they felt weepy, sad, worried, nervous, irritable, and angry at one time or another. You may find that you can’t control some of these feelings. If this happens, it’s a good idea to seek emotional support. Your healthcare provider can refer you to MSK’s Counseling Center. You can also reach them by calling 646-888-0200.

The first step in coping is to talk about how you feel. Family and friends can help. Your healthcare providers can reassure, support, and guide you. It’s always a good idea to let us know how you, your family, and your friends are feeling emotionally. Many resources are available to you and your family. Whether you’re in the hospital or at home, we’re here to help you and your family and friends handle the emotional aspects of your illness.

When to Call Your Healthcare Provider

Call your head and neck surgeon right away if:

• You have a fever of 100.5 °F (38 °C) or higher.
• You have more discomfort, redness, or both around your incision line.
• The skin around your incision line is hot to the touch.
• There’s fluid draining or building up around your incision site.
• You have shortness of breath.
• Your incision is starting to swell or the swelling around your incision is getting worse.

Contact information

Monday through Friday from 9:00 a.m. to 5:00 p.m., call your healthcare provider’s office.

After 5:00 p.m., during the weekend, and on holidays, call 212-639-2000 and ask to speak to the person on call for your healthcare provider.

Support services

This section has a list of support services. They may help you as you get ready for your surgery and recover after your surgery.

As you read through this section, write down questions to ask your healthcare provider.

MSK support services

Visit the cancer types section of MSK’s website at www.msk.org/types for more information.

Admitting Office
212-639-7606
Call if you have questions about your hospital admission, such as asking for a private room.

Anesthesia
212-639-6840
Call if you have questions about anesthesia.

Blood Donor Room
212-639-7643
Call for information if you’re interested in donating blood or platelets.

Bobst International Center
888-675-7722
We welcome patients from around the world and offer many services to help. If you’re an international patient, call for help arranging your care.

Caregivers Clinic
www.msk.org/caregivers
646-888-0200
At MSK, the Caregivers Clinic provides support specifically for caregivers who are having difficulty coping with the demands of being a caregiver. For more information, call Dr. Allison Applebaum’s office at 646-888-0200.

Counseling Center
www.msk.org/counseling
646-888-0200
Many people find that counseling helps them. Our Counseling Center offers counseling for individuals, couples, families, and groups. We can also prescribe medications to help if you feel anxious or depressed. To make an appointment, ask your healthcare provider for a referral or call the number above.

Food Pantry Program
646-888-8055
We give food to people in need during their cancer treatment. For more information, talk with your healthcare provider or call the number above.

Integrative Medicine Service
www.msk.org/integrativemedicine
Our Integrative Medicine Service offers many services to complement (go along with) traditional medical care, including music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy. To schedule an appointment for these services, call 646-449-1010.

You can also schedule a consultation with a healthcare provider in the Integrative Medicine Service. They will work with you to come up with a plan for creating a healthy lifestyle and managing side effects. To make an appointment, call 646-608-8550.

MSK Library
library.mskcc.org
212-639-7439
You can visit our library website or call to talk with the library reference staff. They can help you find more information about a type of cancer. You can also visit the library’s Patient and Health Care Consumer Education Guide.

Nutrition Services
www.msk.org/nutrition
212-639-7312
Our Nutrition Service offers nutritional counseling with one of our clinical dietitian nutritionists. Your clinical dietitian nutritionist will talk with you about your eating habits. They can also give advice on what to eat during and after treatment. To make an appointment, ask a member of your care team for a referral or call the number above.

Patient and Caregiver Education
www.msk.org/pe
Visit our Patient and Caregiver Education website to search for educational resources, videos, and online programs.

Patient Billing
646-227-3378
Call if you have questions about preauthorization with your insurance company. This is also called preapproval.

Patient Representative Office
212-639-7202
Call if you have questions about the Health Care Proxy form or concerns about your care.

Perioperative Nurse Liaison
212-639-5935
Call if you have questions about MSK releasing any information while you’re having surgery.

Private Duty Nurses and Companions
917-862-6373
You can request private nurses or companions to care for you in the hospital and at home. Call for more information.

Rehabilitation Services
www.msk.org/rehabilitation
Cancers and cancer treatments can make your body feel weak, stiff, or tight. Some can cause lymphedema (swelling). Our physiatrists (rehabilitation medicine doctors), occupational therapists (OTs), and physical therapists (PTs) can help you get back to your usual activities.

• Rehabilitation medicine doctors diagnose and treat problems that affect how you move and do activities. They can design and help coordinate your rehabilitation therapy program, either at MSK or somewhere closer to home. To learn more, call Rehabilitation Medicine (Physiatry) at 646-888-1929.
• An OT can help if you’re having trouble doing usual daily activities. For example, they can recommend tools to help make daily tasks easier. A PT can teach you exercises to help build strength and flexibility. To learn more, call Rehabilitation Therapy at 646-888-1900.

Resources for Life After Cancer (RLAC) Program
646-888-8106
At MSK, care does not end after your treatment. The RLAC Program is for patients and their families who have finished treatment.

This program has many services. We offer seminars, workshops, support groups, and counseling on life after treatment. We can also help with insurance and employment issues.

Sexual Health Programs
Cancer and cancer treatments can affect your sexual health, fertility, or both. MSK’s sexual health programs can help you before, during, or after your treatment.

• Our Female Sexual Medicine and Women’s Health Program can help with sexual health problems, such as premature menopause or fertility issues. For more information or to make an appointment, call 646-888-5076.
• Our Male Sexual and Reproductive Medicine Program can help with sexual health problems, such as erectile dysfunction (ED). For more information or to make an appointment, call 646-888-6024.

Social Work
www.msk.org/socialwork
212-639-7020
Social workers help patients, families, and friends deal with common issues for people who have cancer. They provide individual counseling and support groups throughout your treatment. They can help you communicate with children and other family members.

Our social workers can also help refer you to community agencies and programs. They also have information about financial resources, if you’re having trouble paying your bills.

Spiritual Care
212-639-5982
Our chaplains (spiritual counselors) are available to listen, help support family members, and pray. They can contact community clergy or faith groups, or simply be a comforting companion and a spiritual presence. Anyone can ask for spiritual support. You do not have to have a religious affiliation (connection to a religion).

MSK’s interfaith chapel is located near Memorial Hospital’s main lobby. It’s open 24 hours a day. If you have an emergency, call 212-639-2000. Ask for the chaplain on call.

Tobacco Treatment Program
www.msk.org/tobacco
212-610-0507
MSK has specialists who can help you quit smoking. For more information about our Tobacco Treatment Program, call 212-610-0507. You can also ask your nurse about the program.

Virtual Programs
www.msk.org/vp
Our Virtual Programs offer online education and support for patients and caregivers. These are live sessions where you can talk or just listen. You can learn about your diagnosis, what to expect during treatment, and how to prepare for your cancer care.

Sessions are private, free, and led by experts. Visit our website for more information about Virtual Programs or to register.

External support services

Access-A-Ride
web.mta.info/nyct/paratran/guide.htm
877-337-2017
In New York City, the MTA offers a shared ride, door-to-door service for people with disabilities who can’t take the public bus or subway.

Air Charity Network
www.aircharitynetwork.org
877-621-7177
Provides travel to treatment centers.

American Cancer Society (ACS)
www.cancer.org
800-ACS-2345 (800-227-2345)
Offers a variety of information and services, including Hope Lodge, a free place for patients and caregivers to stay during cancer treatment.

Cancer and Careers
www.cancerandcareers.org
A resource for education, tools, and events for employees with cancer.

CancerCare
www.cancercare.org
800-813-4673
275 Seventh Avenue (Between West 25^th & 26^th Streets)
New York, NY 10001
Provides counseling, support groups, educational workshops, publications, and financial assistance.

Cancer Support Community
www.cancersupportcommunity.org
Provides support and education to people affected by cancer.

Caregiver Action Network
www.caregiveraction.org
800-896-3650
Provides education and support for people who care for loved ones with a chronic illness or disability.

Corporate Angel Network
www.corpangelnetwork.org
866-328-1313
Offers free travel to treatment across the country using empty seats on corporate jets.

Gilda’s Club
www.gildasclubnyc.org
212-647-9700
A place where men, women, and children living with cancer find social and emotional support through networking, workshops, lectures, and social activities.

Good Days
www.mygooddays.org
877-968-7233
Offers financial assistance to pay for copayments during treatment. Patients must have medical insurance, meet the income criteria, and be prescribed medication that’s part of the Good Days formulary.

Healthwell Foundation
www.healthwellfoundation.org
800-675-8416
Provides financial assistance to cover copayments, health care premiums, and deductibles for certain medications and therapies.

Joe’s House
www.joeshouse.org
877-563-7468
Provides a list of places to stay near treatment centers for people with cancer and their families.

LGBT Cancer Project
http://lgbtcancer.com/
Provides support and advocacy for the LGBT community, including online support groups and a database of LGBT-friendly clinical trials.

LIVESTRONG Fertility
www.livestrong.org/we-can-help/fertility-services
855-744-7777
Provides reproductive information and support to cancer patients and survivors whose medical treatments have risks associated with infertility.

Look Good Feel Better Program
lookgoodfeelbetter.org
800-395-LOOK (800-395-5665)
This program offers workshops to learn things you can do to help you feel better about your appearance. For more information or to sign up for a workshop, call the number above or visit the program’s website.

National Cancer Institute
www.cancer.gov
800-4-CANCER (800-422-6237)

National Cancer Legal Services Network
www.nclsn.org
Free cancer legal advocacy program.

National LGBT Cancer Network
www.cancer-network.org
Provides education, training, and advocacy for LGBT cancer survivors and those at risk.

Needy Meds
www.needymeds.org
Lists Patient Assistance Programs for brand and generic name medications.

NYRx
www.health.ny.gov/health_care/medicaid/program/pharmacy.htm
Provides prescription benefits to eligible employees and retirees of public sector employers in New York State.

Partnership for Prescription Assistance
www.pparx.org
888-477-2669
Helps qualifying patients without prescription drug coverage get free or low-cost medications.

Patient Access Network Foundation
www.panfoundation.org
866-316-7263
Provides assistance with copayments for patients with insurance.

Patient Advocate Foundation
www.patientadvocate.org
800-532-5274
Provides access to care, financial assistance, insurance assistance, job retention assistance, and access to the national underinsured resource directory.

RxHope
www.rxhope.com
877-267-0517
Provides assistance to help people get medications that they have trouble affording.

Educational resources

This section lists the educational resources mentioned in this guide. They will help you get ready for your surgery and recover after your surgery.

As you read through these resources, write down questions to ask your healthcare provider.

• Caring for Your Tracheostomy
• Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E
• Eating Guide for Puréed Food and Mechanical Soft Food Diets
• Herbal Remedies and Cancer Treatment
• Managing Trismus After Treatment for Head and Neck Cancer
• About Your Recovery Tracker