About Your Surgery
This guide will help you prepare for your surgery for cancer of the nasal cavity and paranasal sinuses at Memorial Sloan Kettering (MSK), and help you understand what to expect during your recovery. Read through this guide at least once before your surgery and then use it as a reference in the days leading up to your surgery. Bring this guide with you every time you come to MSK, including the day of your surgery, so that you and your healthcare team can refer to it throughout your care.
The nasal cavity is a large, air-filled space above and behind your nose in the middle of your face. It has 2 openings called the nostrils, which warm and moisturize the air you breathe in. Your nose and sinuses are covered with a layer of cells that produce mucus and warm the air you breathe. They also affect how your voice sounds when you speak.
Inside the nasal cavity, you have 4 different types of paranasal sinuses. The paranasal sinuses are a group of hollow, air-filled spaces that surround your nasal cavity (see Figure 1). These include:
- Frontal sinuses, which are located above your eyes.
- Ethmoid sinuses, which are located between your eyes.
- Sphenoid sinuses, which are located deep in your nasal cavity, behind your ethmoid sinuses.
- Maxillary sinuses, which are located on the sides of your nose.
Tumors of the nasal cavity and paranasal sinuses are treated with surgery. The goal of the surgery is to remove the entire tumor and a small amount of normal tissue around it. These tumors grow in areas that have many muscles, nerves, and blood vessels and other important structures. If any of these other structures need to be removed, it can impact how you look and perform basic functions. Therefore, another goal of the surgery is to allow you to maintain your appearance and the ability to breathe, chew, talk, and swallow.
Depending on your surgery, your treatment team may include:
- Head and neck surgeon, plastic reconstructive surgeon, and neurosurgeon
- Radiation oncologist
- Speech and swallowing therapist
- Case managers
- Social workers
The different types of surgery are described below. Your doctor will tell you which surgery you are having.
Nasal cavity surgery
Some nasal cavity tumors can be removed with a surgery called wide local excision. This surgery removes the tumor and a small amount of normal tissue around it. A pathologist will examine the tumor to see if it is cancerous.
Tumors that are located on nasal turbinates (long, thin bones located on the inside walls of your nose) can be removed by a surgery called medial maxillectomy.
Tumors that involve the tissue on the outside of your nose may be removed by removing part of your nose or your entire nose.
Surgery for paranasal sinus tumors
The type of surgery for paranasal sinus tumors depends on the where the tumors are located, how big they are, and what other structures are involved.
Tumors that are small, noncancerous, and involve only the ethmoid sinuses are removed with a surgery called external ethmoidectomy.
Tumors that have grown into the maxillary sinus can be removed by a surgery called maxillectomy. The extent of the surgery depends on where the tumor is located and whether it involves nearby tissue and structures. The surgery may require partial or complete removal of:
- Bone around your maxillary sinus
- Bone of the hard palate (roof of your mouth)
- Upper teeth on one side of your mouth
- Part of or your entire orbit (eye socket)
- Part of your cheekbone
- Part of the boney part of your upper nose
If part of your hard palate is removed, there may be an open connection between your nasal cavity and your oral cavity. Your dental surgeon will take impressions before and at the time of your surgery. He or she will place a surgical plate or obturator to close the opening in your palate. This will help with your speech and eating. While in the hospital, your nurse will teach you how to remove the obturator and clean the opening in your palate.
Tumors in the ethmoid, frontal, or sphenoid sinuses are removed by a surgery called craniofacial resection. This surgery involves removing the tumor through incisions on the face and skull to gain access to the tumor. By coming at the tumor from above and below, your surgeons have a better chance of removing the entire tumor while decreasing possible damage to the brain, nerves and other major structures. This surgery is very complex and requires a surgical team consisting of a head and neck surgeon, plastic surgeon, and neurosurgeon.
This surgery uses endoscopes, which are thin, flexible, lighted tubes that are inserted in your nose to reach your nasal cavity and sinuses. This surgery is used for tumors that are small and less involved. It is also used to treat sinus disease.
Removal of lymph nodes
Cancers of the nasal cavity and the paranasal sinuses sometimes spread to lymph nodes in the neck. Lymph nodes are removed through a surgery called neck dissection. Your surgeon will determine if you need a neck dissection based on a medical exam and a computed tomography (CT) or magnetic resonance imaging (MRI) scan. If you have lymph nodes removed, you will have a drainage tube in place for several days. The drainage will be measured, and once the drainage is low enough, the drain will be removed.Back to top
Before Your Surgery
You and your healthcare team will work together to prepare for your surgery.
About Drinking Alcohol
The amount of alcohol you drink can affect you during and after your surgery. It is important that you talk with your healthcare providers about your alcohol intake so that we can plan your care.
- Stopping alcohol suddenly can cause seizures, delirium, and death. If we know you are at risk for these complications, we can prescribe medication to help prevent them.
- If you use alcohol regularly, you may be at risk for other complications during and after surgery. These include bleeding, infections, heart problems, greater dependence on nursing care, and longer hospital stay.
Here are things you can do to prevent problems before your surgery:
- Be honest with your healthcare provider about how much alcohol you drink.
- Try to stop drinking alcohol once your surgery is planned. If you develop a headache, nausea, increased anxiety, or cannot sleep after you stop drinking, tell your doctor right away. These are early signs of alcohol withdrawal and can be treated.
- Tell your healthcare provider if you cannot stop drinking.
- Ask us any questions you have about drinking and surgery. As always, all of your treatment information will be kept confidential.
Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if you aren’t sure.
- I take a blood thinner. Some examples are heparin, warfarin (Coumadin®), clopidogrel (Plavix®), and tinzaparin (Innohep®). There are others, so be sure your doctor knows all the medications you’re taking.
- I take prescription medications, including patches and creams.
- I take any over-the-counter medications, 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 in the past.
- I have allergies, including to latex.
- I am not willing to receive a blood transfusion.
- I drink alcohol.
- I smoke.
- I use recreational drugs.
People who smoke can have breathing problems when they have surgery. Stopping even for a few days before surgery can help. If you want to quit, call our Tobacco Treatment Program at 212-610-0507. You can also ask your nurse about the program.
About Sleep Apnea
Sleep apnea is a common breathing disorder that causes a person to stop breathing for short periods while sleeping. The most common type is obstructive sleep apnea (OSA). This means that the airway becomes completely blocked during sleep, so no air can get through. OSA can cause serious problems when you have surgery. Please tell us if you have sleep apnea or if you think you might have it. If you use a breathing machine (CPAP) for sleep apnea, bring it with you the day of your surgery.
Presurgical Testing (PST)
Before your surgery, you will have an appointment for presurgical testing (PST). The date, time, and location of your PST appointment will be printed on the appointment reminder from your surgeon’s office.
You can eat and take your usual medications the day of your PST appointment. During your appointment, you will meet with a nurse practitioner who works closely with anesthesiology staff (doctors and specialized nurses who will be giving you medication to put you to sleep during your surgery). He or she will review your medical and surgical history with you. You will have tests, including an electrocardiogram (EKG) to check your heart rhythm, a chest x-ray, blood tests, and any other tests necessary to plan your care. Your nurse practitioner may also recommend you see other healthcare providers.
Your nurse practitioner will talk with you about which medications you should take the morning of your surgery. It is very helpful if you bring the following with you to your PST appointment:
- A list of all the medications you are taking.
- Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram, or carotid doppler study.
- The name(s) and telephone number(s) of your doctor(s).
Complete a Health Care Proxy Form
If you haven’t already completed a Health Care Proxy form, we recommend you complete one now. A health care proxy is a legal document that identifies the person who will speak for you if you are unable to communicate for yourself. The person you identify is called your health care agent. If you are interested in completing a Health Care Proxy form, talk with your nurse. If you have completed one already, or if you have any other advance directive, bring it with you to your next appointment.
Do Breathing and Coughing Exercises
Practice taking deep breaths and coughing before your surgery. You will be given an incentive spirometer to help expand your lungs. For more information, please read How to Use Your Incentive Spirometer. If you have any questions, ask your nurse.
Do some form of exercise every day. If it is cold outside, use stairs in your home or go to a mall or shopping market. Walking will help your body get into its best condition for your surgery and make your recovery faster and easier.
Eat a Healthy Diet
You should eat a well-balanced, healthy diet before your surgery. If you need help with your diet, talk to your doctor or nurse about meeting with a dietitian.
Stop Taking Vitamin E
If you take vitamin E, stop taking it 10 days before your surgery, because it can cause bleeding. For more information, read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).
Stop Taking Certain Medications
If you take aspirin, ask your surgeon whether you should continue. Aspirin and medications that contain aspirin can cause bleeding. For more information, read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).
Stop Taking Herbal Remedies and Supplements
Stop taking herbal remedies or supplements 7 days before your surgery. If you take a multivitamin, talk with your doctor or nurse about whether you should continue. For more information, read Herbal Remedies and Cancer Treatment.
Watch a Virtual Tour
This video will give you an idea of what to expect when you come to Memorial Sloan Kettering’s main hospital on the day of your surgery.
Stop Taking Certain Medications
Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil®, Motrin®), and naproxen (Aleve®). These medications can cause bleeding. For more information, read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).
Note the Time of Your Surgery
A clerk from the Admitting Office will call you after 2:00 pm the day before your surgery. He or she will tell you what time you should arrive at the hospital for your surgery. If you are scheduled for surgery on Monday you will be called on the Friday before.
The admitting clerk will tell you where to go on the day of your surgery. This will be either the Surgical Day Hospital (SDH) or the Presurgical Center (PSC). If you do not receive a call by 7:00 pm, please call 212-639-5014.
Both locations are at 1275 York Avenue between East 67th and East 68th streets.
- Surgical Day Hospital (SDH). M elevator to the 2nd Floor
- Presurgical Center (PSC). B elevator to the 6th Floor
Wash yourself with soap and water the night before your surgery.
Go to bed early and get a full night’s sleep.
- Do not eat anything after midnight the night before your surgery. This includes hard candy and gum.
- Between midnight and up until 2 hours before your scheduled arrival time, you may drink a total of 12 ounces of water (see figure).
- Starting 2 hours before your scheduled arrival time, do not eat or drink anything. This includes water.
Take Your Medications
If your doctor or nurse practitioner instructed you to take certain medications the morning of your surgery, take only those medications with a small sip of water. Depending on what medications you take and the surgery you’re having, this may be all, some, or none of your usual morning medications.
Things to Remember
- Do not put on any lotion, cream, deodorant, make-up, powder, or perfume.
- Do not wear any metal objects. Remove all jewelry, including body piercings. The equipment used during your surgery can cause burns if it touches metal.
- Leave valuables, such as credit cards, jewelry, or your checkbook, at home.
- Before you are taken into the operating room, you will need to remove your eyeglasses, hearing aids, dentures, prosthetic device(s), wig, and religious articles, such as a rosary.
- If you wear contact lenses, wear your glasses instead.
- A button-down or loose-fitting top.
- Only the money you may need for a newspaper, bus, taxi, or parking.
- A CD player and CDs or an iPod, if you choose, however someone will need to hold it for you when you go into surgery.
- A case for your personal items, such as eyeglasses, hearing aid(s), dentures, prosthetic device(s), wig, and religious articles such as a rosary.
- Your Health Care Proxy form, if you have completed one.
- This guide. Your healthcare team will use this guide to teach you how to care for yourself after your surgery.
Parking When You Arrive
Parking at MSK is available in the garage on East 66th Street between York and First Avenues. To reach the garage, turn onto East 66th Street from York Avenue. The garage is located about a quarter of a block in from York Avenue, on the right-hand (north) side of the street. There is a pedestrian tunnel that you can walk through that connects the garage to the hospital. If you have questions about prices, call 212-639-2338.
There are also other garages located on East 69th Street between First and Second Avenues, East 67th Street between York and First Avenues, and East 65th Street between First and Second Avenues.
Once You’re in the Hospital
You will be asked to state and spell your name and birth date many times. This is for your safety. Patients with the same or similar names may be having surgery on the same day.
Get Dressed for Surgery
You will be given a hospital gown, robe, and nonskid socks.
Meet With Your Nurse
Your nurse will meet with you before your surgery. Tell him or her the dose of any medications (including patches and creams) you took after midnight and the time you took them. Your nurse will insert an intravenous (IV) line into a vein , usually in your arm or hand. The IV line will be used to give you fluids and anesthesia (medication to make you sleep) during your surgery.
Meet With Your Anesthesiologist
He or she will:
- Review your medical history with you.
- Talk with you about your comfort and safety during your surgery.
- Talk with you about the kind of anesthesia you will receive.
- Answer any questions you may have about your anesthesia.
Prepare for Surgery
Once your nurse has seen you, 1 or 2 visitors can keep you company as you wait for your surgery to begin. When it is time for your surgery, your visitor(s) will be shown to the waiting area. Your visitors should read Information for Family and Friends for the Day of Surgery.
You will walk into the operating room or you can be taken in on a stretcher. A member of the operating room team will help you onto the operating bed. Compression boots will be placed on your lower legs. These gently inflate and deflate to help circulation in your legs.
Your anesthesiologist may also put an epidural catheter (thin, flexible tube) in your spine (back). This will be used to give you pain medication. The medication is delivered into your epidural space, which is the area just outside your spinal cord. It will give you pain relief with fewer side effects, such as nausea, vomiting, and sleepiness. This is similar to what is given to women when they have babies.
The length of your surgery depends on which type of surgery and incisions you have. Your doctor will discuss this with you before your surgery. Once your surgery is finished, your incisions will be closed with staples or stitches.Back to top
After Your Surgery
After your surgery, you will be taken to the Post Anesthesia Recovery Unit (PACU). Your family and friends can visit you in the PACU after your surgery.
While you are in the PACU, a nurse will be monitoring your pulse, blood pressure, and breathing. You will also be wearing boots that squeeze and release your legs to help your circulation after surgery.
You may have one or more of the following:
- A patient-controlled analgesia (PCA) device. PCA uses a computerized pump to deliver pain medication into your IV or epidural space (in your spine). For more information, please read Patient-Controlled Analgesia (PCA).
- A temporary nasogastric (NG) feeding tube to give you nutrition, if necessary.
- Drainage tubes to help drain fluid from your surgical wound.
- A urinary catheter (small, flexible tube) to drain urine from your bladder.
- A facemask and humidifier to keep your airways moist.
While you are in the PACU, you will begin to do the coughing and deep breathing exercises your nurse taught you. These help to prevent pneumonia. You will stay in the PACU for 6 to 12 hours or overnight. You will then be taken to your room on the inpatient unit. You will continue doing the coughing and deep breathing exercises. You will also be helped out of bed to a chair the first day after your surgery.
You will begin to get pain medication by mouth on or about the second day after your surgery. At this time, your PCA will be taken out, if you had one. You will begin to walk around the unit. If you have an NG feeding tube, it will be removed 3 to 5 days after your surgery. You will then begin to eat soft foods.
Your nurse will teach you how to do oral irrigations. These help keep your mouth clean, moist, and comfortable. He or she will also begin to spray your mouth with salt water daily. Your nurse will teach you how to care for your surgical incision(s). If you had a skin graft or reconstruction, you will also learn how to care for your donor site.
Your healthcare team will prepare you for your discharge. Your doctor will give you a prescription for pain medication. Your nurse will teach you the self-care you will need to continue at home. This will involve irrigating your mouth and nose, if necessary. You will also learn exercises to prevent trismus. This is the inability to open your jaw that can develop from scarring or changes in the muscles around the jaw. For more information, please read the resource Preventing Trismus.
How long will I be in the hospital?
Your doctor or nurse will give you an estimate of how long you will be in the hospital.
Will I have pain?
You will have some pain after your surgery. Your doctor and nurse will ask you about your pain often. You will be given medication to treat your pain as needed. If your pain is not relieved, please tell your doctor or nurse.
You will be given a prescription for pain medication before you leave the hospital.
Will I have pain when I am home?
The length of time each person has pain or discomfort varies. Follow the guidelines below to manage your pain.
- Call your doctor if the pain medication prescribed for you doesn’t relieve your pain.
- Do not drive or drink alcohol while you are taking prescription pain medication.
- Pain medication should help you as you resume your normal activities. Take enough medication to make sure you can gradually increase your activities. Pain medication is most effective 30 to 45 minutes after taking it.
- Keep track of when you take your pain medication. It will not be as effective if you allow your pain to increase. Taking it when your pain first begins is more effective than waiting for it to get worse.
As your incisions heal, you will have less pain and need less pain medication. A mild pain reliever, such as acetaminophen (Tylenol) or ibuprofen (Advil), will relieve aches and discomfort.
How can I prevent constipation?
Pain medication may cause constipation, but there are steps you can take to prevent it, including exercising if you can. Walking is an excellent form of exercise. Drink plenty of water.
If these methods do not help, talk with your doctor or nurse. He or she may recommend over-the-counter or prescription medication.
When can I eat?
For the first meal after your surgery, you will be given clear liquids. You will slowly go from a puréed diet to a mechanical soft diet, which you will continue to follow after you are discharged. For more information, read the resource Eating Guide for Puréed and Mechanical Soft Diets.
When will my staples or stitches be removed?
If you stay in the hospital for longer than 1 week, some or all of your staples or stitches will be removed before you leave.
If you stay in the hospital for less than 1 week, your staples or stitches will be removed during your first follow-up appointment with your doctor after your surgery.
If you had radiation therapy to the neck before your surgery, your staples or stitches will stay in place for 2 to 3 weeks.
How do I care for my incisions?
Your doctor or nurse will give you and your caregiver instructions on how to care for your incisions before you leave the hospital.
Call your doctor or nurse immediately if you develop any of the following signs of infection
- A temperature of 100.4° F (38° C) or higher
- Increased discomfort, redness, or both around your incision line
- Skin around your incision line that is hot to the touch
- Drainage or accumulation of fluid from your incision site
When can I shower?
You can shower 24 hours after your drain is removed from your neck. When showering, do not apply direct water pressure to your incision. Rather, allow the soap and water to run over your incision. Gently pat your incision dry with a clean towel.
When can I resume my normal activities?
Your doctor and nurse will tell you when you can resume your normal activities during your first follow-up appointment after your surgery.
When can I resume sexual activity?
Ask your doctor or nurse when you can resume sexual activity.
What type of follow-up care will I receive after I leave the hospital?
Your doctor will discuss your long-term follow-up care with you. Your first appointment after your surgery will be in about 1 week.
Your dental and prosthetic team will follow you after your surgery. If you have an obturator, they will adjust it as needed to help restore your ability to chew, swallow, and speak. If needed, a facial prosthesis will be made to restore your appearance.
If necessary, a speech pathologist from the Speech and Hearing Center will work with you. He or she treats:
- Voice loss
- Swallowing disorders
- Impaired speech
Your speech pathologist will help you regain as much of your speech and swallowing as possible.
If you have any questions or concerns, you can contact your doctor’s office at any time after you have been discharged from the hospital.
When will I get my test results?
The tumor (and lymph nodes, if they were removed) will be examined. The test results are usually ready in 1 week, but can take longer depending on the tests that will be done. Based on the results, you may need further treatment. Your doctor will discuss the results with you during your first follow-up appointment after your surgery.
How can I cope with my feelings?
The diagnosis and treatment of cancer can be a very stressful event. For many, it can be overwhelming at times. Each person who receives a diagnosis of cancer copes in his or her own way. You and your family will almost certainly have ups and downs. Many say it helps to concentrate on the small improvements you will see as the days and weeks go by
Your treatment may change your appearance. This can be especially upsetting. There are many resources to help you and your family during your recovery. Some are here at MSK and others are in your community. Ask your doctor, nurse, or social worker about options. You may also want to speak with a head and neck cancer survivor. This can be arranged through our Patient-to-Patient Support Program. Most people find it very reassuring to see someone who has been through what they are facing.
The Resources for Life After Cancer (RLAC) Program provides support and education for people who are finished with treatment. To learn more about the programs they offer, call 646-888-8106 or go to: www.mskcc.org/experience/living-beyond-cancer/services-survivors.
Depression can occur at any time when you have a serious illness. It is important to recognize the symptoms. Help is available to treat and manage it. Signs of depression are:
- Prolonged feelings of helplessness and sadness
- Inability or difficulty to concentrate and/or carry out normal activities
- Change in mood
- Change in sleep pattern
- Change in appetite
If you have any of these symptoms and they last more than 2 weeks, tell your doctor or nurse.
- A temperature of 100.4° F (38° C) or higher
- Increased discomfort, redness, or both around your incision line
- Skin around your incision line that is hot to the touch
- Drainage or accumulation of fluid from your incision site
- Shortness of breath
- New or increased swelling around your incision
- Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
- Herbal Remedies and Cancer Treatment
- Information for Family and Friends for the Day of Surgery
- How to Use Your Incentive Spirometer
- Patient-Controlled Analgesia (PCA)
- Preventing Trismus
- Eating Guide for Pureed and Mechanical Soft Diets