HOME CARE INSTRUCTIONS FOLLOWING HEAD & NECK SURGERY (EXTENDED)

DIET:

- Patients who have received general anesthesia may experience nausea and occasionally, vomiting.  It is therefore preferable to eat a bland light meal or a liquid diet on the first day after the surgery.  Regular diet may be resumed the next day. Also, pain pills may cause nausea if taken on an empty stomach. It is preferable to take those pills with a piece of toast or some food.

ACTIVITY AND WOUND CARE:

- Elevate the head as much as possible. Sit in a recliner or use two or three pillows when sleeping. Head elevation reduces bruising and swelling. Occasionally, you may notice that the bruises or swelling have migrated to other places (usually lower regions). You may have a dressing or your wound may be exposed.

FOR EXPOSED WOUNDS:

- If your wound is not covered with a dressing keep the exposed wound dry.  Avoid showers for the first 48 hours.  After this you may shower, but avoid shower water directly hitting the surgical wound.  If you do get the wound wet, pat dry the area immediately after your shower.  If you do not have a tracheostomy, you may take a bath with lukewarm (not hot) water.  If accidentally, water reaches the wound, dry it immediately with a clean towel.  Make sure you have someone with you in the house in case you feel drowsy or fainty from taking pain killers. Clean the wound once a day.  This is best done with a cotton swab dipped in 3% hydrogen peroxide.  If you have been instructed to use a topical antibiotic and have not received a prescription for antibiotic ointment, use over-the-counter triple antibiotic such as neosporin.  Apply a scanty amount on the suture line.  At times, you may not see the sutures because they have been placed inside the wound. On other occasions, there may be metallic staples instead of sutures.

WOUNDS WITH DRESSINGS AND OR DRAINS:

- In rare instances, you may have a dressing or a drain. Unless specifically instructed, do not remove them. Avoid showers and keep the dressing dry. Some dressings may be sutured to the skin.  Do not attempt to remove them. Drainage is expected for two to three days after surgery. Just kink the drain tubing, before detaching the bulb and emptying it.  By kinking the tubing, you prevent air and old drainage from being sucked back into the wound.

MEDICATIONS:

- It is important to take all medications as prescribed by your surgeon.  An antibiotic may be prescribed following the surgery. The patient also receives a prescription for narcotic pain killers. These products cause somnolence, drowsiness and constipation. Patients who take painkillers should not operate machinery, drive or make important decisions.

- Do not use aspirin for 2 weeks; it increases the possibility of bleeding.

WHAT TO EXPECT:

- For the first one to two weeks after surgery, there will be a mild to moderate amount of pain in the neck, side of the face, jaw, ear, or throat. This can be controlled with prescription pain medicine received at hospital discharge or Tylenol® (acetaminophen). Ice may be applied to the affected area to help reduce pain and swelling.

- There will likely be some change in the contour of your neck and jaw area following surgery.

- The patient may have numbness, tingling and pain around the surgical site. This may last a long time but will become less noticeable with time.

- It is important to maintain hydration by drinking lots of fluids after the procedure. There may be discomfort during eating, and swallowing hard, crunchy foods may cause increased discomfort in the involved region. 

- Swelling in the surgical site is normal and will peak in 2-3 days.  Call our office if the incision swells excessively, becomes increasingly red and or starts to drain.

- Call our office if the patient has a fever over 101F (38C).

- An antibiotic may be prescribed after the surgery to prevent infection.  If you have been instructed to use a topical antibiotic and have not received a prescription for antibiotic ointment, use over-the-counter triple antibiotic such as Neosporin.  Apply to the incision twice a day or as instructed.

- There may be weakness in the shoulder muscles following surgery, particularly when lifting above the head. This may improve within weeks to months after surgery, but may persist indefinitely. If weakness continues, please discuss this with your physician, as physical therapy may help to improve strength and function.

RESTRICTIONS:

- Bed rest and very light activity is the rule for the first 24 hours postoperatively. You may increase your activity level as necessary, but use common sense.

- Refrain from vigorous activity for the 10 days after surgery. Do not lift objects weighing over 8-10 pounds (roughly the weight of a gallon of mild) for a minimum of 2 weeks following surgery. 

- After surgery, you may shower below the neck. Avoid showering above the neck until at least 48 hours after surgery. We strongly discourage soaking the incision in the bathtub, swimming pool, or hot tub until you have discussed this with your physician.

- If you have a tracheostomy or permanent tracheal stoma, you should never place yourself in risk water submersion.  You should never swim, or board small water crafts.  Patients who have undergone this procedure are unable to protect the airway from water and are at risk for drowning.

- Driving is prohibited while taking prescription pain medicine. Additionally patients should not drive until for a minimum of 2 weeks (or as instructed by your physician) following surgery of the head and neck region.  Surgery in this area may cause decreased range of motion making driving unsafe.  Do not drive if you are unable to look behind your shoulder comfortably.

- Depending on the individual and the type of surgery disability from work may vary.  Most patients are able to return to work or school within 1-2 full weeks after surgery

WHAT ARE SOME REASONS TO CONTACT YOUR DOCTOR AFTER SURGERY?

- Some swelling around the incision is normal. However, if is any sudden significant increase in neck swelling, apply an ice pack to the neck and call our office.  If this occurs after regular business hours, please contact our ENT on call resident.

- If you develop and shortness of breath or difficulty, breathing please present to the nearest emergency department emergently for evaluation.

- There is a risk of damage to multiple nerves in the head and neck area. Often, patients will note some numbness of their ear or neck skin after surgery, which may or may not improve with time. However, nerve injury could also result in problems such as weakness of the shoulder, tongue, or face.

- Patients who have undergone parotid gland removal have a small risk for facial paralysis on the operative side.  If you notice any increase in facial asymmetry, particularly with closing your eyes fully, or with an abnormal droop of the side of your mouth, please contact our office.

- Patients that have underwent thyroid or parathyroid gland removal rarely may experience muscle spasms, twitches, or cramps in the hands, face and legs; this may be a sign of dangerously low calcium levels.  If have undergone this type of surgery and experience these symptoms notify our office immediately and present to the nearest emergency room.

- Many people will experience low-grade fevers after surgery that may persist for one to two days. Temperatures can reach as high as 102 to 104 degrees, but usually will resolve with Tylenol and fluids. If you have a high fever (greater than 101 degrees) that lasts longer than 24 hours without any improvement, you notify the office.

- At any time during the postop period, please call the office if you have any questions or concerns about excessive bleeding, breathing difficulty, pain, persistent fever, nausea, swelling or other concerns that seem out of the ordinary from what you have discussed with your surgeon or read in this handout.