CRANIOFACIAL RESECTION

Transcription

1 CRANIOFACIAL RESECTION This infrmatin aims t help yu understand the peratin, what is invlved and sme cmmn cmplicatins that may ccur. It may help answer sme f yur questins and help yu think f ther questins that yu may want t ask yur cancer care team; it is nt intended t replace advice r discussin between yu and yur cancer care team. AN OVERVIEW TO CRANIOFACIAL RESECTION Cranifacial resectin is the name given t peratins that need tw different appraches (at the same time) t remve a tumur lcated in the nasal cavity, between the eyes. This usually invlves a team f surgens wh wrk tgether. One apprach is thrugh the skull. This is the cranial part and is usually dne by a neursurgen. The ther apprach is frm the frnt, thrugh the face. This is the facial part and is usually dne by a head and neck surgen. WHY IS A CRANIOFACIAL RESECTION NEEDED Cranifacial resectin is recmmended in sme cancers f the nasal and sinus cavities that are near the bne that separates the brain frm the nasal cavity. This is a difficult area t get t. By appraching the tumur frm bth sides - abve, where the brain is, and frm the nse - the tumur can be remved cmpletely and safely. The cancer tgether with an area f nrmal-appearing tissue is remved, t reduce the chance f any cancer cells being left behind. If the tumur is very large, it may be necessary t als remve part f the upper jawbne (maxillectmy), r the eye (rbital exenteratin). Yu may want t dwnlad infrmatin abut these peratins, which is available n the Beynd Five website. Tissue remved frm the cranifacial resectin will be examined in detail by a specialist pathlgist, under a micrscpe t lk fr cancer cells. Thrugh this examinatin, the cancer can be accurately staged. Further infrmatin abut staging f cancer is available n the Beynd Five website Beynd Five. 1

2 HOW TO PREPARE FOR THE OPERATION Befre the peratin: Yu will need t fast (have nthing t eat r drink) fr six hurs befre yur peratin (unless advised differently by yur surgen r anaesthetist) because cranifacial resectin is perfrmed under a general anaesthetic (yu will be asleep and will nt remember what happens during the peratin). Yur surgen will explain the details f yur peratin. Be sure t bring up any questins r cncerns, and share yur needs and wishes with the team (see bx). Yu shuld speak t yur dctr abut hw t manage aspects f yur lifestyle, such as smking, drinking alchl and chrnic cnditins (e.g. diabetes and besity) that may increase the risk f cmplicatins. If yu take bld thinning medicatin fr a heart cnditin r bld clts (such as warfarin, Plavix, aspirin r Pradaxa), make sure yur surgen is aware. Sme f these medicatins need t be stpped mre than a week befre the peratin. Smetimes a shrt-acting bld thinner (such as Clexane) is used befre and after the surgery. Pssible questins that yu may want t ask yur cancer care team Where will the cuts be? Will the surgery affect my visin r my sense f smell? Can I blw my nse after the peratin? Can the surgery be dne endscpically? Will the surgery affect my memry r hw I think? Will I need a feeding tube? Will the peratin affect my speaking? Will I need a trachestmy r breathing tube? Additinal questins are listed at the end f this factsheet. Talk t yur surgen and cancer care team abut any likely side effects yu can expect fllwing the peratin. Yu may find it useful t talk t a dietitian, speech pathlgist r specialist head and neck nurse abut these issues. Visit the Beynd Five website fr further infrmatin n the health prfessinals wh may be part f yur cancer care team 2016 Beynd Five. 2

3 WHAT TO EXPECT DURING THE OPERATION During a cranifacial resectin, usually tw incisins are made: The first cut is acrss the tp f the scalp (frm ear t ear) and will hide in the hair. The secnd cut is alng the side f the nse. The skin f the frehead will be flipped dwn t allw surgens t access the frnt f the skull; a piece f the skull will be remved and the brain will be retracted s that surgens can see the cancer frm abve. The sft tissue in the nse will be separated t access the bne underneath. This bne is remved s that surgens can see the cancer frm belw. Sme surgens will use a telescpe thrugh the nse t see the tumur frm belw, similar t endscpic sinus surgery, this may avid the need fr a cut n the face. The cancer will be remved nce the surgens can see the full extent f the cancer. This includes remving the bne that separates the brain frm the nasal cavity. After the tumur is remved, the hle (defect) where the bne was will be recnstructed. Often this is dne using tissue frm the deep layer f the scalp, called pericranium. Smetimes tissue is taken frm elsewhere in the bdy t recnstruct the defect. Yu may want t dwnlad infrmatin abut recnstructive surgery (sft tissue flap), which is available n the Beynd Five website. A tube may be inserted int the windpipe (trachestmy) t help breathing, and a feeding tube fr feeding. Yu may want t dwnlad infrmatin abut trachestmy and feeding tubes, which is available n the Beynd Five website. If a mre extensive peratin is dne, including remving the eye scket r upper jaw, then a mre cmplicated recnstructive peratin t rebuild the area may be required, this invlves bne r skin flaps. Yu may want t dwnlad infrmatin abut recnstructive surgery (sft tissue and bne flap), which is available n the Beynd Five website Beynd Five. 3

4 WHAT TO EXPECT AFTER THE OPERATION Cranifacial resectin is cnducted very clse t yur brain. After the peratin, yu will be mnitred very clsely in the intensive care unit s that yur treatment team can ensure there has been n damage r infectin in the brain regin. After a few days yu will be mved t a nrmal hspital ward fr the remainder f yur recvery. Yu may feel a bit drwsy and find it difficult t cncentrate after the surgery while yu are in hspital. Yu may ntice sme duble visin and watering f yur eye. Yur anaesthetist and surgical team will give yu medicine t help cntrl any pain and nausea after the peratin. Yu will have a few surgical drains in the area f yur surgery t allw bld r lymphatic fluid t escape and prevent swelling. Yu may als have nse packs in place. These will be remved befre yu g hme. Yu may have a drip in yur arm t give yu fluid until yu are able t drink. Yu will als have a feeding tube inserted thrugh yur nse int yur stmach t help yu receive nutritin in the days and weeks fllwing yur surgery. It is imprtant nt t blw yur nse fr a few weeks after the surgery r air can leak arund the brain. This is nt pssible while the trachestmy tube is in place. Once this has been remved, if yu need t sneeze yu shuld d this with an pen muth t let the air escape. If yu ntice any clear fluid cming frm yur nse, yu shuld let the nurse r dctr knw. The drips and tubes will be remved as sn as they are n lnger needed and befre yu g hme Beynd Five. 4

5 POSSIBLE RISKS OF CRANIOFACIAL RESECTION All peratins carry sme risks such as bld clts, wund infectins, bleeding, chest infectin, adverse reactins t anaesthetic, and ther cmplicatins. These risks will be explained by yur cancer specialist and anaesthetist. Yur dctr will explain details f the peratin, general risks and side effects f the peratin, they may recmmend: stpping bld thinners (e.g. aspirin) befre surgery t reduce the risk f bleeding a bld thinner (called heparin) may be injected befre and after surgery t reduce the risk f bld clts antibitics t reduce t risk f wund infectin early mbilisatin t reduce the risk f bld clts and chest infectin special stckings t reduce the risk f bld clts. Cranifacial resectin is a majr peratin. There are sme specific risks that yu shuld knw abut include: Cerebrspinal fluid leak: Cerebrspinal fluid (CSF) is the fluid that sits arund the brain and spinal crd. It the seal between the brain and nasal cavity leaks, then CSF can cme ut f the nse. This fluid is clear r straw clured and is usually treated with antibitics t prevent infectin (meningitis). This may cause a bad headache and smetimes additinal surgery may be needed t seal the leak. Pressure n the brain r eyes: This can be due t a number f reasns (listed belw) and may lead t difficulty cncentrating, drwsiness, blurred r duble visin, lss f cnsciusness r even death. Smetimes mre surgery is needed t release the pressure. Brain swelling: If the brain is retracted fr a lng time during the surgery, it may start t swell. It may take several days r lnger t imprve. Bleeding: If there is bleeding in r arund the brain it can be dangerus because the bld can put pressure n the brain. If it is minr it can be watched but ften needs t be remved. Infectin: If pus frms arund the brain, called an abscess, it will need t be remved. Prblems with visin: Bruising f the eyes, nerves r the muscles that mve the eyes can ccur due t retractin during the surgery r bleeding after surgery Beynd Five. 5

6 Pneumcephalus: Smetimes air frm the nse can build up arund the brain. If it is minr it can be watched but ften needs t be remved. Water and sdium imbalances: Operatins n the brain can cause hrmnes t be released that can lead t salt (electrlyte) imbalances in the bld. This will be mnitred with bld tests. Tear duct damage: This may cause tearing (watery eye) fr a while after the surgery. If this des nt imprve, surgery may be needed t pen the tear duct. Flap failure. If recnstructive surgery with a flap is needed, then micrsurgery is dne t jin bld vessels tgether that keep the flap alive. If the bld supply blcks, yu will be taken back t the perating rm t fix the prblem. Smetimes the prblem cannt be fixed and a new flap is needed. SIDE EFFECTS AND THEIR MANAGEMENT As with all peratins, there is a chance that cranifacial resectin may lead t a number f side effects. Yu may nt experience all f the side effects. Speak with yur dctr if yu have any questins r cncerns abut treatment side effects. Side effects cmmn fr cranifacial resectin may include: Nausea: General anaesthetic may cause nausea. This will settle dwn sn after the peratin and can be treated with medicatins. Sre thrat: Yur thrat may be sre initially because f the breathing tube placed during the peratin. Infectin: There is a risk f infectin with any surgery. Hwever, as this peratin is cnducted very clse t the brain, any infectin pses a serius risk. The surgen will prescribe antibitics t prevent this ccurring. Lss f smell: The nerves that cntrl the sensatin f smell are lcated very clse t the area being perated. These nerves are ften remved during the peratin and the sense f smell may be affected. Changes in appearance: Yur appearance may change and it may be hard t accept. Seek supprt frm the cancer care team, and family and friends. Cntacting ther patients may als assist. Pain management: Pain is a cmmn side effect f the peratin. Yur anaesthetist will give yu pain medicine during the peratin t keep yu cmfrtable when yu wake up, and yu may cntinue n pain medicines t ensure pain is under cntrl. Ensure yu take pain relief medicatins as prescribed by yur dctr and speak t yur cancer care team if the pain is nt under cntrl, gets wrse r if the medicatin causes any side effects. Yu may want t dwnlad infrmatin abut pain management, which is available n the Beynd Five website Beynd Five. 6

7 OTHER TREATMENT(S) Additinal treatment(s) depend n the nature and extent f the cancer. Head and neck cancers ften require treatment with mre than ne frm f therapy t reduce the risk f the cancer recurring. Many patients need radiatin therapy after the peratin, and smetimes, may als require chemtherapy. Yur cancer care team will be able t discuss the likelihd f needing further treatment befre yur peratin. BEFORE GOING HOME Any particular instructins fr wund care r medicatins will be prvided t yu befre yu g hme. Yu may want t dwnlad further infrmatin abut wund care n the Beynd Five website. Yur dctr may prescribe pain medicatins t help relieve the pain fllwing the peratin. Ensure yu take the pain relief medicatins as prescribed by yur dctr and speak t yur cancer care team if the pain is nt under cntrl, gets wrse r if the medicatin causes any side effects. Yu may want t dwnlad infrmatin abut pain management, which is available n the Beynd Five website. Yu will be assessed by the team invlved in yur care befre yu g hme and fllw-up will be arranged with yur surgen and GP. Fllw-up may als be arranged with any ther allied health prfessinals that may assist yu with supprtive care Yur recvery at hme may vary and yu shuld allw time fr yur bdy t recver and heal. Regular fllw-up helps t assess yur prgress Beynd Five. 7

8 FOLLOW-UP CARE After yur peratin, yu will cntinue t have regular fllw-up visits with yur specialist dctr and cancer care team. Any additinal recnstructin, csmetic prcedures r treatments that yu may need are planned after discharge. This enables time fr yu t recver frm the initial peratin, get results f the pathlgy that examined the tissue remved at the peratin, and make the arrangements fr any additinal treatment r next steps. Fr further infrmatin abut the peratin fr cancer and what t expect, yu can als refer t Understanding Surgery: a guide fr peple with cancer, their families and friends Beynd Five. 8

9 QUESTIONS TO ASK YOUR DOCTOR What type f cancer d I have? Where is it lcated? What will happen if I dn t have the cranifacial resectin? What are the risks f cranifacial resectin? Hw lng will the peratin take? Hw lng will I be in hspital and hw lng d I need ff driving, wrk r exercise? What are the pssible side effects f surgery? Hw can they be prevented r managed? Will I need any extra treatment? What lng-term effects frm treatment will I have? What lifestyle changes (diet, exercise) d yu recmmend I make? Hw much will the peratin cst? Will my health insurance cver it? Will I be able t lead a nrmal life? What fllw up tests will I need after the peratin? If I wanted t get a secnd pinin, can yu prvide all my medical details? 2016 Beynd Five. 9

10 Yu may want t write additinal questins here t ask yur dctr r cancer care team Beynd Five disclaimer: Yu acknwledge and accept that the infrmatin in this factsheet is fr general infrmatin purpses nly. It is nt intended, nr shuld it be relied n, as medical r legal advice, r as a substitute fr cnsultatin with a physician r ther licensed healthcare prvider. Yu agree that if yu have individual healthcare-related questins yu shuld cntact yur dctr prmptly and shuld nt disregard prfessinal medical advice, r delay seeking it, because f infrmatin cntained here. Yu als agree that Beynd Five is nt liable fr any injury r damage t persns r prperty (hwsever caused, including by negligence) arising ut f r related t any use f Beynd Five s patient educatin materials, r fr any errrs r missins. Last updated: 19 Octber Beynd Five. 10