Head and Neck Cancer Surgery involves 3 main parts:

1. Removal of the Primary Cancer

2. Removal of lymph nodes in the drainage pathway of the cancer

3. Reconstruction of the removed area

Your initial appointment will involve discussion of your diagnosis, health, personal background and treatment options, as well as the benefits, disadvantages and risks of surgery. 

After careful review by the various teams involved in your care, your case is discussed at the Hunter New England Head and Neck Cancer Multidiscplinary Team Meeting – your treatment plan is finalised based on evidence and experience in a team to ensure the best outcome for your case.

Our surgical goals are:

1. To treat your cancer in a comprehensive manner

2. To return you to a good level of function

General Health

Health and Nutrition: It is important to maintain adequate levels of hydration and nutrition prior to surgery. Being in good general health will aid your post-operative recover

Smoking: If you are a smoker, consider reducing the amount that you smoke or quitting altogether. Doing so will help to lower your mucous production (which will help you to breathe better), decrease your risk of developing lung infection and decrease your risk of developing a clot. You will not be allowed to smoke during your hospital stay and you will be offered a nicotine patch to help with your cravings. Your GP can offer you strategies to help you to quit smoking

Alcohol: If you are excessive consumer of alcohol, consider reducing the amount that you drink. It is important that you give your doctor an accurate number when estimating the amount that you drink. This will ensure that you are given appropriate levels of medication as excessive alcohol consumption can affect the effectiveness of certain prescription medications. It is important to discuss this with you doctors so that we can keep you safe during and after your surgery

Exercise:  Gentle exercise is recommended in the lead up to your surgery. Consider regular walks to improve and maintain your cardiovascular fitness. 

Mental Health

Your cancer journey will be one of the greatest challenges in your life. The surgery may change your usual level of functioning and, in some cases, you may not return to your pre-surgery level of function. You may have to adapt to a new ‘normal’. If your speech is affected, you may be difficult to understand. Your appearance may be temporarily or permanently altered. Your ability to swallow may be temporarily or permanently changed. There are many factors which are challenging and, without the proper support, may affect your mental health. 

It is normal for you to feel scared, frustrated, anxious or depressed during your treatment and recovery. Dr Tan-Gore can organise for you to speak with a Social Worker or Psychologist to help you through this difficult time. 

A free flap reconstruction is one which is taken from another part of your body and brought to the defect after connecting it to a nearby blood supply. This allows the flap to have its own blood supply and to heal in a robust way. Large defects that are unable to be covered with a simple skin graft may require a free flap reconstruction to restore function. 

Common places for free flaps to be harvested from are your forearm, thigh and leg. This is depending on the type of tissue required, the flap may include skin, soft tissue, muscle, bone or a combination of tissue types. 

There will be a significant scar from the donor site, and your arm/leg function may be affected in the initial stages of healing. You  may require further input from a physiotherapist to improve your function post-operatively. 

The main complication of free flap reconstruction is that the flap does not take. If this happens, you may require further reconstructive surgery. Other complications that require further surgery include excessive bleeding and wound breakdown. 

Bleeding: There is a risk of post-operative haemorrhage, requiring surgical intervention

Infection: Respiratory infections, especially if you are a smoker, diabetic or have high risk medical condition. Wound infections requiring antibiotics

Wound Breakdown: Healing complex wounds can take time and may require medical or surgical intervention

Paraesthesia (numbness): During the surgery, sensory nerves may be removed and can affect sensation in the area. The flap will be insensate

Flap failure: If the flap does not take, you may require further surgery for another free flap or local reconstruction

Function of Donor Site: You may experience temporary or permanent dysfunction at the donor site, depending on the location. For example, numbness, poor mobility at the wrist or ankle, difficulty walking. Wound breakdown in the donor site may require further dressings or surgical intervention

Function Recipient Site: Your function will be affected by surgery. Examples include difficulty chewing due to removal of teeth, changes in swallowing due to changed mobility in the tongue, changes in speech due to nerve involvement. This may require ongoing management with Allied Health Practitioners. You may require further surgeries in the future to manage these issues

During your Consultation with Dr Tan-Gore, you will receive information regarding:

• Your procedure, hospital and date of surgery including expected length of stay

• The reason for your procedure

• The risks of the procedure, as part of the Informed Consent process

• How long your procedure will take

• Any further investigations or tests that are required before surgery

• Your post-operative course, e.g. how much time off work, how long before you can resume exercise

As part of the booking process, Dr Tan-Gore will complete a Booking Form for the Hospital and a Consent Form.

After this, you can choose to complete your Booking Details by either:

1. Completing the form in paper form and submitting it to the hospital, or

2. Online:

•                 Lake Macquarie Private Hospital : lakemacquarieprivate.com. “Online Admissons”

•                 Lingard Private Hospital: lingardprivate.com.au. “Online Admission Form”

The Hospital will contact you a few days before your surgery date to advise you of your arrival time, fasting time and any other relevant information to help you prepare for your stay.

The Anaesthetist will contact you to assess your fitness for surgery.

The Anaesthetist will advise you of their fees based on the type of surgery you are having.

This process is separate from Dr Tan-Gore’s practice at H+ Consulting Suites.

After your Consultation with Dr Tan-Gore, you will receive a Fee Estimate. This will include an itemised invoice, estimated Rebate and estimated Out-of-Pocket Cost.

Payment of the total amount is required before your procedure date. Once you receive your receipt, you will need to lodge a claim with:

• Medicare: for your Medicare Rebate

• Your Health Fund: For your Health Fund Rebate

Your ‘Out-of-Pocket’ amount is the difference between your ‘Total Amount’ and the Rebates that you receive.

Your Fee Estimate contains only an estimate of your rebate and the actual amount from Medicare and your Health Fund may vary.

Please be advised that there may be adjustments to your Fee Estimate if Dr Tan-Gore determines that it is in your best interests during surgery. She will have advised you of this during the Consent process.

Please be advised that Dental Procedures do not attract a Medicare Rebate, and some Dental Procedure do not attract Health Fund Rebate.

Once you have received your Fee Estimate, Dr Tan-Gore advises that you contact your Health Fund to determine your level of cover.

The average hospital stay after surgery is 1-3 weeks, depending on the extent of the surgery and reconstruction.

Your surgical team will continue to monitor you closely to ensure that you are progressing well after surgery

You will be encouraged to sit out of bed and to mobilise when it is safe to do so. 

You will be started on oral intake in a gradual fashion, depending upon your recovery.

You may have input from various allied health teams, including physiotherapy, speech pathology, dieticians and occupational therapists. Each member of the allied health team will assess you and provide you with exercise and assistance to ensure that you are safe for discharge to your home environment. 

Once you are discharged home, it is important that you gradually return to a good level of function. This is a gradual process and varies between patients depending on many factors, including the type of surgery, your pre-surgical level of fitness/activity and your ongoing treatments, including further adjuvant therapy (Radiation or Chemotherapy). It is important to continue follow the advice given to you by the Physiotherapist, Speech Pathologist, Dietician and Wound Care Nurse in order to improve your overall condition.

Wound Care

Dr Tan-Gore will give you clear directions regarding your wound care.

For external wounds, (wounds on your neck and face, forearm or leg), do not cover your wounds with dressings as this encourages moisture and heat to the area, increasing your risk of infection.

You are able to shower. Please remember to carefully dry your wounds afterwards.

Do not immerse your wounds in water (e.g. in bath, swimming pool or the ocean) for 4 weeks after surgery to ensure that the wound heals well.

You can apply a simple moisturiser to the wound if it appears dry.

You should cover the wound loosely if you are going to expose the area to the sun in the initial stages.

If the wound is red, hot, painful or swollen, or

If you have fevers and chills or sweating or

If the wound is leaking – please attend the Emergency Department of the Lake Macquarie Private Hospital or The John Hunter Hospital

If You Have  a Leg Brace

Initially, you may find if more comfortable to wear the supportive brace all day.

You can remove the cast when sleeping or resting.

Please keep your leg elevated when sitting.

At 2-4 weeks post-surgery, you may try having the cast off whilst you are moving around your house but keeping the cast on when you are walking long distances.

After 4 weeks, you can try to keep the cast off for most of the day, using it only when you feel you need the support

For Intraoral Wounds

You may find it difficult to chew and swallow initially.

A soft diet is recommended. This enables you to have adequate nutrition with a modified textures to make it easier for you to chew and swallow whilst you are adjusting to the changes in your mouth.

The consistency of a soft diet includes scrambled eggs, fish, overcooked pasta, soft meat. If eating or chewing causes pain, stop and return to a puree consistency for a few days.

Dr Tan-Gore and the Allied Health Team will recommend a progression of your diet after review.

Remember to stay hydrated with water. Consider smoothies for added calories and nutrition in a easily swallowed form.

Exercise

Dr Tan-Gore encourages you do gentle exercises. You may have exercises prescribed to you by the Physiotherapist. Otherwise, consider gentle walking, increasing the distances as you are able. This keeps your muscle tone healthy during your recovery.

Driving

Driving is not advised in the initial recovery phase (4 weeks).

The Physiotherapist will assess your safety to drive based on your functional movement.

Return to Work

Your return to work will depend upon several factors, including whether or not it is recommended for you to have adjuvant treatments (Radiation or Chemotherapy).

It is realistic to consider that your return to work will take months, rather than weeks.

Dr Tan-Gore will discuss this with you at your review appointments

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