What should I expect after Ameloblastoma surgery?

While there are many variables including size of the tumor, upper vs. lower jaw, and reconstructive aspects, there are some generalizations we can make. This is intended to provide basic information on what to expect after surgery. The details of your tumor and surgery may alter your progress.

For the lower jaw, most of these operations involve incisions in both the mouth and the neck. For the upper jaw, these are mostly accessed through the mouth although sometimes a Weber-Ferguson incision is needed for access to larger tumors.

DRAINS & TUBES

Immediately after surgery, the first things noticed by patients are the various tubes and drains. For neck surgery, there is usually at least 1 drain coming out of the neck. These are most commonly Jackson Pratt drains which are hooked up to a bulb to prevent blood from collecting in the neck. These bulbs are simply emptied when they fill up. The drains are removed when the amount collected in the bulb goes down to less than 20ml per day. If your hospital stay is short, then you will go home with the drain and have it removed in the office 1-2 weeks later. The nursing staff will show you how to empty it.

The most annoying tube is the tracheostomy (trach) which is sometimes needed to protect the airway. Because this tube prevents air from traveling through the mouth, you cannot speak while you have the trach tube. However, this tube is "sized down" after a few days to a smaller one which allows you to speak around it. Not everyone needs a tracheostomy but your surgeon will discuss this with you.

Some patients will have a feeding tube to avoid contaminating the oral sutures with food. This tube goes through the nose directly into the stomach. This tube is usually removed around day 7, although your surgeon may have reasons to keep it longer. If your jaws are wired shut, the feeding tube can be a great way to help you transition to a liquid diet.

A bladder catheter is sometimes useful when patients are not expected to be able to walk to the bathroom easily immediately after surgery. This is more common for fibula flaps and for patients in the ICU.

DAILY PROGRESS

There are daily goals your surgeon wants you to accomplish. As one of my patients told me after surgery, "recovery is lots of baby steps." The recovery process can be frustrating and you may not feel like you're making progress, but there are definitely milestones to work towards while in the hospital.

POST-OPERATIVE DAY 1

There's not much swelling at this point. Depending on the extent of surgery, most surgeons will want their patients to be up in a chair on the first day after surgery. If you had bone taken from the hip or the leg for reconstruction, then your progress will be a little slower. If your surgery was limited to the head/neck area then you will likely be encouraged to get up and walk around. For patients with feeding tubes, nutrition will be given through the tube as a "meal" several times a day. Before starting the tube feeds, you will have an xray of your chest to make sure the feeding tube is going into the stomach and not the lungs. If you had a fibula free flap, someone will check the blood flow to the flap every hour. This often involves a tiny Doppler probe that was attached to the blood vessels which allows your team to listen to the blood flow. One of the most common systems is the Synovis Flow Coupler. This is used by my team in most cases. However, if blood flow to the graft is lost, it can be very difficult to salvage the graft and sometimes is not possible despite our best efforts.

POST-OPERATIVE DAY 2-3

Most patients who had surgery limited to the head/neck will go home by the 3rd day after surgery. If you had a bone graft taken from you leg or hip, you will often stay longer and physical therapists will work with you as early as day 2 to get you walking again. Fibula free flap patients will be wearing either a boot or cast on their leg. The physical therapists will start out slow with basic mobility exercises. An important milestone is for the physical therapist to "clear" you to go home. This doesn't mean you are walking the same as before surgery. The physical therapist simply wants to make sure you can safely and independently move yourself around at home while you continue to heal. This often requires temporary aids such as walkers or canes. Most patients don't need physical therapy after leaving the hospital, but a few patients will benefit from outpatient physical therapy.

POST-OPERATIVE DAYS 4-5

Swelling has usually reached its peak by day 5. It can take a few more days for swelling to noticeably improve. If your surgery involved reconstruction with BMP, the swelling can last for over a month. The tracheostomy (if present) is replaced with a smaller trach tube that allows you to speak around it. After a few more days, a "capping trial" is performed to see if the trach can be removed. This involves plugging the trach so you can breathe through your mouth and nose. For patients with fibula grafts, the physical therapists have cleared you for home ambulation but will still work with you while in the hospital to make sure you continue to make progress. If you had a fibula free flap, the protocol usually changes to checking the blood flow every 4 hours instead of every 1 hour.

POST-OPERATIVE DAYS 7-10

For most patients with a trach, a "capping trial" by day 7 has shown that the trach can be safely removed at this point. Th capping trial involves placing a cap on the trach to verify you can breathe around it through your mouth. Once you have completed the capping trial, the trach can be removed. This simply involves removing the trach and placing a bandage over the hole. The trach site will surprisingly close on its own over the next 2-3 weeks. The bandage is changed once a day. If your surgery was limited to the head/neck region, you have already gone home. Patients with a fibula free flap generally go home after 7-10 days. This is a longer hospital stay up front, but usually decreases the need to go back to the hospital later for additional reconstruction.

AFTER YOU LEAVE THE HOSPITAL

You're not done healing just yet, but the good news is that your surgical team is confident that you have met enough milestones to go home. There is a huge psychological benefit of being in your own home on your own couch. Although leaving the hospital can be scary, you should be comforted that your surgical team is comfortable with you going home.

If drains haven't been removed yet, they will be removed in the office during a postoperative visit. As time goes on, the fluid will go from red to yellow. You will need to measure the daily amount coming out of the drain and the nurses will show you how to do this before you leave the hospital. It's not as complicated as it sounds.

If you had a skin graft from your thigh, the bandage is usually removed in the office. This is a sore area on the thigh which simply requires time to heal. A bandage is sometimes place over the thigh site to keep your clothes from rubbing on it.

Hopefully this gives an accurate overview of what to expect with your recovery. Since every tumor and every patient is different, not every patient will follow this schedule perfectly.