Surgical Procedures: Craniofacial Resection

What is a craniofacial resection?

A craniofacial resection is surgery done to remove cancer in the areas of the head and face. It is used to treat tumors in the:

• Base of the skull.
• Paranasal sinus, including:
  • Ethmoid sinus (next to the upper nose on each side).
  • Frontal sinus (the lower part of your forehead).
• Nasal cavity (your nose).
• Skull cap (the top part of your skull).
• Around the eyes.

How is it done?

Incisions (cuts) are made in the face and skull bone. The surgeon will try to avoid the nerves, brain, and other organs to prevent damage to them. Incisions may be made:

• On the side of your nose.
• Behind your hairline, and possibly down to your lip.
• Under your eye, or across the bridge of your nose.

Your provider will tell you where your incisions will likely be made. Other procedures, such as a maxillectomy, dacryocystorhinostomy (tear duct opening), or orbital exenteration (removal of the eye socket) may be done at the same time as a craniofacial resection.

Bones may be removed so your surgeon can get to the tumor. Metal plates and screws may be used to put these bones back into place. If skin grafts are needed, they are often taken from your thigh.

You may need a tracheostomy and a lumbar (spinal) drain with this procedure:

• A tracheostomy is a tube/hole in the neck that you will breathe through.
• A lumbar drain allows for extra spinal fluid to leave your body and for medication to be given.

What are the risks of a craniofacial resection?

As with any surgery, there are risks and possible side effects. These can be:

• Infection.
• Bleeding.
• Pneumocephalus (Air surrounding the brain).
• Leaking of cerebrospinal fluid (CSF) into the nose.
• Diabetes insipidus (Increased thirst and an increase in the amount of urine being made).
• Loss of smell.
• Facial nerve injury or facial numbness.
• Epiphora (Chronic tearing).
• Loss of sight/visual changes.
• Mucocele (Collection of mucus in the frontal sinus).
• Mucus crusting (hardening).
• Hematoma (Collection of blood).
• Seizures.
• Depression.
• Scarring.

What is recovery like?

Recovery from a craniofacial resection depends on other procedures done at the time. You will need to stay in the hospital to be watched closely.

Your care team will talk with you about the medications you will be taking, such as those for pain, blood clot, infection, and constipation prevention and/or other conditions.

You will be told how to care for your surgical incisions and will be given any other instructions before to leaving the hospital. In some cases, you may need to go to a skilled nursing facility or rehab center before going home.

Your provider will talk to you about any changes to your activity level, depending on the surgery you had. In general, you should:

• Avoid strenuous activity, heavy lifting, and driving until your provider tells you it is okay.
• Avoid areas where there is smoke or large crowds.
• Avoid being around those who are ill, especially those with coughs and/or colds.
• Do not pick or blow your nose until your provider tells you that you can.
• Avoid sneezing.

What will I need at home?

• A thermometer to check for fever, which can be a sign of infection. Your care team will tell you at what temperature you should call.
• Incision care supplies, which are often supplied to you by the hospital or surgeon’s office.

When should I call my provider?

Your providers will give you details about when you should call them.

If you have straw colored liquid or large amounts of blood coming from your nose, call 911 right away. This could be a sign of a serious medical problem.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.