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Nasal cavity and paranasal sinus cancer

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Side effects of surgery for nasal cavity and paranasal sinus cancer

Side effects can happen with any type of treatment for nasal cavity and paranasal sinus cancer, but everyone’s experience is different. Some people have many side effects. Other people have few or none at all.

Side effects can develop any time during, immediately after or a few days or weeks after surgery. Sometimes late side effects develop months or years after surgery. Most side effects will go away on their own or can be treated, but some may last a long time or become permanent.

Side effects of surgery will depend mainly on:

  • the type of surgery
  • your overall health
  • the effect of other treatments (for example, tissue treated with radiation may not heal well after surgery)

Tell your healthcare team if you have these side effects or others you think might be from your surgery. The sooner they are aware of any problems, the sooner they can suggest ways to help you deal with them.


Pain often occurs because surgery damages tissues. Surgery for cancer in the nasal cavity or paranasal sinuses is a major operation. It may take time for pain to go away after surgery. The intensity of the pain will depend on the procedure, how you heal and how well you tolerate pain.

Your healthcare team will prescribe drugs to control your pain. Tell them if pain doesn’t go away or pain medicines don’t relieve the pain.

Find out more about pain.

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Bleeding, or hemorrhage, can occur if a blood vessel is not sealed off during surgery or if you have a blood clotting disorder. Nursing staff frequently check bandages, packing and drains for heavy bleeding right after surgery. If bleeding occurs and is severe enough, the surgeon may have to take you back to the operating room to find where bleeding is coming from and to stop it.

A small amount of bloody drainage is expected after surgery. Report heavy bleeding to your healthcare team.

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Swelling and bruising

After surgery for cancer in the nasal cavity or paranasal sinuses, the face and neck may swell with fluid and appear bruised. This side effect will gradually go away as the tissues heal.

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Wound infection

Some people develop a wound infection after surgery. This is not a common side effect, but it can happen after any type of surgery. Wound infections are a temporary side effect of surgery.

Sometimes the surgeon will place tubes into the wound to drain extra fluid. You may be given antibiotics to help prevent or treat an infection.

Tell your healthcare team if you have signs of infection, such as redness, pus or foul-smelling drainage, increased swelling or tenderness at the incision site and increased temperature (fever).

Find out more about infection.

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Trouble breathing

Some people with cancer in the nasal cavity or paranasal sinuses have trouble breathing after surgery. This can happen if the airway is cut off by a tumour or by swelling. Your surgeon may do a tracheostomy to help you breathe. A tracheostomy may also help prevent pneumocephalus, which is a condition where air gets into the cranium (the part of the skull that contains the brain) after craniofacial resection.

A tracheostomy is a procedure to create a stoma, or opening, in the trachea (windpipe) through the neck. The surgeon places a small tube in the opening, which the person breathes through. The tube is removed after the swelling goes down and the person can breathe without difficulty.

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Blood clots

A blood clot in the legs is called a deep vein thrombosis (DVT). A DVT can occur immediately after surgery because you may not be moving around very well, along with other factors. In the most serious cases, a blood clot can break away and travel to the lungs (called a pulmonary embolus, or PE). This can cause shortness of breath, coughing up blood, low oxygen levels in the blood and, potentially, heart failure or even death.

Giving anticoagulants, or blood thinners, and applying compression stockings during and after surgery helps prevent DVT and PE. The healthcare team will also recommend exercises to help prevent blood clots from forming.

Tell your doctor or healthcare team if you have any redness, swelling, pain or cramps in the calf of the leg. Also report shortness of breath or coughing up blood.

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Changes to sense of smell

Surgery for nasal cavity and paranasal sinus cancer can cause changes to a person’s sense of smell. This can happen when certain nerves are damaged by the tumour or during surgery. The sense of smell can also change if certain tissues are removed during surgery. This may be a long-term side effect in some people.

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Fluid buildup in the middle ear

After a maxillectomy, fluid sometimes builds up in the middle ear. You may need to have surgery to drain the fluid. The surgeon makes a cut in the ear drum to drain the fluid. This is called a myringotomy.

Fluid buildup in the ear can also cause some loss of hearing. Sometimes hearing aids are used to help treat hearing loss.

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Changes to vision and flow of tears

Surgery near the eye may affect your sight. It can sometimes lead to poor, blurred or double vision. It may also cause the eye to have a sunken appearance. Reconstructive surgery may help with these problems.

The tear duct may also get damaged or removed during surgery, which can cause a blockage. If this happens, surgery may be needed so tears can flow into the nose.

In some cases, an eye needs to be removed to treat cancer in the nasal cavity or paranasal sinuses. You will still be able to see with the remaining eye. If your eye is removed, you will likely get an artificial eye.

Learn more about vision changes.

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Difficulty chewing, swallowing and speaking

Surgery for nasal cavity and paranasal sinus cancer can make chewing, swallowing and speaking difficult if part of the jaw, teeth or mouth is removed.

If you have trouble swallowing or speaking after surgery, your healthcare team may recommend that you get a swallowing assessment by a speech-language pathologist. A speech-language pathologist is a healthcare professional trained in diagnosing and treating swallowing, language and speech problems. Some people may need a prosthesis with dental implants to help them chew food.

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Changes to physical appearance

Surgery for nasal cavity and paranasal sinus cancer may cause scarring, skin changes and other changes to your appearance. Some people may need a facial prosthesis, which can also change their appearance.

Learn more about prostheses for nasal cavity and paranasal sinus cancer.

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Damage to the pathways between sinuses

Surgery for cancer in the nasal cavity or paranasal sinuses can lead to blocked pathways between the remaining paranasal sinuses. This can lead to inflammation of the sinuses, which can cause pain and stuffiness. Sometimes endoscopic surgery is used to drain the sinuses.

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Nerve damage

Different nerves may be damaged or cut during surgery to remove cancer in the nasal cavity or paranasal sinuses or lymph nodes in the neck. The symptoms of nerve damage depend on the specific nerve that is injured. Damage to certain nerves can cause weakness or loss of feeling in your tongue, ear or lip, a hoarse voice or problems moving your mouth. Nerve damage can also cause pain, weakness and limited movement in the shoulder.

Your surgeon will try to avoid damaging nerves or to repair the damage during surgery. If you do have nerve damage, try to start physical therapy as soon as possible to limit the effects. Depending on the type of surgery you have, weakness may go away in a few months. Weakness will be permanent if a nerve was removed.

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Difficulty opening the jaw

Difficulty opening the jaw is a condition called trismus. It occurs when the jaw muscles or jaw joint (called the temporomandibular joint, or TMJ) are damaged or if scar tissue develops in them.

Surgery for cancer in the nasal cavity or paranasal sinuses can cause scar tissue to form in the muscles and joints involved in chewing, which can lead to trismus. There is a greater risk of developing trismus if you have radiation therapy as well as surgery.

Find out more about trismus.

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Graft failure

A graft is the skin and tissue used to reconstruct the face and neck after surgery to remove cancer in the nasal cavity or paranasal sinuses. In rare cases, the graft may not heal and the tissue dies. In this case, you will likely have more surgery using another graft to reconstruct the area where the graft didn’t heal properly.

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If the base of the skull is removed, the surgeon will do reconstructive surgery to repair the barrier between the cranium (the part of the skull that contains the brain) and the nasal cavity and paranasal sinuses. If the new barrier is not watertight, bacteria can get inside the cranium, which can cause meningitis. Meningitis is inflammation of the covering of the brain and spinal cord. You will be given antibiotics if you develop meningitis.

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Cerebrospinal fluid (CSF) leak

After some types of surgery to remove a tumour in a paranasal sinus, there is a risk that the fluid surrounding the brain (called cerebrospinal fluid, or CSF) can leak into the sinuses and drain from the nose. A CSF leak may increase the risk of developing meningitis. It may be treated by draining the fluid and then compressing and packing the area. If these methods don’t work, surgery may be needed to repair the leak. In some cases, a CSF leak will stop with bed rest, medicines or a drain in the back called a lumbar drain. But many people will need surgery to repair a CSF leak.

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Brain damage

In rare cases, surgery for cancer in the nasal cavity or paranasal sinuses can damage the brain. Symptoms of brain damage include difficulty walking and coordinating other movement, confusion, memory loss and seizures.

Brain damage may occur after surgery if the brain swells or is bruised (called a contusion) or if air gets into the cranium (called pneumocephalus). In some cases, more surgery may be needed to relieve pressure on the brain or to look for the defect that is allowing air into the cranium.

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