Preparing for Major Head and Neck Surgery: What to Do Before You Go In

Major head and neck surgery — whether a jaw reconstruction, a neck dissection, a robotic resection of an oropharyngeal tumor, or a procedure requiring a free flap — is not a small undertaking. The operations themselves can range from three to twelve or more hours in the operating room, often followed by several days in an intensive care unit and a hospital stay measured in weeks, not days. What happens before you ever arrive at the hospital matters more than most patients realize.

I’ve found that the patients who recover most smoothly are not necessarily the youngest or the healthiest at baseline. They are the patients who came to surgery as prepared as possible — nutritionally, medically, practically, and in terms of their support system at home. This article walks through each of those areas so that you and your family can approach the operation with as much confidence as the situation allows.

Start with Your Teeth

If your surgery involves the oral cavity, the jaw, or if there is any chance you will need radiation therapy afterward — and for most head and neck cancers, radiation is part of the treatment plan — it is very important to see a dentist before surgery, not after. This is one of the most important steps and one of the most frequently overlooked.

Radiation to the head and neck causes long-term changes to the salivary glands, the soft tissue, and most critically, the blood supply to the jawbone. Any tooth extraction or invasive dental procedure performed after radiation carries a meaningful risk of a serious complication called osteoradionecrosis — a condition in which the irradiated jaw bone fails to heal. The time to address unhealthy teeth, ill-fitting dental prosthetics, or areas of gum disease is before radiation begins, ideally weeks before if possible.

After surgery, while you are recovering, is not the ideal time to be worrying about this dental evaluation, and then possibly additional dental procedures — during this time you are focused on healing and rehabilitation. We encourage patients who are heading toward radiation therapy complete their dental evaluation as early in the treatment planning process as possible, ideally before surgery. If you have not yet seen a dentist, ask your care team to arrange a dental consultation immediately.

Review Every Medication You Take

Before surgery, we review each patient’s medication list in detail, but you can help by being thorough and proactive. Certain medications must be stopped in advance. Blood thinners — including aspirin, warfarin, clopidogrel, and the newer oral anticoagulants like rivaroxaban or apixaban — generally need to be held for a period of days to weeks before a major operation. The specific timing depends on the drug, your underlying cardiac or clotting history, and whether you need to bridge with another agent.

Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen affect platelet function and should typically be stopped at least a week before surgery. Herbal supplements — fish oil, vitamin E, ginkgo, garlic, and others — are often overlooked but can also affect bleeding. Bring a complete list of everything you take, including supplements, to your preoperative appointments.

If you take medication for diabetes, blood pressure, or a heart condition, do not stop those on your own — your surgical and anesthesia team will give you specific instructions about what to take the morning of surgery.

Address Your Nutrition Now

Malnutrition is common at the time of head and neck cancer diagnosis. Tumors of the throat, tongue, or jaw can make swallowing painful or difficult, and patients often arrive in clinic having lost significant weight over the preceding weeks or months. Going into a major operation in a nutritionally depleted state increases the risk of wound complications, impairs healing, weakens the immune response, and lengthens recovery.

If you are having difficulty eating or have lost more than a few pounds unintentionally, tell your team before surgery. We routinely involve our nutritionists in the preoperative period, and for patients who cannot maintain adequate intake orally, a short course of supplemental nutrition — sometimes through a temporary feeding tube — before the operation can meaningfully improve outcomes.

Even if you are eating relatively normally, focus on protein in the weeks before surgery. Healing requires it, and most people underestimate how much they need. Aim for protein at every meal. If your appetite is poor, high-calorie oral supplements can help bridge the gap.

Stop Smoking — Now, Not After Surgery

I will be direct about this: smoking significantly impairs wound healing, reduces tissue oxygenation, increases the risk of postoperative pneumonia, and — in procedures involving free flap reconstruction — raises the risk of partial or complete flap failure. A free flap is a complex surgical endeavor in which a piece of tissue from another part of your body is transferred to your head or neck with its own blood supply. That blood supply depends on vessels that are far more vulnerable to the vasoconstrictive effects of nicotine and carbon monoxide than we can afford.

The ideal is complete smoking cessation before surgery. Even a few weeks of abstinence improves tissue oxygenation and begins the recovery of ciliary function in the airway. If you are struggling to stop, ask about support — nicotine replacement, prescription aids, or a referral to a cessation counselor. The same applies to alcohol: heavy alcohol use impairs immune function, liver metabolism of anesthesia, and the body’s ability to heal. If your consumption is significant, discuss this with your medical team before surgery.

Arrange Your Support at Home

Major head and neck surgery can mean a hospital stay of five to fourteen days depending on the complexity of the procedure. What follows discharge is a period of meaningful dependence that catches many patients and families off guard.

In the weeks after surgery, you may have limited ability to drive, to swallow normally, to manage wound care on your own, or to speak clearly. You may go home with drains that need to be emptied and recorded daily, a temporary feeding tube, or wound care that requires someone else’s help. Plan ahead.

Identify someone — a partner, an adult child, a close friend — who can be present with you for at least the first two weeks at home. Make sure your home is accessible if mobility becomes an issue (a bedroom on the main floor is worth arranging in advance if stairs are a concern). Stock the kitchen with foods appropriate for where you are likely to be in your recovery — soft, high-calorie foods, or the appropriate tube feeding formula if that is part of your discharge plan. Fill any discharge prescriptions before you come to the hospital if possible.

Know What to Bring — and What to Leave Behind

For the hospital stay itself: bring a phone charger and any device that helps you pass time or stay connected. Bring any hearing aids, glasses, and their cases, labeled clearly. Bring your own pillow if sleeping away from home is difficult for you — it is a small thing that matters more than people expect. Leave valuables, jewelry, and most of your belongings at home.

You will be given a gown and everything medically necessary. What you actually need is your identification, insurance information, a brief list of your current medications, and someone you trust to help communicate on your behalf when you are not at full capacity. If you have specific wishes documented in an advance directive or a healthcare proxy designation, bring those as well.

Ask Your Questions Before You Go In

The day of surgery is not the ideal moment to raise questions you’ve been sitting with for weeks. I encourage all of my patients to use their preoperative appointments to ask what they genuinely want to know. What does the surgery actually involve? What is the plan if intraoperative findings change our approach? What will I look and feel like when I wake up? When will I eat again? When will I be able to speak?

I would rather you ask them in clinic, where we can have a real conversation, than wonder about them the night before your operation.

Getting Ready Together

Preparing for major surgery is not a passive process. The effort you put in before you arrive at the hospital — addressing your teeth, your nutrition, your medications, your support system, and your understanding of what lies ahead — directly shapes your recovery on the other side. My team and I work hard to give you the best possible surgical result. The preparation you do before you walk through those doors is your part of that collaboration.

If you have been told you need major head and neck surgery and have questions about what to expect or how to prepare, I welcome you to reach out. Call my office at 414-649-3920 to schedule a consultation.

Dr. Steven Sperry is a fellowship-trained head and neck surgeon specializing in head and neck cancer surgery and microvascular free flap reconstruction at Aurora St. Luke’s Medical Center in Milwaukee, Wisconsin.