Septoplasty / FESS / Turbinate Reduction Information
Septoplasty (Straightening the middle wall of the nose for better airflow), Turbinectomy (Reducing the size of the turbinates for better airflow), Nasal Valve Repair (Straightening and widening the middle third of the nose for better airflow), and Endoscopic Sinus Surgery (increasing the opening into the facial sinuses) with or without stereotactic image guidance (Navigation) are often performed together depending on patients needs and symptoms.
Nasal surgery is typically an outpatient procedure performed under general anesthesia. At times, patients may be considered for local anesthesia with oral sedatives. The purposes of the proposed procedures are outlined above. Every patient’s anatomy and surgical needs are unique. Therefore each patient will have a different intraoperative and postoperative course. Because of this, it is difficult to predict the exact post-operative course that will occur.
Patients are prescribed antibiotics for 7 days, and pain medication postoperatively. You may also be prescribed an oral steroid such as prednisone or medrol around the time of or after surgery. While most patients state that this is mainly uncomfortable and not overtly painful, narcotic pain medication is often prescribed. Bacitracin, and subsequently Vaseline will be used to keep the front of the nose clean and hydrated, and nasal saline is to be used several times a day to keep the nose hydrated in the back (at least 5-7 times per day). A sinus rinse may also be recommended to help wash out mucus crusting to begin per your surgeons instructions.
Minimally invasive techniques are employed to address the nose. Incisions are placed inside the nose, and rarely between the skin of the nostrils, called the columella. Then using endoscopic equipment, the procedure is completed. Postoperatively, your physician may or may not place an intranasal dressing. The use of this depends on the extent of the surgery, and the risk for postoperative bleeding. Whether or not it is used, your nose will be very stuffy postoperatively. This is normal, and universally occurs in all patients for a few weeks. It requires periodic cleaning, or debridement’s to help prevent scar bands, allow for normal healing and to help patients breathe through their nose. For a period of 6 weeks the nose will need to be cleaned, because of mucus production and mucus caking in reaction to having surgery. After 6 weeks, further debridement is not typically needed but may be provided depending on the individual patients needs. Dissolvable drug eluding stents may be placed into your sinuses at your surgeons discretion. If these are used it is absolutely imperative that you follow a robust saline irrigation protocol.
Some bleeding is very normal and decreases over the first few days after surgery. A mustache dressing is commonly used to prevent the clothes from getting dirty. Unless an incision was used on the columella, no swelling or bruising is expected. If this external incision is used, it heals very well as it is hidden. Swelling comes down over several months, although the majority
of swelling decreases in the first 6 weeks. At times, a foul odor might come from the inside of the nose. People around you should not be able to smell this. However, it usually means the nose needs to be debrided.
Some facial pressure or headaches are normal after surgery, and typically exacerbated with leaning forward. Patients are encouraged to try not to lean forward, and instead bend down at the knees to pick things up. Some teeth sensitivity and nose numbness is normal, and will slowly go away over several weeks. Avoid blood thinners like aspirin, Motrin, ibuprofen and fish oil for the first 2 weeks after surgery. Blowing the nose is to be avoided for two weeks. Sniffling is fine, and antibiotic ointment, Vaseline and saline will be prescribed to help keep mucus caking to a minimal. Light exercise can be started at 2 weeks, but full exercise should be avoided for 4 weeks. Contact sports can resume after 6 weeks, as a nasal injury can not only damage the surgical results, but also be excruciatingly painful.
The following is a comprehensive, but not exclusive list of potential risks reported in the literature:
• Need for revision surgery (national average 10-15%)
• Bleeding (1-2%)
• Recurrence of nasal polyps
• Temporary pain, sensitivity and numbness of front teeth
• Difficulty breathing through nose
• Need for medical treatment including nasal sprays
• Poor healing with scar bands
• Septal perforation (hole) (< 1%)
• Decreased smell and taste (< 1%)
• Damage to nasolacrimal duct and excessive tearing (< 1%)
• Excessive crusting requiring cleaning
• Cerebrospinal fluid leak (< 1%)
• Pneuomocephalus (air within brain) (< 1%)
• Change to the appearance of the nose (< 1%)
• Meningitis (< 1%)
• Damage to the structures of the eye – blindness, double vision, orbital hematoma (< 1%)