[ Tests & Procedures]

Nasal Airway Surgery & Surgical Instructions

The following information is provided to help patients and their families prepare for surgery, and to understand more clearly the associated benefits, risks, and complications. Patients are encouraged to ask their doctor any questions that felt necessary to help better understand this procedure.

Nasal obstruction is usually caused by a deviated or crocked septum or enlarged tissues (turbinates) within the nose. A septoplasty is an operation to correct a deformity of the partition (the septum) between the two sides of the nose. A turbinectomy is the surgical removal of an abnormally enlarged turbinate from inside the nose to improve breathing. The goals of nasal airway surgery include the following: To improve airflow through the nose, to control nosebleeds, to enhance visualization of the inside of the nose, to relieve nasal headaches associated with swelling of the inside of the nose, and to promote drainage of the sinus cavities. Nasal airway surgery is done through the nostrils without the need for external incisions.

The following instructions are designed to help persons recover from nasal airway surgery as easily as possible. Taking care of oneself can prevent complications. The doctor will be happy to answer any related questions.

What is nasal airway surgery?

Nasal airway surgery is a group of procedures (septoplasty, turbinectomy) performed to improve nasal breathing. Nasal obstruction is usually caused by a deviated septum or enlarged turbinate within the nose. All surgical procedures have risks and potential complications. Understanding what is involved before, during, and after nasal airway surgery can help patients recover from the surgery as easily as possible.

What are risks and complications of nasal airway surgery?

The surgery will be performed safely and with care in order to obtain the best possible results. Patients have the right to be informed that the surgery may involve risks of unsuccessful results, complications, or injury from both known and unforeseen causes. Because individuals differ in their response to surgery, their anesthetic reactions, and their healing outcomes, ultimately there can be no guarantee made as to the results or potential complications. Furthermore, surgical outcomes may be dependent on preexisting or concurrent medical conditions.

The following complications have been reported in the medical literature. This list is not meant to be inclusive of every possible complication. They are listed here for information only, not to frighten patients, but to make them aware and more knowledgeable concerning this surgical procedure. Although many of these complications are rare, all have occurred at one time or another in the hands of experienced surgeons practicing the standard of community care. Anyone who is contemplating surgery must weigh the potential risks and complications against the potential benefits of the surgery, or any alternative to surgery.

Nasal obstruction due to failure to straighten the septum or later re-deviation of the septum, or the re- growth or swelling of the turbinates.

2. Failure to resolve coexisting sinus infections or recurrence of coexisting sinus problems and/or polyps, or need for further or more aggressive surgery.

3. Bleeding. In rare situations, a need for blood products or a blood transfusion. (Patients are encouraged to consult with the doctor if they are interested in autologous or designated donor directed blood prepared in advance in case an emergency transfusion was necessary.)

4. Chronic nasal drainage or excessive dryness or crusting of the nose or sinuses.

5. Need for allergy evaluation, treatments, or environmental controls. Surgery is not a cure for nor a substitute for good allergy control or treatment.

6. Failure to improve or resolve concurrent respiratory illness such as, but not limited to asthma, bronchitis, or cough.

7. Failure to resolve associated "sinus or nasal" headaches. The exact cause of headaches can be difficult to determine or have many causes. Patients may require consultation with another specialist such as a neurologist.

8. Damage to the eye and its associated structures (rare).

9. Permanent numbness of the upper teeth, palate, or face.

10. Prolonged pain, impaired healing, and the need for hospitalization.

11. Septal perforation, which is a permanent hole inside the nose between the two sides.

12. Failure to restore or worsening of the sense of smell or taste, or to relieve nosebleeds.

What happens before surgery?

In most situations, the surgery is performed as an outpatient at either the hospital or the surgicenter. In both facilities, quality care is provided without the expense and inconvenience of an overnight stay. An anesthesiologist will monitor throughout the procedure. Usually, the anesthesiologist will often call the night before surgery to review the medical history. If he or she is unable to reach the patient the night before surgery, they will talk with the patient the morning of surgery. If the doctor has ordered preoperative laboratory studies, patients should arrange to have these done several days in advance. They should also arrange for someone to transport them home from the surgical facility and to spend the first night after surgery with them.

After surgery, the doctor will usually ask patients to start using salt water (saline) irrigation’s. It is best to use a water pick for these irrigation’s. Patients will need to either purchase or borrow a water pick to start using after the packs have been removed. The doctor will instruct on how and when to start using the water pick irrigator.

Patients should not take aspirin, or any product containing aspirin, within 10 days of the date of surgery. Non-steroidal anti-inflammatory medications (such as ibuprofen or naproxen) should not be taken within 7 days of the date of surgery. Many over-the-counter products contain aspirin or ibuprofen type drugs so it is important to check all medications carefully. If there is any question patients should call the office or consult a Pharmacist. Acetaminophen (Tylenol) is an acceptable pain reliever. Usually the doctor will give prescriptions at the preoperative visit. It is best to have these filled prior to the date of surgery.

Patients must not eat or drink anything 6 hour prior to the time of surgery. This includes even water, candy, or chewing gum. Anything in the stomach increases the chances of an anesthetic complication. Smokers should make every effort to stop smoking, or at least reduce the number of cigarettes. This will help to reduce postoperative coughing and bleeding.

If patients are sick or have a fever the day before surgery, they should call the doctor’s office. If they wake up sick the day of surgery, they could still proceed to the surgical facility as planned for an evaluation. The doctor will decide if it's safe to proceed with surgery.

What happens the day of surgery?

It is important for patients to know precisely what time to check in with the surgical facility, and to allow sufficient preparation time. Patients should bring all papers and forms with you including any pre-operative orders and history sheets. They should wear comfortable loose fitting clothes which do not have to be pulled over head. All jewelry and valuables should be left at home. All make-up should be removed with a cleansing cream. Patients should thoroughly wash their face with soap and water. They should not apply make-up or cream to their face.

Patients should not take any medication unless instructed by the doctor or the anesthesiologist. Usually in the pre-operative holding room, a nurse will start an intravenous infusion line (IV) and patients may be given a medication to help them relax.

What happens during surgery?

In the operating room, the anesthesiologist will usually use a mixture of a gas and an intravenous medication to put the patient to sleep and to maintain anesthetic at a safe and comfortable level. During the procedure, they will be continuously monitored including pulse oximeter (oxygen saturation) and cardiac rhythm (EKG). The surgical team is prepared for any emergency. In addition to the surgeon and the anesthesiologist, there will be a nurse and a surgical technician in the room. The entire procedure usually takes one hour. The doctor will come to the waiting room to talk with any family or friends once the patient is safely to the recovery room.

What happens after surgery?

After surgery, the patient will be taken to the recovery room where a nurse will monitor. They will be able to go home the same day as the surgery once fully recovered from the anesthetic. This usually takes several hours. They will need a friend or family member to pick them up from the surgical facility and to take them home. This friend should spend the first night after surgery with them patient for assistance.

When patients arrive home from the surgical facility, they should go to bed and rest with their head elevated on 2-3 pillows. By keeping the head elevated above the heart they can minimize fluid accumulation in the tissues (edema) and swelling. They may get out of bed with assistance to use the bathroom. Patients should avoid straining. If constipated they should take a stool softener or a gentle laxative.

Patients may have some swelling of the nose, upper lip, cheeks, or around the eyes for several days after surgery. This swelling will gradually go away and is normal. They can help reduce it by keeping ice on the face, bridge of the nose, and eyes as much as tolerated. This will also help with postoperative edema and pain. Some patients have found frozen vegetable in packages (for example bags of frozen peas) to be a convenient ice pack which is more likely to conform to the face.

Moderate bleeding from the nose is normal, and will gradually decrease. The gauze dressing ("mustache dressing") will collect blood and should be changes only when saturated. It is not unusual to change these dressing every hour during the first 24 hours after surgery. After a few days patients will usually not need to use the dressing any longer. Patients should not take aspirin, aspirin-containing medications, or non-steroidal anti- inflammatory medications (such as ibuprofen or naproxen) for 3 weeks following surgery.

It is best for patients to eat a light, soft, and cool diet as tolerated once recovered fully from the anesthetic. They should avoid hot liquids for several days. Even though they may be hungry immediately after surgery, it is best to go slowly to prevent postoperative nausea and vomiting. Occasionally, they may vomit one or two times immediately after surgery; if it persists, the doctor can prescribe medication to settle the stomach. It is important to remember that a good overall diet with ample rest promotes healing.

Patients will be prescribed antibiotics after surgery, and should finish all the pills that have been ordered. Some form of a narcotic will also be prescribed and is to be taken as needed. If patients require narcotics they are cautioned not to drive. In some situations the doctor may give steroids to reduce inflammation either preoperatively and/or postoperatively. It is very important that patients take this medication as prescribed, and not discontinue it prematurely. If patients have nausea or vomiting postoperatively, they may be prescribed anti-emesis medications such as phenergan. If patients have any questions or you feel that you are developing a reaction to any of these medications, they should consult the doctor. Patients should not take any other medication, either prescribed or over-the-counter, unless they have discussed it with the doctor.

General Instructions and Follow-up Care

In most situations, packs will have been placed in your nose to control bleeding. The doctor will say when patients are to return to the office to have these removed. Patients may need to call the office to schedule this postoperative appointment and should arrange for someone to drive them to and from the office for this first visit. They should eat a light meal before going, and avoid taking excessive pain medications. They will also have several subsequent office visits to assess healing, remove crusts, and insure a speedy recovery. The nose will probably be tender after surgery, so the doctor will spray it with a special numbing medication before removing crusts.

After the packing has been removed, patients may breathe through the nose, but are not to blow or sneeze through it for 7-10 days. If they must sneeze, they should open their mouth. Patients can expect some light blood-tinged drainage from the nose for several days. If bleeding becomes excessive, apply ice and rest quietly with head elevated while holding the nose. If bleeding continues, they should call the office.

One of the most important things patients can do after surgery is nasal irrigation (rinsing). Immediately after the nasal packs are removed they should use a saline nasal spray such as "Ocean Spray" several times per day to prevent crusts from forming in your nose. The doctor will also have the patient start using a water pick irrigator during the first week of surgery. Patients are to continue using the water pick irrigator until we tell you to stop. Many patients will use it indefinitely or when they have an upper respiratory infection. Failure to irrigate will likely cause the surgery to fail!!

Patients may go back to work or school only when the doctor says. They should rest for the first week following surgery. They must also avoid excessive talking, smiling, hard chewing, strenuous activities, lifting heavy objects, bumping your nose, and bending over. They should not rest glasses on the bridge of the nose until soreness and swelling subsides. They may wear contact lenses once eye swelling and any irritation has resolved. Alcohol and tobacco should be avoided because they may prolong swelling and healing. Smoke, dust, and fumes may irritate the nose and cause an infection. Facial tanning is discouraged for 6 months after surgery. If patients must be in the sun they should use a number 15 or greater sun block. They may use their usual make-up anytime after surgery.

Patients should lubricate the nostrils, as instructed, with a Q-tip and Vaseline to soften harden crusts. Peroxide helps to loosen crusts. After several days they may notice a few of the absorbable sutures. They must be gentle while brushing the upper teeth. These will often be tender for several weeks, and there may be some numbness of the teeth and palate for several months.

After 3 weeks if patients are not having problems with bleeding, they may resume exercise and swimming, but no diving for two months. They should plan to stay in town for 3 weeks to allow for postoperative care and in case you have bleeding.

Patients Should Notify The Doctor If They Have:

A sudden increase in the amount of bleeding from the nose unrelieved by pressure, ice, and head elevation.

A fever greater than 101.5 degrees F which persists despite increasing the amount of fluid and acetaminophen (Tylenol). A person with a fever should try to drink approximately one cup of fluid each waking hour.

Persistent sharp pain or headache which is not relieved by the pain medication prescribed.

Increased swelling or redness of the nose or eyes.