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Nasal Surgery

August 4, 2016

 

NASAL SURGERY NOTES

 

We consider nasal surgery mostly for those who have both symptoms and signs of problems in the nose.  

 

Other than "balloon sinuplasty", the surgery we perform is done under general anesthesia at a hospital.

  • Before Surgery

Before surgery, there will be a consultation and sometimes two, with discussions about the plan and the anatomical considerations.  Many require nasal imaging (ie "CAT scans") and as a courtesy to you, hudsonENT staff will obtain prior-authorization from insurance.  If needed, you can tour the hospital.

 

Medicines prescribed will be used only after surgery (unless discussed), but can be picked up the evening before surgery.  Not everyone needs medicine, and the exact regimen is tailored by Dr. Kortbus for you. 

Do not take blood thinners for ten to fourteen days (10-14) before your surgery date.

These pages are helpful to determine what a blood thinner is.....

https://goo.gl/C5UEAV

https://goo.gl/XHWZoR

 

  • The Day of Surgery

You will register at the hospital ground floor, then come up to the third floor.  Ambulatory nursing will ask you questions about your health, robe you and obtain IV access (ie "put an IV in").

You will see Dr. Kortbus, the anesthesiologist, and other staff.  Your family member or friend can be with you all the way to the "preop holding area".  Thereafter, you'll be escorted into the operating room (OR).

In the OR, myself, the anesthesiologist, the surgical technician and the circulating nurse will be there during the entire procedure. The first step will be to situate you comfortably; then give medicine through the IV; then through the breathing tube. While that happens, Dr. Kortbus will be working through your nostril to correct the issue for which you are there.  Be it straightening the septum or opening the sinuses, it is done through the nostrils.  

SInce the surgery is done through the nostrils, scars, "black eyes", and changes in the shape of the nose are not intended.  In fact, these would be very rare unless Dr. Kortbus has discussed this with you before-hand.

The exact steps in surgery are beyond this blog, and can be discussed with me should there be interest.

After you wake up [from anesthesia], you will be in the "PACU" (post-anesthesia care unit, aka recovery room) for an hour or so.  There will be a bandage on the nose.  You might have some ice chips here.  When the anesthesia personnel and nurses find you to be ready, you'll leave the PACU for the ambulatory bed you started at earlier in the morning, have some food and drink, then be allowed to go home if you and the ambulatory nurses feel ready.

Nasal saline spray will be required starting in PACU, given each 15 minutes, and continued until discharge.  At home, use the nasal saline as often as you can, maybe not more than once per 30 minutes but not less than once every two hours.

 

  • After Surgery: first week, before first "post-op" visit

At home, you can eat and drink whatever you would like.  You may bathe. In the shower, resist the urge to bow the nose!

-You should not blow your nose at all until you see me again

-You should not take blood thinners (see above websites)

-You should not lift anything more than ten pounds (10#), including children, TV sets, trays of baked ziti and such.

You can take acetaminophen (Tylenol) for pain, or the stronger medicine I have prescribed.  If you are constipated, do not force yourself, but take 100 mg of colace (stool softener).  Bearing down (aka Valsalva maneuver) leads to markedly increased nasal pressure, and could create a nasal hemorrage.

The top two front teeth and/or roof of the mouth might be numb or tingling.  This is normal and should resolve over time.

Expect nasal bleeding.

It should be light, but present.  If you have none, that is alright, but since I do not use nasal packing, you should expect a small trickle.  You will notice more when you go up to change the channel, grab a snack, or go to the bathroom. If you have a serious, profuse, dark red nasal bleeding please call the office right away, call 911, or proceed directly to the nearest emergency room.

For those inclined to take "alternative medicine", Arnica montana is acceptable in it's sublingual form before and after surgery.

You should not leave the general Hudson Valley area without discussing with the office [before surgery] until further notice, but typically for the first two weeks after surgery.

The nasal saline spray should be continued.  No other things shall be placed into the nose without our consent. In other words, do NOT do sinus rinse, nasal medicine spray, pepper spray, or use a finger in the nose.

The nose will be more clogged after surgery than it was before.  This is normal, expected, and temporary.  You might want to sleep on a recliner (e.g. LazyBoy), or use pillows.  A humidifier in the room on the night stand next to your head could help keep moisture.

 

  • First Postop: Day 8 (POD 8) or 11 (POD 11)

When you come to Red Hook to have your first postop, the nose will be sprayed with the decongestant you had before and you will have something called "nasal endoscopy with debridement".

This is critical for many reasons:

1. The debris, mucus and clots are removed

2. The status of the surgery is seen

3. Any early problems with healing can be addressed and usually corrected right then and there

4. You will have relief of breathing

5. Usually, you will be relieved of peri-operative restrictions.

Sometimes, implants (but not packing) are placed in the nose.  These, sutures and such may be removed at this visit.  It will be gentle, through your nostrils, and effective. You can drive yourself to and from this appointment.

Missing this appointment can yield bad results. This appointment and it's timing are ESSENTIAL.

This next phase (after POD 8) is when the nasal saline bottle spray can be changed to as needed, and the sinus rinse will begin. We would like you to start the rinse that night (Friday night), then continue it twice a day.

The rinse is best done with your torso horizontal to the ground, which usualluy needs a shower so that your other floors don't get soiled. We will give you the rinse bottle, and you will get distilled water and packets.  Use it twice daily for the first two weeks after this visit, then once daily during weeks 3 and 4.

We usually tell patients, "you might see any color of the rainbow come out with the rinse", and then some.....including black or brown mucus.  THis is normal.  If this discoloration comes out without rinse, with fever, with pain, or something else not discussed, please notify the office right away, Sinus infections can happen after sinus surgery, especially in the first month or two as the nose is healing.

You also might see portions of clear lattice (if implant used), little blue things that look like the number one (1), and or sutures.  These can be expected, but again, if they are not seen that is acceptable as well.  Whatever surgical new-age equipment was used (eg implants, sutures, surgical fasteners), they are absorbable and "well-tolerated".

If nasal medicine is needed (e.g. fluticasone), it will be recommended at this time and should be sprayed in the nose about 15 monutes after the rinse, either morning or not but not usually both.

 

  • Second Postoperative Visit

About a month after the first visit, and 5 weeks or so after the surgery, you will be seen again. Often, this visit is a check with the nasal endoscope (which interestingly is labeled surgery by your insurance but is not really surgery) and sometimes a debridement takes place here too.  As above, this means removing clots or debris.

After this, sinus rinses are recommended on an as-needed basis.

After this visit, and depending on how you are doing, Dr Kortbus will see you one, three or six months thereafter.  If any concerns arise in that period, please don't hesitate to call.

When done in experienced hands, nasal surgery is meant to increase the quality of life.  Breathing typically is improved after some healing period.  Nasal surgery is not a cure for the common cold or for allergies, but nasal surgery should decrease the quantity and quality of nasal and sinus problems.

(c.f. Int Forum Allergy Rhinol. 2014 Oct;4(10):823-7. doi: 10.1002/alr.21366. Epub 2014 Sep 11.)

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