Download Septoplasty Turbinoplasty

SEPTOPLASTY/TURBINOPLASTY: PATIENT INFORMATION
Date:_____________________
Dear _____________________
Please find the following literature informative and helpful with respect to your upcoming surgical procedure.
You have been scheduled for an operation on your nose called a septoplasty/turbinoplasty designed to improve your nasal airway function
due to an internal structural deformity. A septoplasty straightens the internal nasal septum; the midline cartilage and bony partition which
divides your nose into a right and left nasal passage. It is a deviation of the septum into either nasal airway which leads to functional
obstruction of the nasal airway passage and restricted breathing problems, and at times sinus conditions. Additionally, abnormally enlarged
bony and mucosal projections from the lateral walls of the nasal cavity called turbinates, often contribute to the nasal airway compromise.
These structures may become congested, hypertrophic and/or may compensate by enlargement on the opposite side of the septal deviation
promoting additional nasal airway compromise. It is the turbinates which are commonly addressed medically with over-the-counter or nasal
steroid sprays to improve nasal airway patency. When resistant to medical therapy, they often benefit from surgery. Along with
straightening the nasal septum, the turbinates may be reduced with cauterization, electrically shrunk, treated with radiofrequency
currents/lasers, or partially removed to improve nasal airway function. The rhinoplasty is the surgical procedure utilized to alter the external
appearance of the nose for either cosmetic or functional improvement with respect to the very deviated or traumatized nose. This may be
performed at the same time as septal surgery, or as a separate procedure.
The procedure of Septoplasty/Turbinoplasty is performed under general anesthesia on an outpatient basis. All incisions are performed inside
the nose, unless an open rhinoplasty is additionally performed which will require external nasal incisions. Upon reduction of the turbinates
and straightening of the nasal septum, soft, pliable intranasal Silastic splints with attached airways are sutured inside the nose for internal
septal support during the postoperative healing period. Rarely is intranasal packing required. The splints are often unnoticed externally,
although you may see the tips of the splints upon very close examination of the nostrils. The splints are removed at one week postoperatively
in the office. The purpose of nasal splints is to stabilize the nose and provide nasal passages for breathing during the recovery period. With
septoplasty surgery there is only mild external swelling of the nose, with anticipated intranasal congestion pressure, and blood tinged to clear
nasal drainage. If a rhinoplasty is additionally performed, an external nasal cast is required. Rhinoplastic procedures result in external facial
swelling, bruising around the nose and eyes, and moderate discomfort postoperatively. Discomfort varies individually with these procedures
and is managed with pain medications.
As with any surgical procedure, risks/complications can occur:
1. Bleeding: Usually minimal after surgery. The nose has the potential to bleed during or after the surgical procedure. This may require
additional packing, further surgery or rarely a blood transfusion.
2. Infection: Though uncommon, may have adverse effects on the nose. Signs of infection are progressive pain, fever or purulent nasal
drainage, a rash on the body or palms of the hands, and lowering of blood pressure with lightheadedness. If infection is treated early, it
usually resolves quickly. If there is delay, surgical drainage may be required and a nasal deformity may occur. Progressive nose
infections may advance to a central nervous system infection and meningitis in very rare cases.
3. Nerve Injury: Rare to have permanent numbness of the nose, but may take several months to resolve. Rarely upper lip numbness, roof
of mouth pain, numbness (temporary or permanent).
4. Septal Perforation: If unfavorable healing occurs, a persistent hole may occur in the septum resulting in whistling in the nose, chronic
bleeding and crusting.
5. Additional risks include eye trauma or injury, tear duct injury, external cosmetic deformity, irregularities/unevenness/depressions,
scarring, tooth/lip/skin numbness, breathing problems, sinusitis, (this surgery does not correct allergies), and rarely, CSF drainage of
brain fluid have been reported.
6. Others: There are other rare and less severe complications.
7. There are no guarantees that breathing will improve completely after the procedure, or that the external appearance will meet
expectations. The goals are for improvement. Additional surgical procedures or therapy may be required.
Postoperative Instructions:
1. Diet: Begin with clear liquids & progress to a bland regular diet as tolerated after surgery. Avoid acidic & spicy food products.
Smoking & alcohol drinking should be avoided for up to two weeks after surgery to promote good healing & reduce risk of bleeding.
2. Take all medications as prescribed. You will be provided with an antibiotic and analgesic. Avoid all aspirin, aspirin containing products
or anti-inflammatory medications (i.e., Motrin, Advil, Naprosyn, etc.), vitamin E or herbal supplements for up to two weeks
postoperatively. These medications promote bleeding.
3. Sleep with your head elevated on two pillows or in a recliner to control swelling. A bedside humidifier reduces nose and throat dryness.
4. No nose blowing until the splints are removed one week postoperatively. You should sneeze with your mouth open.
5. Avoid exposure to temperature extremes.
6. All strenuous activity including exercise, straining, heavy lifting, bending, stooping and sexual activity should be avoided for up to two
weeks postoperatively. All contact activities that may traumatize the nose should be avoided for up to six weeks. If a rhinoplasty is
performed, it requires six weeks for the nasal bones to stabilize and heal. Additionally, with rhinoplastic patients, one should avoid all
contact or trauma to the external nose. No water should contact or be introduced underneath the cast (no showering).
7. Do not attempt to remove or disturb the Silastic splints which may be slightly visible upon very close examination of the nostrils. Do not
attempt to remove or disturb the external nasal cast (if applicable).
8. The day after surgery recommended care is to begin “sniffing” intranasal saline spray (i.e., AYR or Ocean Mist Spray) 3-5 times daily.
You may prepare a home mixture of nasal saline by mixing cooled, 1 quart previously boiled water with 1 Tbs. salt & 1 tsp. baking soda.
9. Expectations: Expected sequelae from a septoplasty procedure include nasal congestion and pressure, mild facial swelling and
discomfort, and nasal obstruction requiring mouth breathing postoperatively. If a rhinoplasty is performed to correct the external nose,
there is additional facial swelling, bruising and moderate to severe pain. It is not uncommon to experience mild external nasal and upper
lip numbness for several weeks postoperatively.
 Nasal congestion and smelling changes are normal. These may persist for up to two months after surgery due to the healing process.
You should experience a reduced sense of smell and taste until the splints are removed.
 It is normal to experience nasal drainage for several days after this surgery. This drainage will initially be bright red blood, which
shall later darken and form clots and then resort to blood tinged mucousy discharge. A drip pad or small cottonballs may be gently
placed in the nostrils and used for the first 24 hours or intermittently as needed until your follow-up appointment. Occasionally, you
may have an episode of vomiting after surgery which may contain dark blood.
 There will be crusting and swelling in both nostrils for several weeks after the surgery, so some difficulty breathing through your
nose is normal. Clean the nostril rims gently with Q-tips and peroxide. Proper, gentle cleaning will simplify the removal of the
intranasal splints one week postoperatively.
10. Steam showers (avoid if rhinoplasty) and a bedside humidifier may be utilized twice a day to improve intranasal moisture.
11. If the nose should bleed, sit quietly with your head elevated at 45. Gently apply pressure by pinching the tip of the nose and avoid any
nose blowing. Cottonballs gently placed in the nostril openings may be used and left in place for 6-8 hours. Ice may be applied to the
back of the neck and the facial areas. If bleeding does not stop after 15 minutes or show improvement, please call the office or have
someone drive you to the nearest Emergency Room.
12. If you have undertaken a Rhinoplasty, please abide by all rhinoplasty instructions as these differ and are more complex from those
procedures which entail a Septoplasty procedure alone.
13. Please contact the office for a follow-up appointment one week postoperatively.
14. You may return to work one to two weeks after surgery.
15. Please notify the office if you develop a temperature greater than 101 or any signs of increasing facial pain, swelling, redness,
malodorous nasal drainage, neck stiffness, rashes or skin peeling. Please contact the Office at (303) 651-6770 or the Answering Service
at (303) 684-3043.
16. The nose may be blown routinely only after the splints are removed upon your first postoperative visit (seven days after surgery). Avoid
pulling on the base of the nose or applying force to the lateral walls of the nose (especially with rhinoplasty) during nose blowing
activity. Any nose blowing prior to intranasal splint removal will result in additional nasal airway obstruction and postoperative
discomfort. Frequent nasal saline washes and steam showers along with a bedside humidifier are recommended for up to eight weeks
postoperatively. Antibiotic ointment utilized in the nostrils postoperatively for up to three weeks is also beneficial. Topical nasal steroid
sprays will be resumed at one month postoperatively if you suffer from allergic rhinitis.
Please note that the majority of Septoplasty/Turbinoplasty surgical procedures are successful, uneventful and very well tolerated. My office
staff and I look forward to working with you personally, and shall support you during your hospital course and recovery period. Please do
not hesitate to ask for assistance.
After you have read and understand these instructions, please sign the acknowledgment below.
______________________________
Patient Signature
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Date
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Witness/Surgeon Signature
____________________________
Date
PMS/rdc-7/23/08
(Septoplasty/Turbinoplasty)