Download Septoplasty and Turbinate Reduction

 SeptoplastyandTurbinate
Reduction
SurgicalInformation
PREOPERATIVEDISCUSSIONFOR
SEPTOPLASTYandTURBINATEREDUCTION Septoplasty
Thenasalseptumismadeofcartilageandbonecoveredwithalining(mucosa).Itdividesthenoseintotwo
separatechambers,leftandright.Normally,theseptumisrelativelystraight,withrightandleftnasalcavities
ofsimilarsize.Occasionally,however,thenasalseptummaybeseverelybent,ordeviated–enoughto
encroachonanasalcavity.Adeviatednasalseptummaydevelopasthenosegrows,orcouldresultfroman
injurytothenose.Commoncomplicationsarebreathinginterferenceandapredispositiontosinusinfections.
AdeviatednasalseptumthatinterfereswithproperfunctionofthenoseiscorrectedbySeptoplasty.The
surgerycantakeplaceundergeneralorlocalanesthesia.Usingaheadlightoranendoscope,thesurgeon
makesanincisioninsidethenose,liftsuptheliningoftheseptum,andremovesandstraightensthedeviated
portionsoftheseptalboneandcartilage.Surgeryusuallytakesabout1‐1.5hoursandisscheduledasan
outpatient.
Intheearlyperiodfollowingthesurgery,thereisusuallysometendernessandswellinginsidethenose.Over
time,becausethenasalcartilagehassome"memory,"therecanbeatendencyfortheseptumtoreshapeitself
backtowarditsdeviatedposition.Othercomplicationsfromthesurgeryareveryrare,butcaninclude
bleeding,changeinshapeofthenose,somenumbnessofthefrontteeth,orimpairmentandevenlossofthe
senseofsmell.Aseptalperforationmayoccuronrareinstances.Thisisaholethroughbothsidesofthe
liningofthenasalseptum.Crusting,bleeding,andwhistlingtypenoisesmayoccurifaperforationexists.
Smallperforationsmayoccurthatdonotrequirefurtherintervention.Repeatoperationsarerarebutdo
occasionallyneedtobeperformed.
PREOPERATIVEDISCUSSIONFORTURBINATEREDUCTION
Reduction/RemovaloftheInferiorTurbinate
Protrudingintoeachbreathingpassagearebonyprojectionscalledturbinatesthatincreasethesurfacearea
oftheinsideofthenoseandboostits'airconditioning'andair‐filteringfunctions.Therearethreeturbinates
(inferior,middle,andsuperior)oneachsideofthenose.
Large,swolleninferiorturbinatescanleadtoblockageofnasalbreathing.Therearetwomainreasonsfor
enlargement.Mostofthetime,enlargedinferiorturbinatesaretheresultofallergies,irritatingenvironmental
exposure,orsomeminorpersistentinflammationwithinthesinuses.Anotherreasonisdeformityofthenasal
septumthathascausedtheboneonthewidersideoftheturbinatetoincreaseinsize.Inthecaseofallergy‐
orirritant‐relatedenlargement,treatmentoftheunderlyingproblemmayreduce
turbinateswellingandsolvetheproblem.Ifnot,turbinatereductionsurgerymayberequired.Becausethe
turbinateshelpthenosetocleanandhumidifytheairwebreathe,itisusuallybettertoleaveasmuchtissue
intactaspossible.Thedoctorwillprobablyoptforselective,ortargeted,turbinatereduction–ratherthan
extensivereduction.
Iftheprocedureisisolated,andnotpartofanothersinusoperation,reductionoftheinferiorturbinateis
usuallyperformedunderlocalanesthesia.Sometimes,surgeryisguidedbyaheadlight,butincreasingly,
surgeonsuseendoscopestoimprovevisualizationandprovideamagnifiedviewduringsurgery.Once
oriented,thesurgeonmakesanincisionintheliningmucosaoftheturbinateandcarefullyremovesthe
underlyingboneoftheturbinate.Ifselectiveremovalofsofttissueisalsonecessary,itcanbeaccomplished
usingamicrodebriderorlaser.Occasionally,persistentswolleninferiorturbinatesareeffectivelytreated
withafreezingtechnique(cryotherapy).Alternately,theyareheatedwithradiofrequencyelectricalcurrent
(cauteryorradiofrequencysurgery).Thesemethodscannotbeusedwhenthesurgeonmustremovean
enlargedunderlyingturbinatebone.
Complicationsassociatedwithinferiorturbinatesurgeryincludebleeding,crusting,dryness,andscarring.If
youundergoaninferiorturbinatereduction,yourdoctormayprescribeasprayorwaterysolutiontorelieve
drynessandaidinhealing.Thereisgenerallylessriskofseriouscomplicationstodaythaninthepast,when
inferiorturbinateswereextensivelycutout,sometimescausingexcessivecrustingandnasaldysfunction.
Reduction/RemovalofMiddleTurbinate
Protrudingintoeachbreathingpassagearebonyprojectionscalledturbinatesthathelpincreasethesurface
areaoftheinsideofthenoseandboostits'airconditioning'andair‐filteringfunction.Therearethree
turbinates(inferior,middle,andsuperior)oneachsideofthenose.
Occasionally,themiddleturbinatemaybecomeenlargedbythepresenceofaninvadingaircell(concha
bullosa),oritmaybeabnormallyshaped(paradoxicallybent).Severeethmoidsinusitisornasalpolypscan
alsoleadtodiseaseofthemiddleturbinates.Sincemostimportantsinusdrainageoccursjustalongsidethe
middleturbinate,abnormalformationsoftheturbinatecancontributetosinusproblemsandrequiresurgical
correction.
Liketheinferiorturbinates,healthymiddleturbinatescontributetonormalnasalfunctioning.Theyalso
containsomeoftheolfactorynerveendingsthatmakeupoursenseofsmell.Forthisreason,yourdoctorwill
probablyprescribethemostminimalsurgicalprocedurerequiredtocorrectthesituation.Ifthereisan
abnormalenlargement(conchabullosa),thismayinvolveremovingtheboneononesideoftheinvadingair
sac.Inthecaseofanabnormallyshapedmiddleturbinate,partoftheturbinatemayberemoved.Whenthe
middleturbinatehasbecomeseverelyinflamedorcomplicatedwithpolyps,however,itmaybenecessaryto
removemuchorallofthestructure.
Septoplasty
WHATCANIEXPECTAFTERSURGERY?
Therewillbeamildtomoderateamountofpainanddiscomfortassociatedwiththesurgery.Thisshouldbe
easilycontrolledwithoralmedications.Thediscomfortandpainshouldbegintodecreasewithin72hours
aftersurgeryandasignificantincreaseinpainafterthisperiodshouldpromptyoutocalltheoffice.
Bruisingandswellingarenotunusualafterthesurgery.Thesesymptomsoftenworsenonthesecondday
followingsurgery,andthensteadilyimprovethereafter;thisisnormal.Onlyslight,ifany,bruisingwill
normallybeexpectedtooccur.
Somebloodynasaldischargeistobeexpectedafteranynasalsurgery.Asmall"mustache"typegauze
dressingwillbeplacedbeneathyournoseafteryoursurgery.Duringthefirst24‐48hours,thisabsorbent
dressingoftenneedstobechanged10‐20times;thisistobeexpected.
Oftenatthecompletionofthesurgery,plasticsplintsareplacedontheinsideofthenose.Internaland
externalnasaldressingsareremovedin5‐7daysaftersurgery.
Nasalstuffinessisthemostannoyingproblemthatyouwillfaceaftersurgery.Itismostdistressfulinthefirst
weekaftersurgery,andsignificantlyimprovesoncetheinternalnasalsplintsareremoved.Anyresidual
stuffinesscanbeexpectedtograduallyimproveoveraperiodofseveralweeksthereafter.
Excessmucusisoftenpresentinthethroataftersurgery.Itisduetothesplintsinsidethenosestimulating
thenosetotemporarilyproducemoremucusthanisnormal.Thiswillresolveoncethesplintsareremoved
(5to7daysaftersurgery).
Numbnessinthetipofthenose,upperfrontteethorroofofthemouthfollowingsurgeryistobeexpected
becausenasalsurgerytypicallycausesatemporarydisruptionofsomeofthenervesinthearea.Sensation
willgenerallyreturnslowlyoveraperiodofseveralweeks,andrarely,months.
Sometemporarydecreaseoralterationinthesenseofsmellortasteistypicalaftersurgery.Thisis,again,
secondarytodisruptionofsomenervesinthenoseduringsurgery.Thesechangeswillbegintoimprove
withinthefirst1to2weeksaftertheprocedure.
Patientswhohaveundergoneonlyseptalsurgerydonotnormallyhaveanysignificantswellingonthe
outsideofthenose.
CALLTHEOFFICEPROMPTLYIFYOUNOTICEANYOFTHEFOLLOWING:
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developmentofatemperatureelevationexceeding100degrees.
unusualamountofbleedingfromthenose.Anysignificantreinjuryofthenose.
asignificantprogressiveincreaseinpainwhichisnoteasilyrelievedbytakingyourprescribed
medication
Ifanyoftheaboveshouldoccurafterregularofficehours,donothesitatetoreachusthroughtheanswering
service.Forwhateverreason,ifyounoticeoneoftheabovechangesandcannotreachusatourofficeor
throughtheansweringservice,presentyourselftotheemergencydepartmentforevaluation
HOWDOICAREFORMYSELFAFTERSURGERY?
Makearrangementstohavesomeonedriveyouto,andfrom,yoursurgery.
Havingsomeonestaywithyouonatleastthefirstnightafteryoursurgeryishighlyrecommended.
Besuretofillyourprescriptionsbeforeyoursurgerysinceitmeansonelessthingforyoutoworryabout
afterwards.
Youshouldsquirtsalinemistspray(e.g.salinex,oceanspray)andthenplaceasmalldabofeithervaselineor
antibioticointment(e.g.polysporinorbacitracin)insideyournose4to6timesaday,beginningonthefirst
dayaftersurgery.Thiswillminimizenasalcrustingandmakeyoufeelmorecomfortable.Boththesaline
sprayandantibioticointmentareavailableatdrugstoreswithoutaprescription.AQ‐tipmoistenedwith
hydrogenperoxidemaybeswabbedinthenose(becarefulnottowettheoutsideofthenose)2to3timesa
daytoalsohelpreducenasalcrusting.
Arriveforyoursurgeryinloose,comfortableclothing.Yourtopshouldbuttonorzipratherthanpullover
yourhead.
Taketheantibioticsandpainmedicationonlyasprescribedbytheoffice.
Donottakeanyaspirinoranyanti‐inflammatorycompoundsfor2weeksbeforeand2weeksafteryour
surgeryunlessyoufirstdiscussitwithyoursurgeon.
Ifyouareasmoker,youshouldnotsmokeforatleast2weekspriortosurgeryand2weeksaftersurgery.
Smokingandchewingtobaccoinhibityourcirculationandcansignificantlycompromiseyoursurgical
outcome.
Tominimizeswelling,youmayusecool,cleancompressesoricewrappedinadrycloth.Applythesegentlyto
yourclosedeyesfourtosixtimesadayforthefirsttwentyfourhoursaftersurgery.
Sleepwiththeheadelevatedforthefirstweekaftersurgery.
Youshouldnotblowyournosefortwoweeksaftersurgeryasitcandisruptproperhealingandcause
bleeding.Ifyouhavetosneeze,sneezewithyourmouthwideopenasthiswillminimizeanydisturbance
withinthenose.
Donottravelbyplanefor10to14daysafternasalsurgeryinordertoavoidanypossibilityofsinusblockage.
Usually,yoursurgeonwillusedissolvablesuturesinsidethenosewhichwilldisappearontheirownwithina
fewweeks.Anyexternalsuturesshouldbekeptcleananddry.Ifnon‐dissolvablesuturesareusedonexternal
incisions,theyshouldberemovedwithin5to7daysaftersurgery(atthetimeofsplintremoval).
Youshoulddonovigorousexerciseandshouldavoidanysignificantphysicalexertion,liftingorstrainingfor
aminimumof3weeksafteryoursurgery,asthisactivitycoulddisruptyourwoundhealingandcause
bleeding.Planontakingiteasy.Althoughyournosewillnotfeelpainfulwhilehealing,itisstillsusceptibleto
injury.Becarefulnottobumpitorsqueezeit.Beawarethatthemostcommonsourcesofinadvertentinjury
toyournoseaftersurgeryarechildrenandpets.
RECOVERYTIMETABLE
DAY1
Returnhome.Nasalcongestionmild.Changemustachedressingasneeded(often10
to20times).
DAY2‐5
Nasalstuffinessismainproblem.
DAY5‐7
Internalnasalsplintsremoved.Stuffinessandnasalcongestionmuchbetter.
DAY7‐10
Slightlyworsenasalcongestion.
WEEK3‐4
Nasalbreathingmuchimproved.
REMEMBER:Ifyouhaveanyconcernsorquestions,youshouldbecomfortablecontactingouroffice
anytime.Ourofficeshouldbeasourceofinformationandreassurancethroughouttheentireperiod
fromthetimeofyourfirstconsultationandcontinuingafteryoursurgery.
If we can help you at all, please do not hesitate to contact us.
Dr Sims Cell Phone: 270.791.1006 Greenview: 270.793.1000 Medical Center: 270.745.1000 Office: 270.782.7768 Nasal Septoplasty and Turbinate Surgery
Any surgery will require a healing period, which varied with the type of the operation performed and from
patient to patient. The more you are informed about what to expect after surgery, the easier it will be for
you or your child during this time.
I will be happy to answer any questions you might have. During the weekday call my office @ 270-7827768. After hours you may the office and will be directed to the on call physician. If there is an
emergency and you cannot reach us at these numbers, call the emergency room at Greenview Regional
Hospital 270-793-1000 or The Medical Center 270-745-1000.
SYMPTOM
RECOMMENDATION
1. Pain & Headache............... Use pain medication as prescribed. It may be felt in the top and back of
your head or in the teeth as well as the face. If any nasal packs or stents
are used, it will improve after they are out.
2. Nasal Congestion.............. Expect the nose to be congested after surgery. Salt-water nose spray,
humidifier and vaporizer along with gentle nose blowing will help. Blow
gently with both sides open. A "cold pill" might help the symptoms. Scabs
will be produced inside the nose for up to several months. Breathing will
improve as they clear up.
3. Bleeding...........................
Your nose will likely bleed for several days. If large amounts of blood are
seen, contact the office.
4. Humidification................... Use a vaporizer and salt-water nose spray to keep your nose moist. The
nose spray can be used every hour with 2-3 squirts in each side followed
by gentle blowing to clear it.
5. Activity.............................
Do not bend over or do any heavy lifting or straining. I will tell you when to
return to work if heavy physical exertion is needed.
6. Medications......................
Resume any medications you have been on unless they are "blood
thinners" or I have told you otherwise.