Septoplasty / Turbinate Surgery

The nasal septum separates the nose into two halves. For many different reasons, the nasal septum can curve or bend onto one/ or both sides of the nose. The result of this abnormality, call a deviated septum, can result in nasal airway obstruction (difficulty breathing through the nose) facial pain, nasal drainage, nosebleeds, increase snoring and or sinusitis.

Turbinates are special fins inside the nose, which warm and moisturize the air in preparation for breathing. These turbinates, when swollen from allergies, upper respiratory tract infections, hot to cold changes, or lying down increase the chances for nasal airway obstruction.

The procedure to correct the deviation of nasal septum is called a septoplasty. It is performed through the nose (through the nostrils) and there are no outside incisions. While the surgery is minimum in nature, you should still allow for recovery time and follow some basic postoperative instructions.

The procedure to reduce the turbinates is called a turbinectomy or turbinate reduction. It is also done solely through the nose.

Preoperative Instructions

Unless prescribed by a physician, do not take any aspirin or aspirin products for one week prior to surgery or after surgery. Tylenol is generally OK. If you are on Coumadin or Plavix, the prescribing physician should give you the instruction for the pre and post operative use. Do not eat or drink anything after midnight the day before surgery. If you have any required medications, you should take them in the morning with a sip of water. In addition, it is important that you wash your hair the night before surgery and do not use make up the day of surgery. Please remember that you will need to make arrangements for transportation to and from the hospital the day of surgery.

Post Operative Instructions

Following surgery, you may remain in the hospital for one to several hours to be sure you will recover as expected. Typically, there is no swelling or bruising around the face after the surgical procedure. Post operatively, you may experience some nasal stuffiness or pressure or decrease sense of smell. There may be some other symptoms such as increased mucus drainage, mild headache, or throat irritation. Snoring may be worse then usual. There will likely be some soreness just inside the nostrils, at the tip of the nose, or in the upper teeth. It is not unusual to feel somewhat tired and lethargic right after surgery. In addition, there is often nasal packing inside the nose which. This will be removed one to two days post surgery.

All these symptoms typically disappear within days to weeks. If they persist, please bring them to the attention of the physician at the postoperative visit.

At any time during the post operative period, you have questions concerning pain, bleeding, drainage, fever, nausea, that are out of the ordinary, please call the office or the physician on call.

Post Operative Office Visits

The postoperative examinations and cleanings are essential to a successful outcome. During sinus surgery, openings are made into the sinus cavities. There is a window of time when things heal, or, as I like to think of it, “harden.” If you can get the sinus openings and configurations to “harden” in the right shape, they will usually work well for life. The sinus openings that are created during surgery will always become somewhat smaller as they heal. If examinations suggest that they will become too small to achieve the goal of improved drainage, then simple measures in the office can correct things during the immediate post-operative period.

One way that the sinuses can heal incorrectly is when crusts of dried blood remain in the cavities. These crusts can act like bridges and permit the mucous membranes to heal across gaps that they were not intended to cross. By cleaning these crusts post operatively, the healing process becomes more predictable, quicker, and more likely to achieve the surgical goals.

A common postoperative visit begins with a simple nasal exam. If this is the first post-op visit, the amount of cleaning will depend on what was done and how sensitive things are. The nasal passage will be numbed with a lidocaine and neo-synephrine solution. Once the nasal passage is decongested and numbed, an endoscopic exam may be performed. If everything looks good and is healing well, the exam is terminated and a return visit is scheduled. Occasionally a good bit of cleaning is needed. In most cases, cleaning crusts and material out of post-operative sinus cavities is not very painful.

Activity

  • Bed rest and light activity for the first twenty-four hours post operatively. You may increase your activity level as you can tolerate but do so slowly. There should be no driving of vehicles for forty-eight hours. Avoid any heavy lifting, bending, straining, or stooping for two weeks post surgery. Light exercise, e.g. walking can begin ten days post surgery. If you have any questions, please ask.
  • Try to keep your head elevated during sleep for at least 3 days after surgery. Sleeping on two or more pillows is effective. A recliner chair is also an excellent option.
  • Depending on the individual and the type of surgery done, disability from work may vary. Most patients are able to return to work or school within 48 hours after surgery.
  • It is okay to shower or bathe postoperatively. Avoid particularly hot or steamy showers for several days after surgery.
  • Treat your nose with care. Avoid situations that might result in any trauma to your nose.

Diet

Begin with a liquid or very soft diet for 24 hours. You may advance to regular foods as soon as it is comfortable for you.

Medication

  • Pain, if any, is usually minimal, though this varies from individual to individual. Tylenol (acetaminophen) by itself is an excellent choice for mild post-operative discomfort. For more significant or persistent pain, do not hesitate to use the pain medication prescribed. Do not take the prescription pain meds and Tylenol at the same time. Avoid aspirin products or Motrin (ibuprofen) for the next 2 weeks unless aspirin has been prescribed as a daily medication.
  • Tylenol may be taken for mild fever, though again, avoid taking the prescription pain medication and over the counter Tylenol at the same time. If Postoperative fever (>101 degrees) persists for more than 24 hours, notify the office.
  • Antibiotics also will be given during the postoperative period. Take all medications as prescribed for you by the physician. If you are nauseous, you can begin the antibiotics the day after surgery. Call the office for any adverse reactions to your medications (vomiting, diarrhea, rash, difficulty breathing, or swallowing).
  • You will need to obtain some nasal saline spray, which can be purchased over the counter.

Wound Care

  • Within 24 hours of surgery, you should begin frequent saline irrigations 10 to 15 times per day (see attached nasal saline irrigation form). You can also begin to blow your nose lightly at this time.
  • If you have to sneeze, it is better to do so through your mouth.
  • It is not unusual to experience some nasal bleeding during the first several days after surgery. For this reason, a nasal drip pad will be will be applied post-operatively. The nurse at the hospital/surgery center should be giving you some gauze to take home so that this can be changed as necessary. Bleeding will slow over time.

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