Sinus surgery follow-up. At one week out, those who have had surgery on their sinuses will need to have an endoscopic debridement procedure.
This is where your nose is topically decongested and anesthetized, then mucus, old blood, crusting, and early adhesions are removed and cleaned out to allow for good results. This is typically repeated at least one more time in 1 to 2 weeks.
Rinsing you nose with saline regularly and keeping the mucus membranes moist and lubricated can decrease how many times and how involved this is. While most of the healing occurs in the first month, healing–particularly on the microscopic level–may continue to occur for 6 to 12 months.Modern innovation and technology has advanced the diagnosis and surgical treatment for chronic sinus disease.
Functional endoscopic sinus surgery (FESS) using a small lighted metal telescope is now commonly performed without incisions and entirely through the nose. Current practice believes the best way to obtain normal healthy sinuses is to open the natural pathways to the sinuses. Once an improved drainage system is achieved, the diseased sinus mucosa has an opportunity to return to normal.
Sinus surgery has evolved and greatly improved over the last several years. In the past, sinus surgery was performed though incisions in the mouth and face. It required nasal packing and resulted in a lengthy recovery. Today, sinus surgery is typically performed through the nose using a small, thin tube with a camera called an endoscope.
The endoscope allows the doctor to see inside the nose and sinuses in order to open the nasal passages and clear blockages. Because endoscopic sinus surgery is less invasive, it has a lower rate of complications and a much shorter recovery time.
Indications for Sinus Surgery
When sinusitis does not respond well to medical treatment, surgery may be the best option for some patients. Surgery can be very beneficial for patients suffering from the following conditions.
- Chronic sinusitis that has not improved with medical treatment
- Recurrent infections
- Nasal polyps
- Chronic sinus headaches
- Tumors in the sinus cavities
- Impaired sense of smell
Before Scheduling Sinus Surgery
In most cases, there are some specific medical therapies that should be tried before a decision to have sinus surgery is made.
- Antibiotics when the cause is infection. If infection persists, cultures of the nasal mucous can be done to determine which antibiotics will be most effective.
- Decongestants to reduce the amount of mucous
- Nasal irrigation to help clear the nasal passages and promote drainage
- Steriods to reduce swelling
- Allergy medications such as antihistamines, nasal steroids, and allergy shots when allergies are the cause of the sinusitis
Endoscopic Sinus Surgery Evaluation
When consulting with your doctor initially, you should bring medical records, which include your history and all sinus treatment you have undergone. Bring any CT scan or MRI, if available. If a CT scan has not been done, one will need to be performed to assess the possible need for surgery. Any decision to have endoscopic sinus surgery will be based on a physical assessment and your medical history.
Sinus Surgery Preparation
If blood work is needed, it will be done no more than one month prior to surgery so it is current. Depending on age and medical history, other studies such as an EKG or chest x-ray may be performed. You may be prescribed oral steroids or antibiotics during your pre-surgical period. Patients will be given Afrin® (Oxymetazoline) nasal decongestant spray in the hospital on the morning of surgery. Patients having an in-office procedure are asked to use Afrin® (Oxymetazonline) nasal decongestant spray 30 mins before leaving their home
What to Avoid Prior to Sinus Surgery
- Do not use non-steroidal anti-inflammatory drugs (NSAID) for a minimum of 7-10 days prior and after surgery. This includes Ibuprofen (Motrin®, Advil®) and naproxen (Aleve®).
- Do not take aspirin (ASA) or salicylate containing analgesics, herbals, garlic supplements, vit E capsules, fish oil, green tea and green tea supplements 2 weeks before and after surgery. Even small amounts of aspirin can result in significant increase in bleeding during and after surgery.
- Stop blood thinners like warfarin (Coumadin®) 5 days before surgery.
- Do not smoke for a minimum of 3 weeks prior to surgery.
- Do not eat or drink anything after midnight the night before surgery. Consult your surgeon to see if you should take any of your usual medications the day of surgery.
The Day of Sinus Surgery
Arrive at the hospital or surgery center approximately 2 hours before your surgery. Once admitted, you will meet with your anesthesiologist to discuss your medical history and any history you have with anesthesia. It is important to convey any adverse reactions to anesthesia that you have experienced. Endoscopic sinus surgery can be performed under local or general anesthesia. Your medical team will help you decide which option is best for you.
Endoscopic Sinus Surgery
Endoscopic sinus surgery can be preformed under general anesthesia (in a hospital or surgery center) or under local anesthesia (in an office setting) depending on the patient and the extent of the surgery needed. During surgery, an endoscope is inserted through the nostril allowing the surgeon to view the inside of the nose, passages and sinuses. Most people have four sinuses on each side of the face. The maxillary sinuses are located in the cheeks, the ethmoid sinuses are between the eyes, and the sphenoid sinuses are in the center of the forehead. Sinusitis can affect all or only some of these sinuses. The surgeon will determine which sinuses are affected and the surgical procedures needed based on the patient’s symptoms, a nasal exam, and CT scans. Depending on the cause of sinusitis, the surgeon may remove diseased tissue and growths (polyps), repair structural problems such as a deviated septum, and open or widen narrow sinus openings and passages.
Balloon Sinuplasty® (Balloon Sinus Opening Dilation)
Balloon sinuplasty is a procedure that can be performed in conjunction with endoscopic sinus surgery to maximize results. Using a catheter-based system, a balloon is inserted though the nasal passages and positioned in the sinus opening. The balloon is then inflated and the opening of the sinus is widened. This allows for drainage from the sinus cavity while maintaining the integrity of the sinus lining. Learn more about Balloon Sinuplasty® (Balloon Sinus Opening Dilation). This procedure can also be performed as an in-office procedure by Dr. Monty Trimble.
Results of Endoscopic Sinus Surgery
The results of endoscopic sinus surgery are excellent, and most patients experience significant improvement in their symptoms. While surgery is not a cure for all conditions, it can be a necessary step in managing the disease. Sinus surgery is most effective when used in conjunction with medication and home treatment to prevent future sinusitis.
Recovery from Endoscopic Sinus Surgery
Recovery is different for each patient and depends on the extent of the surgery. The majority of patients will experience significant improvement in symptoms after surgery. Some patients will notice dramatic relief immediately following surgery while others may take a few days to a few weeks. Because endoscopic sinus surgery is minimally invasive, pain is typically mild and can be well managed with pain medication. Some bleeding may occur, but will typically subside in a few days.
Expectations after Sinus Surgery
Most patients are released within a few hours of surgery. You will be observed to ensure that you are alert, stable and prepared for discharge. A dressing will be placed beneath the nose to absorb mucus and blood. You will experience some mild bloody discharge and possibly some temporary difficulty breathing through your nose. If you feel a significant amount of blood (more than a few tablespoons) has drained down your throat, or your dressing needs to be changed every few minutes, please notify your doctor. Mild discharge may last for about 2 weeks, improving steadily. Do not blow your nose for 4-7 days after surgery. It is normal, after a week, to experience some thick, bloody mucus.
Risks of Endoscopic Sinus Surgery
- As with any surgery, anesthesia can have occasional, yet serious, risk. Your anesthesiologist will discuss these with you.
- Risk with Nasal Septum Reconstruction
- Should nasal septum reconstruction be required, there is a chance of numbness of the front teeth and nasal septum bleeding or infection. Septal perforation could occur, which could cause nasal breathing difficulty. Renewed deviation or a change in nose shape can also occur.
- If significant bleeding occurs, surgery may be terminated and nasal packing required. On rare occasions, a blood transfusion could be needed.
Cerebral Spinal Fluid (CSF) Leak
- Ethmoid sinus surgery includes a slight risk of causing a leak of CSF (the fluid that surrounds the brain). Leakage can increase chances for infection or meningitis (inflammation of the brain). Should this occur, a hospital stay and additional surgery could be required.
- In extremely rare cases, patients have experienced vision loss or double vision after surgery.
Decreased Sense of Smell
- Sense of smell can be affected by surgery. Most patients, however, who experience a decrease in smell prior to surgery, have improvement post surgery.
Other risks include tearing of the eye, persistent sinus inflammation, discomfort or numbness in front teeth, temporary swelling and bruising of the lip or eye, and slight change in voice.
Sinus Surgery Follow-Up
Sinus surgery follow-up. At one week out, those who have had surgery on their sinuses will need to have an endoscopic debridement procedure. This is where your nose is topically decongested and anesthetized, then mucus, old blood, crusting, and early adhesions are removed and cleaned out to allow for good results. This is typically repeated at least one more time in 1 to 2 weeks. Rinsing you nose with saline regularly and keeping the mucus membranes moist and lubricated can decrease how many times and how involved this is. While most of the healing occurs in the first month, healing particularly on the microscopic level, may continue to occur for 6 to 12 months.