Postoperative Care: Nose and Sinus Surgery

Nose and sinus surgery includes septoplasty, turbinectomy or turbinoplasty, FESS (Functional Endoscopic Sinus Surgery), rhinoplasty (“nose job”), or a combination of the above.

Septoplasty is an operation on the septum or dividing cartilage and bone wall between the left and right nose. It is usually performed to straighten a deviated septum to improve airflow. In this operation, a cut is made on the left or right of the inside of the nose, and the crooked cartilage or bone is straightened or removed. A potential risk of this operation is a perforation or hole through the septum between the left and right nose.

Turbinectomy or turbinoplasty refers to operations to reduce the size of turbinates. Turbinates or chonca are bony protrusions or cushions inside the nose that act as a filter and airflow director in the nose. These cushions can get clogged up and swollen which then obstruct breathing. Reducing their size is intended to allow better airflow through the nose. A potential risk of this operation is excessive patency of the airflow, which gives some patients the sensation of ‘too much airflow’ or a paradoxical sense of no airflow because the flow in the nose become turbulent rather than linear (“Empty Nose Syndrome”)

FESS is any operation on any of the sinuses in the nose. There are 4 pairs of sinuses or airbags inside the nose. They sit within the cheek, between the eyeballs, and under the brain. When they’re repeatedly infected, their one-way openings get clogged up and sometimes they produce polyps, or fluid-filled swellings in the nose. The goal of sinus surgery is to remove the polyps, open up the sinuses and lavage them thoroughly to allow better delivery of medications. Each sinuses are individually targeted, depending on which sinuses are diseased. If there is a strong underlying history of allergy or hypersensitivity, there is probability that polyps may regrow over months or years and re-obstruct the nose, requiring revision surgery and long term medications. A potential, but rare complication of sinus surgery is damage to the eyeballs causing permanent double vision, bleeding into the eyeball causing blindness, or injury to the roof of the nose, causing brain fluid leak (which can be repaired).

Rhinoplasty is any surgery to the nose that alters its internal and external appearance with a goal of better function and better cosmetic appearance. It is usually done through a small cut under the nose or around the nose. Usually there will be significant alterations to the external bony and cartilaginous structure of the nose which require internal and external nasal splinting. Patients will typically experience more pain, bruising and swelling around the nose and eyes for a couple of weeks.

Caring for the nose:

Mild to moderate nosebleeds is expected in the first 5-7 days after surgery. The nose is internally packed with dissolving dressing that helps blood to clot. Patients typically describe having what looks like blood clots and clumps of dressing coming out from the front and the back of the nose for up to 2-3 weeks after surgery. Most people feel congestion and blockage, rather than pain (unless you had a rhinoplasty with significant bone work). The tip of the nose, the base of the nose, the upper teeth and gum can feel quite sensitive and numb for a few weeks after surgery. In some cases, an internal plastic nasal splint and/or an external splint is applied to ensure stability of the nose. These splints will be removed in clinic 1-2 weeks after surgery.

Patients will be sent home on pain killers, antibiotics and a nasal wash. The nasal wash is important as it washes the clots and dissolveable dressings from inside the nose. It also prevents infections. The washes are to be done 3-4 times a day for a minimum of 1 month. Do not blow your nose as it may dislodge the splint or scabs in the nose. Instead, use the nasal washes regularly. These washes will get rid of the mucous, clots, dressing and all the other ‘gunk’ (sophisticated medical term) from inside the nose. The nose usually feels much cleaner after a good wash. Start gently in the first few days. Patients describe the good feeling they have after a good nasal wash that clears up their nose. If you sneeze, open your mouth.

Normally, it takes up to 2 months before the nose feels normal again. You’ll still feel some blockage or numbness in the mean time. Often, there is still some scabs and crusts inside the nose even 2 months after surgery. Do not fiddle with the nose or insert anything. Stronger pain killers, antibiotics and more frequent washes may be required if the nose appears infected a couple of weeks after surgery.

Most patients can return to sedentary mild activities a week after surgery. Avoid blowing your nose, bending down, straining, or carrying heavy things. These activities may trigger a bleed. You can return to normal activities 2 weeks after surgery, and strenuous activities 4 weeks after surgery. You will have an appointment usually around the 4 week mark, and most patients will not require any further appointments after.

If there are any significant concerns, it is recommended that the patient be seen by a doctor either at the GP practice, the emergency department or the ENT Practice. It is often quite difficult to give a safe advice over the phone without directly examining the patient.