There are many different types of nasal and sinus operations carried out to treat nasal obstruction, to correct the shape of the nose, to relieve headaches and to treat chronic sinusitis.
Nearly all of these operations are carried out under a general anaesthetic. However, minor procedures may sometimes be performed under a local anaesthetic.
Nearly all the operations are carried out with instruments inserted through the nostrils, and it is rare to require external incisions. The most common nasal operations take approximately 30 minutes, but more extensive sinus surgery may take an hour or more.
Nasal packs are often used after surgery to the nose or sinuses to help prevent bleeding. They are usually removed after a couple of hours, and this is sometimes associated with a small nose bleed, which settles after a few minutes.
Length of stay in hospital
Most nasal and sinus operations are done as day-cases, but occasionally it may be necessary to stay in hospital for 1 night after surgery.
Nasal and sinus surgery are not particularly painful procedures, but the nose may be tender afterwards. You will be provided with a supply of painkillers, which you may need to take regularly for the first few days.
b) Nasal blockage
The nose will be blocked for 7 to 10 days and it may be up to 6 weeks before the full result of the operation is felt.
During the first week it is common to have blood-stained watery secretions, mucus and occasionally liquid clots coming out from the nose. The nose will block and unblock. It is also common to get a sensation of blocked ears.
After nasal surgery there is a small risk of a nose bleed in the first few days. It is important to rest for the first 3 to 4 days and then to gradually increase activity to return to normal after about 10 to 12 days. Try to avoid blowing the nose or picking at it for the first week. It is important to avoid smoking after nasal surgery to allow the nose to heal.
If you want to sneeze, it is best to sneeze through your mouth rather than your nose.
Dissolvable sutures are used inside the nose. These do not need removing. Occasionally a piece of suture will become visible at the nostril. Avoid pulling at it as it will hurt! It can easily be trimmed with a pair of scissors.
In addition to pain killers you may be given various treatments to take after your nasal or sinus operation. Salt water douches are useful in helping to unblock the nose and to clear the crusts out. After sinus surgery it is common to be given a short course of antibiotics to prevent a secondary infection. In addition, you will be given a 1 month course of steroid nose drops.
Management of a post-operative nose bleed
If your nose does bleed, sit propped up in bed, let the nose bleed into a dish or bowl and ask for some ice to be placed, either on the nose or to be sucked, which may help reduce the blood flow to the nose. The nose bleed will usually stop spontaneously after 5 or 10 minutes, but if it is persistent or unusually profuse, then it is important that you contact the ward or go straight to the nearest Accident & Emergency Department, as you will need to have the nose bleed stopped.
Length of time off work
For most of the operations it is usual to have about 7 to 10 days off work.
You should avoid driving and making any intelligent decisions for the first 48 hours after a general anaesthetic. After that light work at home, such as paperwork or computer work would be possible. However, any strenuous activities or sport should be avoided for the first 2 weeks and then restarted gradually.
Flying should be avoided for at least 2 weeks after nasal/sinus surgery.
Possible complications of nasal/sinus surgery
Most nasal and sinus operations are extremely straightforward, but as with any operation there is always a small risk of complications.
a) General anaesthetic
General anaesthetics are very safe in this day and age. The Anaesthetist will visit you on the ward before the operation and discuss the risks of the anaesthetic and any other concerns with you.
In the first 1 to 2 weeks after nasal surgery, there is a risk of having a nose bleed. This usually stops spontaneously, but occasionally requires readmission to hospital, and sometimes packing.
Only very rarely is it troublesome enough to require a re-operation.
There is a small risk of sinusitis or infection in the nose following nasal and sinus surgery. This usually settles spontaneously with antibiotics if it occurs.
d) Change of shape of the nose
Following operations to straighten the partition of the nose (septum) there is a tiny risk of change in the shape of the nose. This is very rare.
Following operations to straighten the septum of the nose, there is a small chance of a perforation through the septum. This is very uncommon with the techniques used nowadays. If it does occur, it may cause a small amount of crusting or bleeding from the nose and rarely a whistling noise.
f) Numb teeth/lip
It is quite common to get a sensation of numbness in the upper teeth or upper lip following nasal surgery. This relates to the use of local anaesthetic in the nose, but sometimes occurs due to swelling around the nerve that innervates the teeth and lip. This is nearly always transient and nearly always the symptoms settle spontaneously quite quickly.
Occasionally the nose feels drier than normal for the first few weeks. This usually improves over time and is very unlikely to cause a longterm problem.
h) Specific risks of sinus surgery
Endoscopic sinus surgery is an extremely safe procedure. However, there is a tiny risk of damage occurring to the neighbouring structures around the sinuses. This could include damage to the eye or eyesight, damage to the smell organ, damage to the brain or leakage of fluid from the brain, resulting in possible infection of the brain or meningitis.
i) Rhinoplasty surgery
Rhinoplasty surgery is carried out to change the shape of the nose. This is usually a straightforward procedure, but there is a tiny risk of scarring of the nose and a tiny risk of an unsatisfactory cosmetic result.
If you have any concerns once you have returned home, do not hesitate to telephone for advice to one of the following numbers:
Level 4 ward Tel: 0117 9804088
Spire Bristol Hospital Tel: 0117 9804000
or myself for advice via my PA Mrs Beverley Bloor Tel: 0117 9804050