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Septoplasty
Nasal surgery, including septoplasty, turbinoplasty, sinus surgery or polypectomy, is a safe, effective procedure performed to treat difficulty breathing through the nose. This nasal airway obstruction may cause mouth breathing, snoring, sleep apnea, and recurrent sinus infections or frequent nosebleeds. Septoplasty is straightening of the cartilage that divides the interior nose to improve nasal airway breathing. Sinus surgery is performed for recurrent sinus infections, most commonly three or more per year, which are diagnosed by medical history, physical exam and CT scan. As with any surgery, along with the benefits of surgery certain risks must be discussed in order to obtain an informed consent.
Bleeding
Some bleeding is to be expected after nasal surgery, however, abnormal postoperative bleeding or hematoma occurs in about one percent of cases. Bleeding, which most often occurs in the immediate postoperative period, can occur at anytime during the first two weeks after surgery. Avoid strenuous activity and smoking as this contributes to bleeding. Treatment to control bleeding is usually performed in our office. However, in rare cases treatment may require control in the operating room under general anesthesia.
Infection
Infection is rare due to the excellent vascularity to the tissues. A prescription for preventative antibiotics is provided for use in the postoperative period.
Injury to the lacrimal (tearing apparatus), visual impairment or brain damage.
Due to the proximity to the surgical site it is not uncommon to have tearing down the face postoperatively. Usually these problems are due to surgical swelling and improve spontaneously. Visual impairment or brain damage is an extremely rare complication.
Septal Perforation
0ne or more holes in the septum, which can be permanent or repairable, are most uncommon risk of septal surgery. These are seen more commonly as an effect of drug abuse, smoking or in revision septal surgery.
Nasal Obstruction
A blockage, clogging, or narrowing can be permanent or reversible. This is seen with swollen membranes as is seen in nasal allergies and polyp disease. Although excision of polyps may provide immediate relief, polyposis most commonly requires long term medical management as well as surgical resection.
Altered sense of smell
Almost always reversible, altered sense of smell is most common in the immediate postoperative period due to surgical swelling. If loss of smell is present prior to surgery approximately 50% of patients may anticipate improvement.
Anesthesia
Complications from anesthesia are known to exist. These complications are quite uncommon since patients are usually young and healthy.
Procedure
You will be asked to call the Center on the business day before the procedure to confirm your arrival time, which will be about an hour prior to the procedure. Upon arrival at the Center you will talk with a nurse (who will start an IV), an anesthesiologist and Dr. Coniglio before the procedure. Septoplasty and/or sinus surgery takes about an hour depending on the extent of the obstruction. Recovery time takes about one half hour and you will be discharged about three to four hours from the time of admission.
Pre-Operative Instructions
Nothing to eat or drink after midnight the evening before the procedure. This includes all food, liquids, water, candy, mints or gum. You may brush your teeth. Your procedure will be cancelled if you do not follow these instructions.
- Notify us of all routine medications and significant health history. Take medications as directed with just a sip of water the morning of surgery.
- Please avoid any aspirin, aspirin-containing products, ibuprofen (Advil®, Aleve®, etc.) or Vitamin E for one week prior to your surgery. If you are on any medications that affect bleeding such as coumadin or warfarin please notify the office immediately.
- Do not bring valuables (cash, credit cards, watches, jewelry, etc.) to the Center.
- Remove all make-up and nail polish before coming to the Center.
- At your preoperative appointment you will be given prescriptions for an antibiotic and pain management. These will all be used following your surgery. Please fill these prescriptions before your surgery so you will have them ready for use when you return home after your surgery has been completed.
- Please call Westfall Surgery Center at 256-3862 before noon on the day prior to your procedure to confirm your arrival time.
The sedative medication and/or general anesthesia may make you drowsy for as long as 24 hours. Therefore, do not
- drive or operate machinery for 24 hours
- drink alcoholic beverages for 24 hours
- make major decisions, sign contracts, etc. for 24 hours
Someone will need to drive you home from the Center and stay with you that evening. It is a good idea to have someone drive you to the office for packing removal the following day.
Post-Operative Instructions
After surgery your nose will be packed with soft nasal packing. There will be soft silastic splints along each side of your septum (divider of the inside of the nose). You may notice that tears run down your cheeks. This is due to swelling and will subside during the first week following surgery. The nasal parking will prevent breathing through your nose so you will have to breathe through your mouth. Draining of red-tinged mucous through your packs on to your drip pad is normal. If you are completely saturating the drip pad with bright red blood every five minutes for an hour, notify our office. Your mouth will become very dry. Please drink as much fluid as you can which will help you from becoming dehydrated. Drinks at the bedside along with a humidifier (cool or warm) may help.
Following your procedure the nurses will ask assist you to meet the discharge criteria; to drink liquids, walk with a steady gait, void, manage your discomfort, and to have you nasal drainage under control. The nurses will teach you how to change your drip pad under your nose, which you will need for about 24 hours. You will be asked to come to Dr. Coniglio's office the following day for packing removal. Although removal of nasal packing has been described by most patients as discomfort rather than pain, you are encouraged to take your pain medication about an hour prior to packing removal. Packing removal will help relieve some of the pressure, however, due to swelling, you will not be able to breathe well through your nose for one week.
Activity
Sleep with head of the bed elevated or use two to three pillows. Sneeze with your mouth open and do not blow your nose for seven days. Absolutely no bending, lifting or straining. If you have little children, bend at the knees or sit on the floor and let them climb onto your lap. One week off work is recommended following septoplasty or sinus surgery.
Diet
Advance diet from liquids to soft food to solids as tolerated. Avoid extremely hot liquids or foods.
Wound care
You will have a gauze drip pad placed beneath your nose. Change this as needed for the first 24 hours following surgery. If you completely saturate the pad with bright red blood every five minutes for one hour, call the office. Following removal of the packing, the drainage will subside and the drip pad will no longer be required.
Medications
You may be given refills on all prescriptions. You do not need to use the refills unless instructed to do so.
Use pain medication as directed and as needed. Although packing removal has been described as pressure rather than pain, we recommend that you take your pain medication before coming to the office for packing removal.
Start your antibiotic on the day following your procedure. (During your surgery you received antibiotics through your IV, which will cover you for the day of surgery.) Take as directed (usually one in the morning and one in the evening until gone). It is not uncommon to have a low-grade fever following surgery.
Start the decongestant the day following your procedure. Take one tablet in the morning until gone.
Salt-water rinse and ointment
ENTsol is the best saline solution and can be purchased in our office. Start your saltwater rinses following packing removal. Salt water rinsing is very important for your postoperative healing. The salt water moisturizes, cleanses and facilitates healing. You can make your own salt water by mixing two tablespoons of sea salt, 16-oz. lukewarm water and 1 teaspoon of baking soda in a small plant mister bottle. Place the tip of the mister gently near the opening of the nose arid spray your nose. If you prefer you can purchase saline spray in your drugstore without a prescription. Please rinse your nose with salt water five to six times per day until your splints are removed. You may then decrease your rinsing to three times per day.
Start using the ointment two times a day (morning and evening) inside each nostril following packing removal.
Appointments
Your packing will be removed the day following your surgery. Your splints will be removed approximately one week following your surgery.
Please Remember
Nasal congestion, facial fullness, headache and disrupted sleep are very normal postoperative symptoms and will decrease as the healing process occurs. It is not uncommon to have numbness on the roof of the mouth (palate) behind the front teeth. Therefore avoid extremely hot liquids or food in the immediate postoperative period.
Notify the office for any of the following:
- difficulty breathing or painful swallowing.
- coughing up blood or persistent bleeding. (You may notice some slight blood-tinged sputum which is not uncommon.)
- pain not managed by pain medication
- Fever over 101° F
For an emergency please call our professional answering service at 585-258-4840.
Please notify the office 585-256-3550 for any concerns. We are here to help in any way we can.
Dr. John U. Coniglio and Staff
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