- Things to Know
- Surgery Procedure
- When to Call a Doctor
Things to know about nasal airway surgery (septoplasty)
The following information is provided to help patients and their families prepare for deviated septum surgery (septoplasty) and turbinectomy (nasal airway surgery), and to understand more clearly the associated benefits, risks, and complications. Patients are encouraged to ask their doctor any questions or concerns to help better understand these procedures. Nasal airway surgery is almost always performed through the nostrils without the need for external incisions.
In the following sections, instructions are designed to help individuals recover from nasal airway surgery as easily as possible. Taking care of oneself can prevent complications. The doctor that performs the surgery will be happy to answer any related questions about these procedures.
- Deviated septum surgery (septoplasty) is surgery to correct a deformity in the nasal septum. Turbinectomy or turbinoplasty is the surgical reduction or removal of an enlarged turbinate (nasal tissue) inside the nose. Both surgeries are done mainly to improve airflow or improve sinus drainage but may have other purposes such as nosebleed control.
- There are risks and complications for all surgeries; those for deviated septum and turbinate surgeries are infrequent but include the following:
- nasal obstruction,
- chronic nasal drainage,
- eye damage (rare),
- brain fluid leak or infection (rare),
- numbness of facial structures,
- septal perforation,
- alteration of the sense of smell or taste, and
- failure to resolve any associated nasal or sinus problem.
- Prior to undergoing these surgical procedures, the patient needs to obtain instructions from their doctors (surgeon and anesthesiologist) in regard to preparing for the surgical procedure (for example, what medications to stop taking prior to surgery, when the last meals or drinks may be consumed prior to surgery).
- Deviated septum surgery and turbinate surgery last approximately an hour, and the patient is closely monitored because they usually will be under general anesthesia. Complications rarely occur, and the patient usually can go home the same day as the surgery.
- After surgery, the patient will need someone to transport them home. To avoid nose bleeding, it is important for the patient to keep their head elevated, and to avoid any straining during bowel movements or exercise. Some mild swelling of the face and nose may occur but is not common, and ice packs can help reduce this swelling (a bag of frozen peas or corn will easily conform to the face, and may provide the most comfort).
- Following the doctor's instructions in regard to surgery after-care is very important, and the success of the surgery may depend on this surgery after-care. Patients will be instructed about nasal packing, nasal packing removal, necessary follow-up examinations, and the importance of the use of nasal irrigation to reduce nasal crusting or scab formation. The surgical site will be very sensitive to normal activity such as lifting objects, wearing glasses, bending over, nasal congestion, and other activities, thus, these situations should be avoided if possible.
- If a patient experiences a sudden increase in nose bleeding, fever greater than 101.5 F (38.6 C), persistent sharp pain, or increased swelling after surgery, they should contact their surgeon immediately.
What is nasal airway surgery (septoplasty) or turbinectomy/turbinoplasty?
Nasal obstruction is often caused by a deviated or crooked septum or enlarged tissues (inferior turbinates or inferior nasal conchae) within the nose. A septoplasty is an operation to correct a deformity of the partition (the septum) between the two sides of the nose. A turbinectomy is a surgical reduction or actual removal of an abnormally enlarged turbinate from inside the nose to improve breathing.
The goals of nasal airway surgery include the following:
- Improve airflow through the nose
- Control nosebleeds
- Enhance visualization of the inside of the nose (to identify other nasal problems)
- Relieve nasal or sinus headaches associated with swelling of the inside of the nose
- Promote drainage of the sinus cavities
What are risks and complications of nasal airway surgery (septoplasty) or turbinectomy?
Although the surgery will be performed safely and with care to obtain the best possible results, patients have the right to be informed that the surgery may involve risks of unsuccessful results, complications, or injury from both known and unforeseen causes. Because individuals differ in their response to surgery, anesthetic reactions, and healing outcomes, ultimately, there can be no guarantee made as to the results or potential complications. Furthermore, surgical outcomes may be dependent on preexisting or concurrent medical conditions. Additional surgery may be necessary after the nose has had a chance to heal after surgery. Moreover, adherence to follow-up instructions and appointments by the patient can influence the surgical results.
The following complications have been reported in the medical literature. This list is not meant to be inclusive of every possible complication. They are listed here for information only, not to frighten patients, but to make them aware and more knowledgeable concerning these surgical procedures. Although many of these complications are rare, they can occur even in the hands of experienced surgeons practicing the standard of care for the procedure. Anyone who is contemplating surgery must weigh the potential risks and complications against the potential benefits of the surgery or any alternative to surgery. The following is a list of complications that may occur with these nasal surgeries:
- Nasal obstruction due to failure to straighten the septum or later re-deviation of the septum, or the re-growth or swelling of the turbinates. This may necessitate revision surgery.
- Failure to resolve coexisting sinus infections or recurrence of coexisting sinus problems and/or polyps, or need for further or more aggressive surgery.
- Bleeding. In rare situations, a need for blood products or a blood transfusion.
- Chronic nasal drainage, or excessive dryness or crusting of the nose or sinuses
- Need for allergy evaluation, treatments, or environmental controls. Surgery is neither a cure nor a substitute for good allergy control or treatment.
- Failure to improve or resolve concurrent respiratory illnesses such as, but not limited to asthma, bronchitis, or cough.
- Failure to resolve associated "sinus or nasal" headaches. The exact cause of headaches can be difficult to determine and have many causes that are not due to nasal septum or turbinates. Patients may require consultation with another specialist such as a neurologist.
- Damage to the eye and its associated structures.
- Brain fluid (CSF) leak or infection.
- Permanent numbness of the upper teeth, palate, or face.
- Prolonged pain, impaired healing, and the need for hospitalization.
- Septal perforation is a hole inside the nose (septum) that produces an open connection between the right and left sides of the nose.
- Failure to restore or worsening of the sense of smell or taste, or failure to relieve nosebleeds.
What happens before nasal airway surgery (septoplasty) or turbinectomy?
In most situations, the surgery is performed as an outpatient at either a hospital or a surgical center. In both facilities, quality health care is provided. An anesthesiologist will monitor the sedated patient throughout the procedures. If the doctor has ordered preoperative laboratory studies, patients should arrange to have these done several days in advance. Patients should bring a copy of these results with them on the day of surgery for the anesthesiologist and surgeon to review. Patients need to arrange for someone to transport them home from the surgical facility, and to spend the first night after surgery with the patient, as previously mentioned.
After surgery, the doctor may ask patients to start using salt water (saline) irrigations. The doctor will instruct the patient on how, what, and when to start and use irrigation.
Patients should not take aspirin, or any product containing aspirin, within 10 days prior to the surgery date. Nonsteroidal anti-inflammatory medications (such as ibuprofen or naproxen) should not be taken within 7 days prior to the surgery date. If you are on any blood thinners, such as Coumadin or Eliquis, tell your doctor, and follow any instructions. Many over-the-counter products contain aspirin or ibuprofen-type drugs so it is important to check all medications carefully. If there is any question individuals should call the health care professional's office or consult a Pharmacist. Acetaminophen (Tylenol) is an acceptable pain reliever. Usually, the doctor will give necessary prescription medications at the preoperative visit. It is best to have these filled out prior to the date of surgery.
Patients will receive instructions about eating and drinking limitations prior to surgery. These instructions also will include water, candy, or chewing gum. Anything in the stomach increases the chances of an anesthetic complication. Patient's who smoke should make every effort to stop smoking, or at least reduce the number of cigarettes. This will help to reduce postoperative coughing and bleeding. Patients should discuss this precaution specifically with their surgeon and specifically inform the anesthesiologist about their smoking history so that the doctors clearly understand the patient's preoperative condition.
If patients are sick or have a fever the day before surgery, they should call the doctor's office. If they wake up sick on the day of surgery, they could still proceed to the surgical facility as planned for an evaluation. The doctor will decide if it's safe to proceed with surgery.
What happens the day of nasal airway surgery (septoplasty) or turbinectomy?
It is important for patients to know precisely what time to check in with the surgical facility, and to allow sufficient preparation time. Patients should bring all papers and forms with them including any pre-operative orders and history sheets. They should wear comfortable loose-fitting clothes which do not have to be pulled over the head. All jewelry and valuables should be left at home. All make-up should be removed with a cleansing cream. Patients should thoroughly wash their faces with soap and water. They should not apply make-up, lotion, or cream to the face.
Patients should not take any medication unless instructed by the doctor or anesthesiologist. Usually, in the pre-operative holding room, a nurse will start an intravenous infusion line (IV) and patients may be given a sedative medication to help them relax.
What happens during nasal airway surgery (septoplasty) or turbinectomy?
In the operating room, the anesthesiologist will usually use a mixture of gas and an intravenous medication to put the patient to sleep and to maintain anesthetic sedation at a safe and comfortable level. During the procedure, the patient will be continuously monitored with devices including a pulse oximeter (oxygen saturation) and a cardiac rhythm monitor (EKG). The surgical team is prepared for any emergency. In addition to the surgeon and the anesthesiologist, there will be a nurse and a surgical technician in the room. The entire procedure takes approximately one hour, however, this can vary greatly depending on the patient's anatomical considerations for the surgeon. The doctor will come to the waiting room to talk with any family or friends once the patient is safely transported to the recovery room.
What happens after nasal airway surgery (septoplasty) or turbinectomy?
After surgery, the patient will be taken to the recovery room where a nurse will monitor the patient. They will be able to go home the same day as the surgery once fully recovered from the anesthetic. This usually takes several hours. The patient will need a friend or family member to pick them up from the surgical facility and take them home. It may be necessary for the family member or friend to spend the first night with the patient after surgery for assistance.
When patients arrive home from the surgical facility, they should go to bed and rest with their heads elevated on two to three pillows. By keeping the head elevated above the heart they can minimize fluid accumulation in the tissues (edema) and swelling. They may get out of bed with assistance to use the bathroom. Patients should avoid straining while urinating or passing stool. If constipated they should take a stool softener or a gentle laxative.
Patients may have some swelling of the nose, upper lip, cheeks, or around the eyes for several days after surgery. This swelling will gradually resolve and is normal. They can help reduce the swelling by putting ice on the face, bridge of the nose, and eyes as much as tolerated. This will also help with postoperative edema and pain. Some patients have found frozen vegetables in packages (for example bags of frozen peas) to be a convenient ice pack that is more likely to conform to the face.
Moderate bleeding from the nose is normal, and will gradually decrease. The gauze dressing ("mustache dressing") will collect blood and should be changed only when saturated. It is not unusual to change these dressings every hour during the first 24 hours after surgery. After a few days, patients will usually no longer need to use the dressing. Patients should not take aspirin, aspirin-containing medications, or nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen or naproxen for three weeks following surgery.
It is best for patients to eat a light, soft, and cool diet as tolerated once recovered fully from the anesthetic. Hot liquids should be avoided for several days. Even though the individual may be hungry immediately after surgery, it is best to proceed slowly with food intake to prevent postoperative nausea and vomiting. Occasionally, the person may vomit one or two times immediately after surgery; if vomiting persists, the doctor can prescribe medication to settle the stomach. It is important to remember that a good overall diet with ample rest promotes healing.
Patients will be prescribed antibiotics after surgery and should finish all the pills that have been prescribed. Some form of a narcotic may also be prescribed and is to be taken as needed. If patients require narcotics, they are cautioned not to drive. In some situations, the doctor may prescribe steroids to reduce inflammation either preoperatively and/or postoperatively. It is very important that patients take this medication as prescribed, and not discontinue it prematurely. If patients have nausea or vomiting postoperatively, they may be prescribed anti-nausea medications (antiemetics). If patients have any questions or they feel they are developing a reaction to any of these medications, they should consult their doctor. Patients should not take any other medication, either prescribed or over-the-counter unless they have discussed the medications with the doctor.
General instructions and follow-up care for nasal airway surgery (septoplasty) or turbinectomy
In most situations, packs will have been placed in the nose to control bleeding; often a septal splint is placed that will be removed by the surgeon at the first post-operative visit. The doctor will let the patient know when they are to return to the office to have these packs removed. Patients may need to call the office to schedule this postoperative appointment and should arrange for someone to drive them to and from the office for this first visit. They should eat a light meal before going, and avoid taking excessive pain medications. They may also have several subsequent office visits to assess healing and remove crusts (debris) that may accumulate at the surgical site, especially if combined with sinus surgery. Such visits help ensure a speedy recovery. The nose will probably be tender after surgery, so the doctor will spray it with a special numbing medication before removing the crusts.
After the packing has been removed, patients may breathe through the nose but are not to blow or sneeze through the nose for 7 to 10 days. If the person must sneeze, they should open their mouth. Patients can expect some light blood-tinged drainage from the nose for several days. If the bleeding becomes excessive, apply ice and rest quietly with the head elevated while holding the nose. If bleeding continues, they should call the surgeon's office for advice.
One of the most important things patients can do after surgery is nasal irrigation (rinsing). Immediately after the nasal packs are removed they should use a saline nasal spray such as "Ocean Spray" several times per day to prevent crusts from forming in their nose. Patients are to continue using irrigation until the doctor tells them to stop. Many patients will use irrigations (for example, neti-pots) indefinitely or when they have an upper respiratory infection. Failure to irrigate especially as instructed after surgery will likely cause the surgery to fail.
Patients may go back to work or school only when the doctor indicates it is safe to return. They should rest for the first week following surgery. They must also avoid excessive talking, smiling, chewing hard foods, strenuous activities, bumping their nose, bending over, and lifting heavy objects. They should not rest glasses on the bridge of the nose until soreness and swelling subside. They may wear contact lenses once eye swelling and any irritation have resolved. Alcohol and tobacco products should be avoided because they may prolong swelling and healing. Smoke, dust, and fumes may irritate the nose and cause an infection. Facial tanning is discouraged for six months after surgery. If patients must be in the sun they should use a number 15 or greater sunblock. Patients may use their usual makeup any time after surgery.
Patients should lubricate the nostrils, as instructed with a Q-tip and Vaseline to soften crusts that are hard and firmly attached to healing tissue. Peroxide helps to loosen crusts. After several days they may notice a few of the absorbable sutures and should not try to disturb or remove them. They must be gentle while brushing their upper teeth. These teeth will often be tender for several weeks, and there may be some numbness of the teeth and palate for several months.
After three weeks if patients are not having problems with bleeding, they may resume exercise and swimming, but no diving for two months. They should plan to stay in town and not travel for three weeks to allow for postoperative care and in case bleeding occurs.
When to call the doctor after septoplasty or turbinectomy
Patients should notify the doctor if they have:
- A sudden increase in the amount of bleeding from the nose is unrelieved by pressure, ice, and head elevation.
- A fever greater than 101.5 F (38.6 C) persists despite increasing the amount of fluid and acetaminophen (Tylenol). A person with a fever should try to drink approximately one cup of fluid each waking hour.
- Persistent sharp pain or headache which is not relieved by the pain medication prescribed.
- Increased swelling or redness of the nose or eyes.
Most surgeons want to know about complications or problems that develop with their patients, so do not hesitate to call the surgeon to inform them and ask questions about any problems you are experiencing.
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Ketcham AS, Han JK. Complications and management of septoplasty. OtolaryngolClin North Am. 2010 Aug;43(4):897-904.