Surgery to improve breathing can consist of straightening the septum (septoplasty), reducing the size of the turbinates (turbinectomy), or enlarging the openings of the nose with spreader grafts.
Septoplasty is done by raising the mucosa off of the cartilage and bone of the septum and then removing the portions that are crooked or out of alignment. The cartilage removed can be re-shaped and replaced, or discarded if not needed for support.
Spreader grafts involve placing tissue harvested from other parts within the nose to enhance the airway and prevent collapse.
Turbinates can be reduced by literally trimming them with special scissors, cauterizing (burning) the mucosa to cause it to shrink, freezing the mucosa (cryotherapy), or radiofrequency treatments.
The goal of surgery is to reduce sinus infections, pain or pressure, or to repair a broken nose or nasal fracture. The sinus openings are made large enough that they will remain open.
Infected mucous or diseased mucosa can then be cleaned out. The majority of sinus patients will require septoplasty, turbinectomy, or spreader grafting along with the sinus operation.
Most sinus surgery is done using endoscopes, special surgical telescopes that allow the surgeon to see into the nose and make fine alterations in the anatomy. This technology allows almost all sinus surgery to be done through the nostrils. It brings about quicker recovery and less pain and bleeding than the older methods and is very safe.
Surgery today is usually done under general anesthesia, meaning that the patient is completely asleep for the procedure. Patients who are otherwise healthy can usually go home the same day, and be back at work within a week. People who do heavy lifting in their jobs will need to be off work longer.
Outpatients usually have surgery at the Minor & James Surgery Center, located in our offices. This is a Medicare-certified surgery center, and our anesthesiologists are from Physicians Anesthesia Service, the group which also provides care at Swedish Medical Center. Some of our patients will have surgery at Swedish Medical Center (either the First Hill or Providence campus).
Patients arrive about 45 minutes prior to surgery, which allows time for the nursing staff and anesthesiologist to interview and evaluate the patient. The surgeon will answer any last-minute questions or concerns. Surgery will last from 45 minutes to 90 minutes, depending on the extent of the procedure. Patients are usually ready for discharge about 1 to 1.5 hours after surgery.
Nasal surgery usually requires some form of packing to prevent bleeding. Pressure packs stop bleeding by applying pressure and are usually removed the next day, either by the patient at home or by the surgeon in the office. Gelatin (Gelfoam) packs work by sticking to the surface and encouraging clotting. These packs are not removed, and will either slowly dissolve, or come out on their own after several days.
Internal splints may be used to hold the septal mucosa flat and straight. These stay in for about 5-7 days and are removed in the office.
Patients will have some degree of minor bleeding and nasal crusting for several weeks after surgery. Irrigation with saltwater and frequent visits to the surgeon’s office are needed to prevent a build-up of uncomfortable crusts which can block breathing and allow infection.
Unless a cosmetic change in the appearance of the nose is being made, there is generally no significant visible swelling or bruising. Discomfort is mild to moderate, and most patients will take narcotic pain pills for a few days.
It is common for the sense of taste and smell to be diminished or even absent for a few days to weeks after surgery. This is due to swelling and rarely persists. Pain or numbness in the front teeth is also common and again resolves within a few weeks.
Strenuous exercise and airplane flights are restricted for two to four weeks (check with your surgeon), although light exercise such as walking is acceptable as soon as the patient feels up to it.
As in any procedure, there is always the possibility of complications. Bleeding which could require additional packing occurs in 1-2% of patients. Since there are a lot of bacteria in the nose, infection is also possible, although it is infrequent. All patients are kept on antibiotics for a period of time after surgery, and sometimes a change in antibiotics is needed.
Serious or life-threatening bleeding or infections are very rare. Even rarer would be complications related to the structures surrounding the nose and sinuses, namely the eyes and brain. These have been nearly eliminated by the modern endoscopic techniques. Overall, nasal and sinus surgery is extremely safe.
Nasal surgery to improve breathing is very successful, with 95% of patients being satisfied with their breathing. Minor revisions will usually help the remaining few patients to achieve good results.
Sinus surgery is also very successful, although because the surgery cannot correct the allergic problems or other mucosal abnormalities, ongoing therapy is needed in some cases. Patients with polyps, in particular, need meticulous follow-up care and treatment, and this can be a recurring problem.
Your surgeon can give you personalized information about your procedure, and answer any questions you may have.
