Broward Head Neck & Facial Plastic Surgery

    220 S.W. 84 Th Ave. Suite 203

 Plantation, Fl. 33332

Sinus surgery information

 In order to help you better understand the sinus procedure, which I have discussed with you, and you are considering, I have put together the following information. Generally when sinus surgery is undertaken several diagnoses may be present. First of all you may have been diagnosed with a septal deviation and possibly turbinate enlargement. A separate review sheet discusses these procedures. Second, you may have been diagnosed as having nasal polyps, sometimes associated with allergies or chronic sinusitis, a recurrent sinus infection, which have not responded to medical therapy. Third, you may have been diagnosed as having chronic sinus inflammation or chronic sinusitis, which has prompted a CT scan. In general the CT scan has been reviewed and shown evidence of chronic sinus inflammation, which is noted as a lack of air within the sinuses. If this CT scan has not been reviewed with you, you certainly may request that I review this scan with you. In order to remove the blockage of your sinuses and improve or resolve the sinus inflammation and chronic infection, surgery is performed inside the nose. There are special instruments utilized in accomplishing this surgery. These instruments and various telescopes or special viewing instruments are designed to improve the safety as well as the exactness of the surgery. Additionally some sinus cases are performed with image guidance which allows even more precise surgery. The surgery itself actually involves removing inflamed tissue to allow ventilation of the sinuses. Once this is accomplished, generally the sinus tissue, which is now exposed to air, can begin resuming its normal function. Before this, the tissue, which blocked the ventilation of the sinuses, caused a lack of ventilation or air inside the sinuses. In response to this lack of air, the sinus tissue becomes inflamed as well as more commonly infected with bacteria. In addition, viral infections may be prolonged and progress into bacterial infections because of this sinus blockage. Thus, all the efforts of sinus surgery are to remove this blockage, to improve ventilation and to reduce bacterial infections inside of the sinus, which have caused your symptoms. In general the resolution of your symptoms will take some time to occur. It is hard to say how long it will be before you will notice a significant improvement. Many patients who have had long-standing chronic sinus inflammation may take up to six months before significant and noticeable improvements have occurred. Of course there are many other patients who in a matter of weeks notice tremendous improvements. In any event one of the most important elements of successful sinus surgery is proper postoperative care. Generally, after the sinus surgery is completed a packing which is composed of telfa gauze is placed inside your nose and loosely tied over the front of the nose with a black silk suture. Normally you'll remove the packing from the nose one or two days after the surgery has been completed. This is easily accomplished and the Telfa gauze will only have a small amount of resistance to being removed. There will still be absorbable or partially absorbable packing left inside the actual sinus cavities. It is important that this packing be kept moist after the surgery is completed. In order to accomplish this you will be spraying the nose several times daily with a saline or salt solution. This absorbable sinus packing may be removed two or three weeks after the surgery if it has not completely absorbable or almost completely absorbed on its own. It is normal for you to have a large amount of postnasal dripping as well as light bloody discharge from the nose for many weeks after this surgery. The more moist you can keep the nasal and sinus environment, the easier it is for this discharge to spontaneously resolve. Normally you'll be seen in the office every week or two until I am satisfied that sufficient healing has taken place. Generally, I begin patients on a topical steroid spray two to four weeks after completion of this type of surgery. The rationale for resuming the steroid spray is that it will retard the recurrence of sinus inflammation and also help promote healing within the sinus cavities. Once your sinus cavities have nicely healed and you are generally free of symptoms you'll be seen back in the office every four to six months. As the informed consent discusses there are some risks involved with sinus surgery. Fortunately my patients have never experienced any catastrophic complications such as brain injury, spinal fluid leak, vision impairment, eye injury, profuse uncontrollable bleeding or other major complication. Occasionally a patient will experience a mild postoperative nosebleed, rarely a nosebleed that requires a return to the operating room. Most postoperative nosebleed's can be controlled in the office setting. Recurrence of sinus disease is dependent upon the amount of preoperative sinus disease which was present. In general the more severe your sinus disease before surgery the greater the chance of a recurrence of sinus disease. Steroid nasal sprays can help to reduce the recurrence rate. Regular follow-ups also provide the opportunity for recurrences to many times be addressed in an office setting. Most patients will experience some nasal crusting, which is generally managed by removal of the crusts and continued use of saline sprays. Pain is usually mild to moderate after this type of surgery and well controlled with the pain medication in most cases. Patients are advised not exercise heavily for at least 10 to 14 days after this type of surgery. Patients are requested to not fly for 10 to 14 days and possibly longer. Patients can begin blowing their nose approximately 5 to 10 days after surgery. Please try to avoid blowing your nose with excessive force. Please feel free to contact our office if you have any questions.

Sincerely,

Stephen E. Guilder M.D.