Procedure

• Entire surgery through the nostrils with endoscopes connected to a camera which projects on to a large screen

• Nose is decongested with gauze and medication to improve visualisation

• Entire nasal passage and area behind nose (nasopharynx) and sinus openings are inspected

• Septoplasty consists of making a small incision in the pink mucosal lining over the septum and lifting it up on both sides.  The cartilage or bone that is skew is removed and either moulded straight or discarded.  The mucosa is sutured tightly against the cartilage on both sides.  If it doesn't adhere tightly, the doctor might place a splint inside to keep it straight

• Turbinoplasty is done either by gently removing the soft tissue and a part of the bone with a debrider or by shrinking the soft tissue with radiofrequency ablation

• If there are polyps they are carefully removed with forceps or a debrider and if it is your first surgery or they look suspicious, they will be sent to the laboratory for further testing

• Functional endoscopic surgery (FESS) consists of opening up the sinuses which are blocked by removing the soft tissue and bone around the openings of these sinuses to improve natural drainage, and to allow more space for medication to go into them

• Any polyps or pus in the sinuses are removed and washed out and bleeding is controlled

• Absorbable sponge is packed in the nose to help control the bleeding

Postoperative

• Moderate pain and discomfort especially in first two days and up to two weeks

• Sleep with head up (at least 30º) on an extra pillow for first three nights

• Your nose will feel blocked for up to two weeks due to swelling in the nasal cavities as well as the sponge inside

• Mild bleeding in the form of specks of blood or clots in nasal secretions is to be expected, but if active bright red blood, please do not hesitate to contact Dr Du Toit

• Avoid blowing your nose for the first week and then start gently if necessary

• If you have to sneeze, try and keep mouth open so as to avoid high pressure in your nose

• Start Saline irrigation the morning after surgery and do it twice a day thereafter

• Apply Bactroban ointment to inside of nostrils twice a day

• Start your cortisone spray after one week and use twice a day

• Avoid strenuous activity for two weeks

Possible complications

• Bleeding

• Infection

• Recurrence of polyps is common if optimal medical treatment not given or used appropriately

• Septal haematoma is caused by - bleeding into the mucosal lining of the septum causing swelling in the midline of nose. This can also lead to a septal abscess.  These needs to be drained immediately to avoid the cartilage being destroyed and causing a collapse of nasal structure

• Eye complications if orbit entered eg. haematoma causing swelling, double vision, blindness. If haematoma forms, the pressure needs to be relieved immediately by making a small incision in the eyelid

• Neurological complications if the thin bone between sinuses and brain breached eg. Cerebrospinal fluid leak, meningitis, brain abscess

• Sore throat from tube to ventilate during anaesthesia

• Anaesthetic risks

Follow up

• Weekly to assess healing and remove any blood clots or crusts for first month until healed

• One month to assess healing  and advise on further medical management

• Three to six months depending on procedure to assess success of surgery and maintain optimal medical treatment