Diseases

Depending on the extent of the surgery, recovery may take a few days. It may take up to 3 to 5 days to feel completely back to normal. Patients should refrain from activities that increase heart rate or blood pressure such as running, exercising, weight lifting, or other similar activities. It is imperative to obtain guidance from the surgeon as to when they may resume all normal activities. Until this time, patients should rest and limit physical exertion.

The following complications of sinus surgery have been reported in the medical literature. This list is not meant to be inclusive of every possible complication. It is here for patient information only - not to make patients overly concerned - but to make them aware and more knowledgeable concerning potential aspects of sinus surgery. The surgeon will review the risks and benefits of the surgery when obtaining consent for the operation, and will be able to discuss the chance of these complications with respect to an individual's potential risks of surgery at that time.

• Failure to resolve the sinus infections or recurrence of sinus problems and/or polyps.
• Bleeding. In very rare situations, a need for blood products or a blood transfusion may be required. Patients have the right, should they choose, to have autologous (using their own stored blood) or designated donor blood prepared in advance in case an emergency transfusion is necessary. Patients are encouraged to consult with their doctor regarding these issues if they are interested.
• Chronic nasal drainage or excessive dryness or crusting of the nose.
• Need for further and more aggressive surgery.
• Need for allergy evaluation, treatments, or environmental controls. Surgery is not a cure for or a substitute for good allergy control or treatment.
• Failure to improve or resolve concurrent respiratory illness 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 may have many different causes that are not sinus-related.
• The patient or physician may require consultation with another specialist such as a neurologist.
• Damage to the eye and its associated structures.
• Damage to the skull base with resultant meningitis, brain abscess, or leakage of spinal fluid.
• Permanent numbness of the upper teeth, palate, or face.
• Nasal obstruction due to failure to control infection or polyps.
• Prolonged pain, impaired healing, and the need for hospitalization.
• Failure to restore or worsening of the sense of smell or taste.

After surgery, the patient will be taken to the recovery room where a nurse will monitor the patient's vital signs. Usually, patients will be able to go home the same day as the surgery once they have fully recovered from the anesthetic. This usually takes several hours. Patients will need a friend or family member to pick them up from the surgical facility. Someone (a responsible adult) should spend the first night after surgery with the patient in case any post-surgical problems develop. On arrival at home from the surgical facility, the patient should go to bed and rest with their head elevated on two to three pillows. By keeping the head elevated above the heart, edema and swelling from the sinus surgery can be minimized. Patients may get out of bed with assistance to use the bathroom but should avoid straining with bowel movements because this may cause some surgical site bleeding. If the person is constipated, they should take a stool softener or a gentle laxative. Some patients may have noticeable swelling of the nose, upper lip, cheeks, or around the eyes for several days after surgery. This swelling is normal and will gradually go away. People can help reduce it by putting an ice-pack 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 which nicely conforms to the face. The frozen material should be separated from the skin by a towel or similar barrier to avoid any skin damage. Many clinicians suggest periods of 15 minutes of such ice-pack treatment followed by 15 minutes of removal to not damage the skin. Moderate bleeding from the nose is normal, and will gradually decrease. The gauze dressing ("mustache dressing") will collect blood and should be changed as needed. It is not unusual to change these dressings every hour during the first 24 hours after surgery. It is recommended to purchase gauze pads prior to surgery so that the patient will have enough for dressing changes. After a few days the patient will probably not need to use the dressing any longer. Do not take aspirin, aspirin-containing medications, or nonsteroidal anti-inflammatory medications (such as ibuprofen/Advil, Naprosyn, and others) for as long as the surgeon has instructed following surgery, because such medications may increase bleeding and slow clotting at the surgical site. It is best to eat a light, soft, and cool diet as tolerated once the patient has recovered fully from the anesthetic. Avoid hot liquids for several days. Even though people may be hungry immediately after surgery, it is best to go slowly to prevent postoperative nausea and vomiting. Occasionally, patients may vomit one or two times immediately after surgery. If vomiting persists, please contact the surgeon; the doctor may prescribe medication to reduce or eliminate vomiting. It is important to remember that a good overall diet with ample rest promotes healing. Patients may be prescribed antibiotics after surgery, and should finish all the pills that have been ordered. Some form of a narcotic may also be prescribed and is to be taken as needed for pain. If the patient requires narcotics, they should not drive and should consider having a responsible person stay with them. In some situations the doctor may give steroids to be taken either preoperatively and/or postoperatively. It is very important that the take this medication as prescribed, and not discontinue it prematurely. The steroids are instrumental in facilitating proper healing. If patients have any questions or they feel that they are developing a reaction to any of these medications, he or she should consult their doctor immediately. Patients should not take any other medication, either prescribed or over-the-counter, unless they have discussed it with the doctor. Picture of Mustache Dressing

In most situations, the surgery is performed as an outpatient at either the hospital or a surgical center (surgicenter). In both facilities, quality care can be provided without the inconvenience of an overnight stay. An anesthesiologist will review the patient's medical history before surgery, and will monitor the patient throughout the procedure. If the doctor has ordered pre-operative laboratory studies, the patient should arrange to have these done several days in advance, and bring all lab results to the hospital the day of surgery for review. Arrange for someone to spend the first night after surgery with the patient, if possible in case the patient needs to remain overnight. After surgery, the doctor will usually advise the patient to start using saline irrigation. There are many different ways to irrigate the sinuses; depending on the surgery that was performed, the surgeon will advise the patient on the best method for this to be done. In general, patients that have sinus surgery should not take aspirin, or any product containing aspirin, within 10 days prior to the date of surgery. Nonsteroidal anti-inflammatory medications (such as Advil) should not be taken within 7 days of the date of surgery. Many over-the-counter products contain aspirin or Advil-like drugs. Therefore, it is important to check all medications carefully. If there is any question please call the doctors that prescribed the medications (surgeon, primary care physician, cardiologist or other specialists) or consult your pharmacist. Depending on the planned surgery, the surgeon may have the patient refrain from such medications for a longer period of time. Acetaminophen (Tylenol) is an acceptable pain reliever. Usually the surgeon will give prescriptions for post-surgery pain medications at the preoperative visit. It is best to have these filled prior to the date of surgery. In most pre-operative preparations, patients must not eat or drink anything 8 hours prior to the time of surgery; the surgeon or hospital/surgicenter will let the patient know the specific details regarding what time to stop eating and drinking. This includes even water, candy, or chewing gum. Smokers should make every effort to stop smoking, or at least reduce the number of cigarettes as much in advance of surgery as possible. This will help to reduce postoperative coughing and bleeding. If a person is sick or has a fever the day before surgery, they should inform the surgeon. If a patient wakes up sick the day of surgery, still proceed to the surgical facility as planned. The surgeon and the anesthesiologist will decide if it is safe to proceed with surgery.

In the operating room, the anesthesiologist will usually use a mixture of a gas and an intravenous medication to put the patient to sleep and to maintain anesthesia at a safe and comfortable level. During the procedure, the patient will be continuously monitored. 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 whole procedure usually takes several hours. The surgeon will come to the waiting room to talk with any family or friends once the patient is safely in the recovery room.

Traditional sinus surgery involves the precise removal of diseased sinus tissue with improvement in the natural drainage channels by the creation of a pathway for infected material to drain from the sinus cavities. In most situations, the surgeon will employ endoscopic techniques which allow better and more precise visualization without the need for external incisions. As a result, there is less swelling, bleeding, and discomfort, and a faster recovery from sinus surgery.Sinus surgery, unlike other types of surgery where a diseased part or organ is removed, involves the re-routing of existing sinus pathways in addition to removal of diseased tissue. It cannot be emphasized more strongly that post-operative care is as equally important as the surgery itself. One of the most common causes of failure of this procedure is poor post-operative care and follow-up. The doctor can only do so much. It is up to the patient to share in the responsibility of caring for this chronic illness. The following instructions are designed to help patients recover from sinus surgery as easily as possible and to prevent complications. It is very important that patients read these instructions or those provided by their surgeon and follow them carefully.The following information is provided to help individuals prepare for sinus surgery and to help them understand more clearly the associated beliefs, risks, and complications of sinus surgery. However, people are encouraged to ask their doctor any questions to help them better understand the procedure.Picture of the anatomy of the sinusesPicture of the detail of the sinuses

It is important that patients know precisely what time they are to check-in with the surgical facility, and that they allow sufficient preparation time. Bring all papers and forms, including any preoperative orders and history sheets. Patients should wear comfortable loose fitting clothes which do not have to be pulled over their head. Leave all jewelry and valuables at home, including ear rings, watches, rings, etc. Remove all make-up with a cleansing cream. Patients should thoroughly wash their face with soap and water. Do not apply make-up or cream to the face. If possible, avoid using hair clips or other materials to hold up hair. Do not take any medication unless instructed by the doctor or the anesthesiologist. Usually, in the pre-operative holding room, a nurse will start an intravenous infusion line (IV) and the patient may be given a medication to help them relax.

• A sudden increase in the amount of bleeding from the nose unrelieved by pressure, ice, and head elevation.
• A fever greater than 101.5 F (38.6 C) that persists despite increasing the amount of fluid intake and acetaminophen (Tylenol) use.
• Persistent sharp pain or headache which is not relieved by the prescribed pain medication.
• Increased swelling or redness of the nose or eyes.
• Drainage of a thin, clear fluid in large quantities from usually only one side of the nose. This would be different from the clear, thicker mucus drainage normally produced by the nose.