POST OPERATIVE CARE AFTER ENDOSCOPIC SINUS SURGERY:
Postoperative care is essential to maximize the success of the surgery. It is as important, if not more, than the surgery itself. The aim of good postoperative care is to prevent infection, promote mucosal healing and prevent adhesion formation. Adhesions and excessive scarring may narrow or obstruct sinus drainage pathways which were widened during the surgery. This is one of the commonest causes of recurrence of sinus infections after the surgery. Another objective is to look out for any developing complication and deal with it in a timely manner.
My post-operative care protocol after endoscopic sinus surgery is described below:
On the day of the surgery:
Immediately after the surgery while you are still in the recovery room, I will review you to check on your vital signs. Your eyes will be examined for any swelling around the eye. Eye movements, the pupils and vision will be tested. You will also be examined to ensure that there is no excessive bleeding. While in recovery, as you are still recovering from general anesthesia you may not recall this visit.
After about 2-3 hours, I will visit you in the ward by when you will be fully roused. During this visit, I will explain the details of the surgery and intra-operative findings etc. Once again, I will examine you as mentioned above. You may expect some oozing of blood from the nose and the bolster on your nose may require to be changed on a few occasions. Post-operative pain is common. You will be prescribed analgesics to counter the pain. You may experience some discomfort and dryness in the throat as a result of intubation. There is no need to worry about this.
If you have been admitted as a Day Surgery Case, you will be discharged in the evening.
On the 1st Post-operative Day:
Once again a quick examination will be done as mentioned above. Any nasal packing will be removed. Most patients experience a lot of anxiety before the removal of the nasal packing. An anxiolytic and analgesic may be prescribed about an hour before pack removal. There will be some bleeding from the nose following the removal of the packs. This is stale blood that has accumulated in the nose and stops after a few minutes. You may be discharged about an hour after the packs have been removed. After the discharge, I will see you in the clinic to gently vacuum out the blood clots in your nasal cavity.
Subsequent follow up:
Postoperative advice includes, light activity and refrain from blowing the nose too vigorously. Antibiotics, antihistamines, oral steroids and nasal decongestants may be prescribed.
Following that I will see you twice a week for 3 weeks and then once a week for the next 3 weeks.
During each visit the nasal cavity and the sinuses are cleaned with suction to remove stale blood clots, and any crusts formation. Sometimes nasal irrigations may be carried in the clinic. Healing is carefully monitored. If any infection is noted, a culture may be taken so that culture directed antibiotics may be prescribed. If oedema is persistent and severe, a pulse dose of steroids may be prescribed. Frequent nasal irrigations may be necessary.
It takes up to 6 – 8 weeks for the sinus cavities to heal though in some cases it may take even longer. Subsequent appointments are scheduled depending on the progress.