Care of the nose following functional endoscopic sinus surgery (FESS).

 

When you wake up after having your sinus operation you may notice that your nose is blocked on one side or both depending on whether it has been necessary to place a dressing in your nose. If it has been necessary to place a small metal frontal trephine cannula through the skin of your eyebrow into your frontal sinus then there may be one or two small cannulae still present in your eyebrows and these will remain overnight. They will be periodically used to irrigate saline into your sinuses and the nurses will perform this with a small syringe. This is done in order to prevent blood clot forming in the sinuses which may subsequently form scar tissue.

 

You'll be checked regularly by the nursing staff in recovery and on the ward.

It will be examined as a really patient can develop bleeding into the eye socket after sinus surgery which can have a catastrophic effect on vision if not treated promptly. It is to be stressed that this is very rare. Usually you will remain in hospital for one night after surgery. You will be seen by Doctor Bridger the next day and any dressing in the nose will be removed as will any cannulae in eyebrow. Removing a nasal dressing is usually a little painful but only for a very brief period of time. It is common for the nose to bleed for 10 minutes or so after having a nasal dressing removed.

 

Typically patients will spend an hour or so in hospital after having their dressing removed in order to ensure that there is no ongoing bleeding and then they are fit to return home. Usually patients will be placed on an oral antibiotic such as keflex for five days after surgery and may also be placed on an oral corticosteroid tablet such as prednisone again for five days. Patients will need to irrigate their nose regularly with a saline solution which is available over the counter at the chemist. This may be either FLO Nasal Rinse, Neilmed sinus rinse or FESS Post operative hypertonic irrigation wash (depending on what is stocked by your chemist). All of these are equally effective and are made up of a sachet containing the irrigation crystals and a douche bottle which the crystals are placed into with boiled and then cooled water and this is then irrigated into either side of the nose three times per day commencing on the day the patient returns home. Once the saltwater solution has been instilled into the nose it will flow out again and maybe somewhat bloody or contain some discharge. This is not concerning. There can be some pain following this type of surgery but this can usually be controlled with Panadol or panadeine. Patients should refrain from using nonsteroidal anti-inflammatory medications as these  can precipitate bleeding. If a patient has had frontal trephine cannulae placed then the small wounds in the eyebrows will heal very quickly. They often gape a little in the first 24 hours after surgery then shrink down. Patients are usually placed on chloromycetin ointment to be used twice daily on these wounds for one week. It is permitted to get these wounds wet in the shower after returning home from surgery.

 

It is usually recommended that patients rest at home for three days after sinus surgery. Most patients can then return to work provided that work does not involve heavy physical labour. Usually three post-operative appointments are booked at weekly intervals after surgery. Patients should refrain from blowing their nose from the time of discharge from hospital until seeing Doctor Bridger at the first post-operative appointment. At the time of that appointment the nose will be inspected and cleaned . Usually patients are given three appointments at weekly intervals after surgery.

 

Patients should avoid heavy exercise, sport and physical activity for two weeks after surgery and should avoid travelling in an aeroplane or to a remote area away from hospitals for three weeks again because of risk of bleeding. Patients should avoid taking any non-steroidal medications for two weeks after surgery.

 

The nose will usually feel congested and blocked for a few weeks after sinus surgery. When the nose is blown old and fresh blood clot may come out. This is normal. The major concern after sinus surgery at home is bleeding. Often a small nosebleed can be settled with a spray of nasal decongestant such as drixine however more significant bleeding does necessitate that the patient visit the emergency room of the nearest major hospital. For patients in the shire this would be at Sutherland Hospital and for those in the eastern suburbs at the Prince of Wales Hospital in Randwick. Also if a patient has a significant unremitting pain in the face or forehead which is not able to be controlled with panadeine or equivalent analgesic medication then this should be reported to Doctor Bridger. During normal hours queries and concerns regarding your post-operative management can be addressed by contacting Doctor Bridger's office on 9525 3500.

 

Often patients will have had surgery to the nasal septum and/or the inferior turbinates at the same time as having endoscopic sinus surgery. An information brochure on the post-operative care of the nose for this operation will also be provided to them.

 

Patients will also have received a college of surgeons information brochure on endoscopic sinus surgery. It also contains useful information on post-operative care.