Sino-Nasal Surgery: Surgical Information Pack

Please note that the following is a general guideline only. For a full assessment, exclusion of any other underlying cause for your symptoms and an individualised treatment approach, you will need to be seen by a qualified specialist.

1 General Pre Operative Instructions

Prior to any surgery it is important that necessary precautions are taken to minimise the risk of operative bleeding as well as of general anaesthesia. Following are some important pre operative instructions.

1. If you or any blood relatives have tendency to bleed or bruise excessively, please notify the surgeon.
2. Disclose all significant medical illness to the surgeon and the anaesthetist.  By doing so the doctors are able to determine your anaesthetic risk, and do   appropriate pre operative investigations and opmise your medical treatment.  If there is a need your surgeon may get other appropriate specialists involved for the pre operative work up.
3. If you are a smoker, you must stop smoking for up to two weeks prior to surgery.
4. If you take blood-thinning medications such as Warfarin, Aspirin or Newer anti platelet medications, these need to be disclosed to the surgeon. The surgeon will ask you stop these for 10 days if it is safe to do so, after consultation with your physician. He may cancel surgery if the risk of stopping such medications is too high.
5. There is potential of certain dietary supplements, including garlic, Ginkgo   biloba, ginger, ginseng, glucosamine fish oil, and vitamin E, to interfere with hemostasis. These and any other supplements should also be stopped well in advance. 
6. Practical matters: Organise sufficient assistance at home. Stay with close proximity to a hospital. Ensure you have some one to drive you to emergency, incase of a bleed. Have access to a phone. Do not plan travel for at least four week following surgery. 

Please read the surgical information sheet given. If you have any concerns or wish to speak to your surgeon please contact the reception.

2. Sinus Surgery Instructions 

Pre Operative

Ensure you have printed films, which you will need to bring on the day (not a CD)

Ensure you have received pre operative steroids and antibiotics (not necessary for septoplasty/ turbinate surgery alone)

Do regular rinsing and sprays to optimise your nasal condition prior to surgery

Post Operative

RINSING

If you have splints, use regular saline spray until removed. Once splints are removed in 1 week, rinsing becomes the single most important thing to keep your nose clean and void of clots. You must start rinsing three to four times a day ( Pulmicort rinses twice per day). After 4 weeks you may reduce the Pulmicort to once per day and later every other day longer term as determined by you surgeon. Not irrigating may affect the final outcome of your operation. (please read the pamphlet on sinus health for details on the rinses) . You must bring your rinse bottle with you to the first post op appointment, for the surgeon to assist you with the technique. 

BLEEDING 

Minor bleeding is normal, and its important to rest. If you bleed more or if any fluid leakage please go to Frankston or Monash (not the Private Hospital ED) and contact the surgeon. You must have access to a phone and a friend to drive you to hospital in the case of haemorrhage. Avoid very hot long showers or heavy exercise util advised by the surgeon.

HEADACHE/ FEVER
Meningitis is a very rare complication. If you have any concerns please to to Ed and ask them to assess and contact your surgeon.

HOME 

Stay close proximity to a hospital even up to four weeks after surgery. Generally is safe to go to school/ Work after two weeks, but NOT Camping!!

SPLINTS

Its common to have splints in if you have had septal surgery. when splints are in place it will feel blocked to a degree. These generally give structural support initially and come out 7 days later. You need to be on antibiotics and saline sprays to the nose to prevent infections.

POST OP MEDICATIONS

Usually you will be given pain medications, antibiotics (as well as steroids: if sinus surgery). You will also be given nasal rinsing and sprays as described above.

FOLLOWUP

If you have a splint, your surgeon will see you in one week to remove this, otherwise review in two weeks is the normal practice. You will have regular suctioning and reviews over several weeks, until the surgeon is happy that crusting and bleeding has completely settled. Bring you sinus rinse bottle to the first post op clinic. 

If Concerns
Contact surgeon, the hospital and if an emergency go to closest ED as above

3.  Consent: For Your Surgery

Informed consent is a process of finding out information about the recommended treatment, alternative options and weighing up the benefits and risks involved. It is not about just signing a form. This involves

• The diagnosis and likely outcome (prognosis) of your condition
• An explanation of the recommended treatment
• The risks of the procedure and common side effects
• Possible complications
• Specific details of the treatment; for example, where it will be performed and who will perform it
• Any other options for treatment and their probability of success.

It is not possible, however, to provide complete information or predict outcomes or assess risks with certainty; and patients need to be aware of this uncertainty.

You would also be provided with a official handout about surgery, which you will be requited to read and understand. If you have any specific matters which you like to further discuss you are requested to contact the surgeon and make another appointment prior to surgery. You have the right to cancel surgery if you wish to do so.

Summary of the risks and complications of sino-nasal surgery which your surgeon has discussed with you include the following

    

1. pain/ Infection/ rare cosmetic change
2. Bleeding
3. Rare risk of haemorrhage and need of a transfusion. 
4. Continuation/ recurrence of symptoms (about 20%)
5. Perforation-hole in the septum- whistling/ crusting
6. Numbness
7. Skull base injury-brain fluid leak, rare risk of Meningitis 
8. Bruising of the eye
9. Extremely rare risk to vision- double vision, blindness 
10. Need for future surgery (about 20%)
11. Altered smell/ taste
12. Anesthetic risk: will be discussed by the anesthetist