The most frequent nasal surgery an adult patient undergoes involves the correction of chronic nasal obstruction associated with a deviation of the nasal septum. The septum is the cartilaginous and bony wall that divides one nasal airway from the other and separates the nostrils.
The septal deviation may result from a trauma that the patient has experienced, or not uncommonly, the septal deviation has persisted since childhood. The deviated nasal septum is seen in the diagram as well as the enlarged turbinate. (Surgical repair of a deviated nasal septum is usually performed in conjunction with the surgical reduction of the nasal turbinates to optimize the nasal airway).
A septoplasty and turbinate reduction is performed as an outpatient procedure under general anesthesia. An incision is made inside the nose to allow access to the bent or crooked cartilage and bone. A minimal amount of cartilage and bone is removed. The shape of the nose is not changed during a septoplasty. (If there is an external deformity of the nose, a rhinoplasty may be performed in conjunction with the septoplasty, to repair and reshape the nose aesthetic appearance).
During the procedure, sutures are used inside the nose that will be resorbed. Frequently, small plastic splints are placed on either side of the nasal septum to ensure that the septum remains in the midline. These “septal splints” are removed at 1 week by the surgeons. Patients undergoing rhinoplasty or external nasal reconstruction will have an external splint on the nose, also removed at 1 week.
The nasal turbinates as seen in the diagram are vascular tissue in the nose that functions to promote efficient airflow and increase the surface area for humidification of inspired air. The turbinate surgery is conservative in that the turbinates do provide a definite function and are not to be fully removed. The surgical procedure involved is by way of Coblation. One of the diagrams demonstrates the placement of a probe within the wall of the turbinates. The probe allows a radiofrequency current to decrease the swollen vascular tissue while maintaining the anatomical structure and function of the turbinate.
A link to Coblation of the turbinate is available for a more extensive discussion of the procedure.
Postoperatively, the patients are able to return home. An antibiotic and pain medication will be prescribed. Postoperative instructions can be found here.
Sinus surgery is indicated in those patients that experience chronic infection, inflammation, and obstruction in the cavities around the nasal passages (sinuses). The surgeons with the Dallas ENT Group combined have performed more than 3,000 endoscopic sinus cases and balloon sinuplasty procedures.
Chronic sinusitis is the inflammation and blockage of the sinus cavities. This obstruction or blockage interferes with drainage and causes the mucus to build up within the cavity. This common condition is also referred to as chronic rhino sinusitis. Patients may have chronic bacterial infections; but frequently, the chronic sinusitis is a result of persistent inflammation or swelling of the nasal tissue. Symptoms include difficulty in breathing through the nose with associated facial pressure, dental pain, and headaches.
The inflammation of the nasal tissue may initially be caused by an infection; but later by persistent inflammation resulting in a benign growth in the nasal airway and sinuses referred to as a nasal polyp. It is not uncommon for the patient to experience a deviated nasal septum and enlarged turbinates.
Most patients experience recurrent episodes of infections with mucopurulent (yellow- green nasal drainage) frequently treated by their primary care physician with antibiotics and possibly steroids. However, those patients with chronic sinusitis generally have symptom’s lasting 8 weeks or longer. It is not uncommon for the patient to experience a cough and pulmonary problems as a result of the aspiration into the trachea and lungs that have a small amount of the bacterial drainage. Reduced sense of smell and taste may occur as well as aching and discomfort in the upper jaw and teeth.
Evaluation is completed by one of the surgeons with the Dallas ENT Group through a careful history and examination of the nose frequently with the use of a lighted endoscope to examine the areas high in the nasal cavity. Completion of evaluation always involves obtaining a CT scan of the sinuses. In the Medical City office, the scan can be obtained the same day within an hour in the scan facility on the 3rd floor. In the Plano Presbyterian Office, the scan also can be obtained that day at an offsite facility. Once the surgeon evaluates the CT scan, a definitive plan for the patient is determined.
For extensive thickening of the nasal cavities, an endoscopic surgical procedure is performed without any external facial incisions. This is frequently performed using an instrument called the “Brain LAB” image-guided sinus system. More information on the Brain LAB image-guided sinus system can be accessed through this link.
The image-guided system allows precise removal of the tissue while virtually eliminating the complications that had been associated with endoscopic sinus surgery in the past including spinal fluid leak and visual loss.
The endoscope is a 4-mm lighted tube that is similar, but smaller than the instrument used by orthopedic surgeons in performing arthroscopic knee surgery, or gynecologists in performing laparoscopic surgery. The endoscope and the small instruments allow precise removal with minimizing tissue damage. The procedure is performed under general anesthesia; usually as an outpatient. No packing is required. If a septoplasty is performed, the surgeon may place plastic “septal splints”.
Initial evaluation in the office may reveal sinus disease that can be treated with a minimally invasive procedure called the “balloon sinuplasty”. The three surgeons with the Dallas ENT Group have been trained in the use of the balloon sinuplasty. A link is available for more extensive discussion of this procedure.
A follow-up for the endoscopic sinus surgery occurs at 2-3 weeks with general suctioning of the nose again using the endoscope. The patient may need to return for 3-4 postoperative visits to debride, or remove, the crusting or scarring that occurs following the procedure. Careful and frequent follow-up leads to a more successful result of the endoscopic sinus procedure.
Postoperative instructions are available on this website through this link.