Deviated Septum and Septoplasty

Septoplasty with or without Turbinate Reduction Education and Preparation

We take surgery very seriously and so should you. Please read (and re-read) the following summary. It would be impossible to cover every possible scenario, so never hesitate to ask questions. Good communication with your surgery team is critical to a successful and safe surgery.

Scheduling and Logistics

If you haven’t met with our scheduler yet, expect a call within the next day. If you have insurance questions, they can help you answer them. Keep in mind that you should also talk to the hospital about their charges as the majority of the fees are from the hospital.

For most patients the location of surgery will be PMC (Physicians Medical Center), 2990 Rodeo Park Dr E., Santa Fe (505) 428-5400. For low-risk patients, the hospital requires a phone health screen from the pre-anesthesia testing (PAT) clinic. A provider will call you the next business day between 9 am and 12 pm. For higher risk patients, the hospital requires an in-person PAT clinic visit at PMC. Your PAT appointment should be as soon as possible, preferably within 5 business days. Expect a call from them, and if you have not heard from them within 2 days, let us know. The PAT clinic number is (505) 913-4411. Our clinic number is (505) 982-4848.

The government requires that you are seen by your surgeon within 30 days before your surgery. If your surgery is scheduled more than 30 days out, you will need to return to clinic before surgery.

Basics

Your doctor has recommended that you have a septoplasty to straighten your septum, which is the wall in the nose that separates right and left sides. This surgery involves reshaping the internal nasal cartilage and bone through a small incision inside the nose. Turbinates are shelves on each side of the nose that are often reduced in conjunction with septoplasty. These procedures will be performed under general anesthesia and are usually outpatient. Patients with obstructive sleep apnea may require an overnight hospital stay.

Preparation

If you are on a blood thinner (aspirin, warfarin, Coumadin, Plavix, etc) discuss discontinuing this with your doctor. If it is not safe to stop your blood thinner, then it is not safe to have thyroid surgery. Blood thinners should be stopped a week before and after surgery. Also please stop anything that might have vitamin E, ibuprofen (Advil), Aleve or similar medications.

Do not eat or drink after midnight. A small sip of water to take essential medications is ok. The pre-anesthesia clinic will tell you which medications are essential and should still be taken the morning of surgery.

Please shower the night before or morning of surgery. Do not wear make-up, hair-products, jewelry, or piercings. Be prepared to remove dentures, contacts, glasses, or hearing aids before surgery begins.

If you feel that you are getting sick within 2 weeks of surgery, call our clinic right away so we can consider re-scheduling.

If you are discharged the same day as your surgery, you must have a capable adult drive you home and stay with you that night. Your surgery will be cancelled if you are having an outpatient surgery and you do not have someone to drive you and be with you that night.

Possible hospitalization

Most patients undergoing sinus surgery and septoplasty can go home the day of surgery. However, you may require hospitalization if you have certain medical conditions or obstructive sleep apnea. When admitted to the hospital, most patients can be discharged the next day but the exact length of stay depends on several things (blood pressure, general health, and extent of surgery).  If you do not live in Santa Fe, you may need to get a hotel room the night of surgery in Santa Fe. There are several hotels that offer discounts and a list is available. The bottom line is to be prepared to stay overnight in the hospital, and, if you live out of town, also be prepared to get a hotel room.

Recovery time and activity

While it is difficult to estimate your exact recovery time, we generally recommend having 7 to 10 days away from work or other responsibilities. During this recovery time, you should not exercise, lift anything heavy, or travel. Walking is still strongly encouraged.

Anesthesia effects

You will have general anesthesia which may make you nauseous or drowsy, particularly the first day. Do not drive a car, operate heavy machinery, or sign legal documents for at least 24 hours AND until you are no longer taking prescription pain medicine. Alcohol is not recommended during the recovery period, particularly the first 24 hours. The combination of alcohol and acetaminophen (Tylenol) can be toxic to the liver. For a full discussion of anesthesia risks, you will meet and talk to your anesthesia team the day of surgery.

Follow-up

Nasal splints will be placed in your nasal cavity. These may create pressure and discomfort. They will be removed by your surgeon anywhere from 6 to 8 days after your sinus procedure.

Nasal Care

You should use saline nasal spray (i.e. Ocean Spray), 2 sprays each nostril every 30 minutes while awake for one week. You will use saline 4-5 times per day for the next 1-2 months to minimize dryness and crusting in the nose. While recovering from septoplasty, please apply topical antibiotic ointment (i.e. Bacitracin) to front of nostrils twice daily for 2-4 weeks. Avoid nose blowing for one week after nasal surgery.

Dressing Care

Change the dressing under your nose as necessary. Mild bloody drainage down the front and back of nose usually lasts 2 to 3 days and progressively tapers off. Please call our office if bleeding is excessive (i.e. if you need to change the dressing every 15 minutes or less 4 to 5 times consecutively). The dressing may be removed once bleeding has subsided.

Diet

After having anesthesia, you will want to advance your diet slowly the first day to avoid nausea.

Pain

Pain level varies from person to person. Most have moderate pain but some people have minimal or severe pain. Those with mild pain usually require only acetaminophen (Tylenol) to control pain. Those with moderate pain usually require the prescribed narcotic pain medicine. Keep in mind the prescription narcotic also contains acetaminophen. Therefore, do not take the prescribed narcotic and acetaminophen. This would result in a double-dose of acetaminophen and can cause liver damage.

Narcotic pain medicine tips and safety:

  • Don’t take narcotic prescription on an empty stomach. Wait at least 10 minutes after eating.
  • If you become nauseous, don’t take any more narcotic pain meds until you feel better.
  • Narcotics can cause sedation. They can be dangerous if overdosed or combined with other sedating medications. Do not take narcotics when drowsy. Never mix narcotics with alcohol, sleep aids or anxiety medications.
  • Narcotics can cause constipation. You can prevent this by taking docusate (an over-the-counter stool softener). You may also need a suppository such as dulcolax if you become constipated.
  • Narcotics can cause itching. If this occurs, take a lower dose or take a non-sedating antihistamine (such as Claritin) to reduce this.
  • Narcotics are not meant for long term use and can cause tolerance and dependence. We generally will not prescribe narcotics beyond 10 days after surgery.
  • Never take a narcotic pain medication that is not prescribed to you.
  • Never adjust your own doses, if any questions about dosage please call our office at (505) 982-4848.
  • Keep track of when you take narcotic medications.
  • Keep your narcotic medications locked in a safe place.
  • Information for proper disposal of any unused narcotics:
  • Santa Fe County Drug Take Back Program

Held twice a year

Call 505-986-6200 for more information.

  • Albuquerque, NM disposal sites

Open Monday through Friday 8 a.m. – 5 p.m.

On website, www.cabq.gov/police/programs click on Disposal of Pharmaceuticals

 

  • US Dept. of Justice – Drug Enforcement Administration

For information about local area Drug Take Back dates/locations go to:

www.deadiversion.usdoj.gov/drug_disposal/take back/index.html

 

Potential Complications

Bleeding

Minor bleeding after surgery is common and usually resolves after a few days but may last up to a week. Profuse bleeding is rare and would require immediate medical attention and nasal packing.

Septal perforation

This is a rare complication of nasal surgery resulting in a small or large hole in the septum. This will not change the external appearance of the nose and may go unnoticed by the patient. However, it may cause a whistling noise when breathing in, nasal dryness, and bleeding. Small to medium sized perforation may be repaired with a subsequent operation.

Infection

Nasal infection is a very rare complication after septal surgery. The nasal splints are coated with antibiotic ointment during the surgery to prevent this. You may be placed on oral antibiotics after surgery as well. Recurrent or persisted sinus infection can occur even after sinus surgery.

Nasal obstruction

Nasal obstruction may persist after a septoplasty. This can be due to a shift of the cartilage back to its original position or it may be the result of a nasal valve obstruction.

Blood clots

Blood clots are uncommon, but can be deadly. A blood clot in the legs is called a deep vein thrombosis (DVT). They can be deadly if the clot travels to the lungs (pulmonary embolism). People are at risk for DVTs up to a month after surgery. The risk is greater with any of the following: lack of movement, age over 40, obesity, dehydration, pregnancy, use of oral contraceptives, or prior blood clot. Some people are more likely to develop a DVT due to a genetic defect, but may not discover this until a DVT happens. Swelling or pain in your lower leg or behind your knee is usually how a DVT presents. If this happens, you should go to an emergency room immediately for evaluation. To prevent a DVT, wear compression stockings and start walking at least three times a day beginning the evening of your surgery. The quicker you regain mobility and the more mobile you are, the lower your risk.

Death

With any surgery there is a small chance of death. Some of the possible causes were mentioned above: blood clot, bleeding, and breathing problems. We do not have very good data on this risk because it occurs so rarely. Averaging two recent studies suggests this risk could be one out of 1000 for thyroid surgery.1,2 We know that the more unhealthy a person is (high blood pressure, diabetes, emphysema, obesity), the greater the risk; conversely, healthier people will have a lower risk. To put this in perspective, the risk of dying in a car accident is one out of 10,000 per year.3

Reducing your risks

What can you do to reduce your risks with surgery?

  • If you are obese, losing weight will reduce your risks. Consider delaying surgery to lose weight, if possible.
  • If you smoke, stop for at least one week before and after surgery.
  • Except for emergencies, sinus surgery should be avoided when pregnant.
  • Sleep apnea. If you are at risk for having sleep apnea, you should be tested beforehand because the risk of anesthesia complications is greater in people with untreated sleep apnea. Your doctor and/or the PAT clinic providers will ask you questions to screen you for sleep apnea. Those suspected of having sleep apnea will require a pre-operative sleep study. If you have moderate or severe sleep apnea, you will likely need to be observed in the hospital overnight. Remember to bring your CPAP to the hospital.
  • Be aware and communicate.

Every surgery has inherent risks that are impossible to completely eliminate. If you recognize a problem after your surgery, it is imperative that you contact us or seek medical attention promptly. Ultimately, it is your responsibility to communicate with your doctor and medical team regarding any concerns. We encourage you to ask questions until all of your needs are addressed. We are happy to talk to or see you any time after surgery. If your surgeon is not available, one of the other doctors will be.

 

I have read and understand the above. I have discussed the risks, benefits, and alternatives to surgery with my doctor. My questions have been answered to my satisfaction.

Patient /Parent signature: _________________________________  Date:     _________________

Pre-op nurse signature:   __________________________________  Date:     _________________

Physician signature:        ___________________________________   Date:     _________________

 

Instructions after Sinus Surgery

x Call 982-4848 for an appointment to remove dressing and sutures in _______________

  • Call 982-4848 for an appointment to remove drain in __________________

x Avoid heavy lifting, straining, exercise, or travel for 14 days

x Avoid lying flat the first two days

x Walk for several minutes at least 3 times a day. Wear compression stockings until you are moving around a normal amount.

x Avoid alcohol

x Do not drive or operate heavy machinery until off of pain medications and able to turn head comfortably.

x Do not sign legal documents until at least 24 hours after surgery

x If you vomit more than twice in one day, call your doctor.

x Regular diet as tolerated

x You may substitute the prescribed narcotic with over-the-counter acetaminophen (Tylenol)

x Don’t take narcotic prescription on an empty stomach. Wait at least 10 minutes after eating.

x If you become nauseous, don’t take any more narcotic pain meds until you feel better.

x Narcotics can cause sedation. They can be dangerous if overdosed or combined with other sedating medications. Do not take narcotics when drowsy.

x Narcotics can cause constipation. You can prevent this by taking docusate (an over-the-counter stool softener). You may also need a suppository such as dulcolax if you become constipated.

x Narcotics can cause itching. If this occurs, take a lower dose or take a non-sedating antihistamine (such as Claritin) to reduce this.

x Narcotics are not meant for long term use and can cause tolerance and dependence. We generally will not prescribe narcotics beyond 10 days after surgery.

x Apply bacitracin antibiotic ointment to front of nostrils twice daily for 1 week

x Use aerosol saline nasal spray (i.e. Ocean Spray): 2 sprays each nostril every 30 minutes while awake for 1 week; then 4-5 times per day for 3 months.

x Avoid nose blowing for 1 week

x Leave nasal drip-pad dressing in place until bleeding from the front of the nose resolves (1-3 days)

x Call or return for fever over 101.5 more than a day after surgery, or increasing redness, pain or swelling

x Call you doctor with any other problems or concerns: (505) 982-4848

 

I have read and understand the above instructions.

Family member signature: _________________________________  Date:     _________________

PACU nurse signature:   __________________________________     Date:     _________________

Physician signature:        ___________________________________   Date:     _________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Instructions after Sinus Surgery

x Call 982-4848 for an appointment to remove dressing and sutures in _______________

  • Call 982-4848 for an appointment to remove drain in __________________

x Avoid heavy lifting, straining, exercise, or travel for 14 days

x Avoid lying flat the first two days

x Walk for several minutes at least 3 times a day. Wear compression stockings until you are moving around a normal amount.

x Avoid alcohol

x Do not drive or operate heavy machinery until off of pain medications and able to turn head comfortably

x Do not sign legal documents until at least 24 hours after surgery

x If you vomit more than twice in one day, call your doctor.

x Regular diet as tolerated

x You may substitute the prescribed narcotic with over-the-counter acetaminophen (Tylenol)

x Don’t take narcotic prescription on an empty stomach. Wait at least 10 minutes after eating.

x If you become nauseous, don’t take any more narcotic pain meds until you feel better.

x Narcotics can cause sedation. They can be dangerous if overdosed or combined with other sedating medications. Do not take narcotics when drowsy.

x Narcotics can cause constipation. You can prevent this by taking docusate (an over-the-counter stool softener). You may also need a suppository such as dulcolax if you become constipated.

x Narcotics can cause itching. If this occurs, take a lower dose or take a non-sedating antihistamine (such as Claritin) to reduce this.

x Narcotics are not meant for long term use and can cause tolerance and dependence. We generally will not prescribe narcotics beyond 10 days after surgery.

x Apply bacitracin antibiotic ointment to front of nostrils twice daily for 1 week

x Use aerosol saline nasal spray (i.e. Ocean Spray): 2 sprays each nostril every 30 minutes while awake for 1 week

x Avoid nose blowing for 1 week

x Use high volume saline irrigations as instructed by your surgeon. Standard instructions: irrigate with 240 ml 2-3 times daily for 3 months using NeilMed Sinus Rinse (available at most pharmacies). Dispense ½ the bottle in each nasal cavity—approximately 120 ml on each side. You may increase the volume and/or frequency if needed. Long-term maintenance and prevention usually involves once daily rinses.

x Leave nasal drip-pad dressing in place until bleeding from the front of the nose resolves (1-3 days)

x Call or return for fever over 101.5 more than a day after surgery, or increasing redness, pain or swelling

x Call you doctor with any other problems or concerns: (505) 982-4848

 

I have read and understand the above instructions.

Family member signature: _________________________________  Date:     _________________

PACU nurse signature:   __________________________________     Date:     _________________

Physician signature:        ___________________________________   Date:     _________________