Nasal Airway SurgeryBy
Sarah Lewis, PharmD
What is nasal airway surgery?
Nasal airway surgery is the surgical repair of abnormal structures in the nasal cavity. Your nasal cavity is a tunnel that extends from your nostrils to the top of your throat. It is made up of various bones, soft tissue, and cartilage. Nasal airway surgery can help restore airflow and full function of a damaged or diseased nasal cavity.
Nasal airway surgery is a common but major surgery with serious risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all your treatment choices before having nasal airway surgery.
Types of nasal airway surgery
The types of nasal airway surgery procedures include:
Ethmoidectomy removes part of the ethmoid bone. Your ethmoid bone is located at the top of your nasal cavity and makes up the ethmoid sinus. Ethmoidectomy can improve nasal drainage into your throat.
Polypectomy removes polyps in the nasal cavity. Polyps are noncancerous swellings in the nose that can block airflow.
Septoplasty corrects a deviated nasal septum or other septal deformity that can obstruct airflow through the nose and cause difficulty breathing. Your nasal septum divides your nasal cavity into left and right sides and ends at your nostrils.
Tumor removal is the surgical excision of a tumor from your nasal cavity.
Turbinate surgery reduces the size of your nasal turbinates, which can cause obstruction and difficulty breathing through the nose. Your nasal turbinates are located on the outer side walls of your nasal cavity. They project out into your nasal cavity and are responsible for conditioning and filtering the air that moves through your nasal cavity.
Other procedures that may be performed
Looking for a Doctor?
Your doctor may perform other procedures in addition nasal airway surgery. These include:
Rhinoplasty is the repair or reshaping of the nose. It is often called a “nose job.”
Sinus surgery is the widening of the sinus passages to allow for proper drainage to the nose.
Why is nasal airway surgery performed?
Your doctor may recommend nasal airway surgery to treat a damaged or diseased nasal cavity. Damaged or diseased structures in the nasal cavity can block the flow of air through your nose. Nasal airway obstruction can lead to chronic mouth breathing, sleep apnea, chronic headaches, and recurrent nasal infections.
Your doctor may only consider nasal airway surgery for you if other treatment options with less risk of complications have been ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on nasal airway surgery.
Your doctor may recommend nasal airway surgery for:
Enlarged nasal turbinates that extend too far into your nasal cavity, blocking efficient airflow
Nasal airway obstruction from polyps or an abnormal ethmoid bone
Nasal polyps or tumors that block efficient airflow
Deviated septum or nasal septal deformity that is making it difficult to breathe through your nose
Septal spur headaches caused by a sharp projection of the septum from a nose injury
Uncontrollable nosebleeds, often from septal deformities
Who performs nasal airway surgery?
The following specialists perform nasal airway surgery:
Otolaryngologists (ENTs) specialize in the treatment of diseases and conditions of the ears, nose and throat.
Head and neck plastic surgeons specialize in correcting physical defects within the head and neck that can affect a person's appearance and ability to function.
Plastic surgeons specialize in correcting physical defects that affect a person's appearance or ability to function.
Pediatric otolaryngologists (pediatric ENTs) specialize in the treatment of diseases and conditions of the ears, nose and throat in infants, children and adolescents.
How is nasal airway surgery performed?
Your nasal airway surgery will be performed in a hospital or outpatient surgery setting.
Surgical approaches to nasal airway surgery
Your doctor will perform nasal airway surgery using one of the following approaches:
Minimally invasive endoscopic surgery involves inserting special instruments and an endoscope through your nose. An endoscope is a thin, lighted instrument with a small camera. The camera transmits pictures of the inside of your nose to a video screen viewed by your doctor while performing surgery. Endoscopic surgery generally involves a faster recovery and less pain and risk of complications than other types of surgery. This is because it requires no incision and causes less trauma to tissues and organs.
Open surgery involves making an incision inside or around the nose. An open surgery incision allows your doctor to directly view and access the surgical area. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients.
Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different procedures and ask why your doctor will use a particular type for you.
Types of anesthesia that may be used
Your surgeon will perform nasal airway surgery using either general anesthesia or regional anesthesia.
General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain.
Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.
What to expect the day of your nasal airway surgery
The day of your surgery, you can generally expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of nasal airway surgery?
As with all surgeries, nasal airway surgery involves risks and possible complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.
Infection and septicemia, which is the spread of a local infection to the blood
Potential complications of nasal airway surgery
Complications of nasal airway surgery include:
Damage to your eye, eye socket, or related structures
Damage to your skull resulting in meningitis (infection in the brain), brain abscess, or spinal fluid leakage
Failure to restore, or loss of your sense of taste or smell
Nerve damage resulting in numbness of the upper teeth, palate, nose, or face
Pain and impaired healing
Recurrence of nasal airway obstruction, enlarged turbinates, or polyps
Septal bending and return of the septum to its original shape
Septal perforation or a permanent hole in your septum
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery
Informing your doctor or anesthesiologist if you are nursing or if there is any possibility of pregnancy
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or nose or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my nasal airway surgery?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.
You can best prepare for nasal airway surgery by:
Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Arranging for a ride home from your surgery and for someone to stay with you for the first 24 hours after surgery.
Getting preoperative testing as directed. Testing varies depending on your age, health, and specific procedure. Preoperative testing may include X-rays, blood tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need nasal airway surgery? Are there any other options for treating my condition?
Which type of nasal airway surgery procedure will I need?
How long will the surgery take? When can I go home?
What restrictions will I have after the surgery? When can I return to work and other activities?
What kind of assistance will I need at home?
What medications will I need before and after the surgery?
How will you treat my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular office hours.
What can I expect after my nasal airway surgery?
Knowing what to expect can help make your road to recovery after nasal airway surgery as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
You will probably go home on the same day if you are recovering well. Someone will need to stay with you for the first 24 hours after surgery.
You may need to wear a nose splint for a few days to a week after your surgery. You may also have packing in your nose for a few days after surgery. You should not touch the nasal packing unless instructed to do so by your doctor. Call your doctor if it is uncomfortable.
You may have some swelling and bruising around the nose and eyes. This should gradually disappear over a couple of weeks. You may also have some nasal drainage and bleeding. Your doctor will tell you how much drainage or bleeding to expect and how much is abnormal for you.
Using a cool mist humidifier as directed by your doctor may be helpful during recovery.
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. Full recovery takes two to four weeks.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your nasal airway surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after nasal airway surgery. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Bleeding, especially a sudden increase in bleeding from the nose. A small amount of blood draining from your nose is normal after nasal airway surgery. Follow your doctor’s instructions for how to handle bleeding and when to call for bleeding.
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change alertness, such as passing out, dizziness, unresponsiveness, or confusion
Drainage of large quantities of thin, clear fluid from one side of your nose
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate, pass gas, or have a bowel movement
Pain that is not controlled by your pain medication
Numbness of the nose, mouth or face that is unexpected or does not go away as expected after surgery
Unexpected drainage, pus, redness or swelling of your nose, eyes or incision
How might nasal airway surgery affect my everyday life?
Nasal airway surgery may cure your condition or significantly reduce your symptoms. Nasal airway surgery may relieve your pain and restore unobstructed airflow through your nose. This can help improve your sleep, increase general comfort, avoid dry mouth, and reduce nasal headaches and infections.
Nasal airway surgery may cause changes to your nose that can affect everyday life including the need to:
Avoid allergens, smoke and dust, which can irritate your nasal airways
Prevent colds and other infections of your nasal airways
Visit your allergy doctor on a regular basis to keep nasal allergies under control
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