Archive for Surgical Procedures

SEPTOPLASTY

SEPTOPLASTY

Septoplasty is an operation performed to straighten the partition between the nostrils (septum) by trimming and refashioning cartilage and bone.

A septoplasty is usually performed to improve the nasal airway and can also allow for better access for nasal sprays.  It may be performed as part of a septorhinoplasty (“nose job”) or to provide access for surgery to the sinuses (endoscopic sinus surgery).  Turbinate trimming and/or cautery may also be indicated at the same time especially if you have allergies.

GENERAL POINTS – AFTER SURGERY

  • Packing of the nose is uncommonly required but if inserted may remain in for 24-48 hours.
  • There is usually mild pain only – Paracetamol should be sufficient in most cases.
  • Gentle nose blowing only to clear loose clots and mucous.
  • A bloodstained mucous discharge and nasal blockage is common for 2-3 weeks.  It is due to local reaction with swelling and production of mucous.  Sleeping with head elevated may help.  It may take 6 weeks to clear completely.
  • Use a nasal spray or drops if prescribed by your surgeon and try to breathe through your nose as much as possible.
  • Saline douche will help to clear clots and mucous.  Advice regarding saline douche will be provided.
  • Avoid strenuous activity for 3 weeks.  Lifting and straining may precipitate bleeding.
  • Clean nostrils with cotton buds gently.  Use antibiotic ointment if prescribed.
  • Take antibiotics if prescribed.
  • Black eyes are not expected with this procedure.
  • Dissolvable stitches occasionally appear from the nostrils.  Do not attempt to pull these out.

 

YOUR CONSULTATION

If you think that you may need a septoplasty, please call 031 201 3118 for an appointment. A complete history will be taken,  and a thorough examination will be conducted to determine whether a septoplasty is indicated. Best ENT specialist practice guidelines will be followed at all times.

 

 

 

TONSILLECTOMY & ADENOIDECTOMY

TONSILLECTOMY

A tonsillectomy is a procedure done to remove the tonsils

WHAT ARE TONSILS?

The tonsils are lymphoid tissue lying on either side of the back of the throat.  This tissue is similar to lymph nodes or ‘glands’ found in the neck, groin and other parts of the body.  They have a role in immune defence (defence against infection), although like the appendix their role has become less important as humans have evolved.  If they are recurrently or chronically infected they become a source of, rather than a defence against, infection.

 

WHY REMOVE TONSILS?

  • Recurrent/persistent infection causing sore throat, fever, halitosis and time lost from employment or studies.
  • Large size causing obstruction (a problem more common in children) with snoring or obstructive sleep apnoea.
  • Suspicion of tumour or malignancy (rare!).

 

GENERAL POINTS

  • Tonsillectomy is performed under General anaesthetic
  • Removal is performed through the mouth.
  • Tonsillectomy is usually a day stay procedure.

ADENOIDS

The adenoids are tonsil-like tissue in the back of the nose, up behind the roof of the mouth (palate).  They are often large in small children and are commonly also removed with the tonsils (adenotonsillectomy).  As children grow the adenoids tend to shrink and the adenoids seldom require removal in older children and adults.

AFTER SURGERY

  • Tonsillectomy is a painful operation!  Adequate pain relief is important.  A combination of paracetamol, anti-inflammatories, antibiotics and possibly other medications will be prescribed.  Pain usually “peaks” 5 – 7 days post-operatively and it is important to keep taking pain relief regularly for 10 days.  Pain is often referred to the ears, which share the same nerves as those which supply the throat.
  • There is no food restriction.  Adequate fluid intake (2-3 litres/day) is essential (avoid citrus juices as they sting).  Encourage chewing to lessen jaw muscle stiffness: chewing gum is helpful.
  • A yellow layer called slough is normal over the surgical site.  It usually separates around 5 – 7 days, sometimes with a small amount of blood.
  • At least a week and often up to 2 weeks off work or school is required to recover.
  • Avoid strenuous activity/sport for two weeks (lack of energy is common).

 

POSSIBLE COMPLICATIONS

  • Bleeding may occur for up to 2 weeks after the operation (most commonly after 5 – 7 days).  Most bleeding is brief and settles with bed-rest and sucking ice.  About 5% of patients will experience bleeding severe enough to be readmitted to hospital.  If bleeding is more than a cupful or lasts longer than 10 minutes, contact your family doctor, local A & E clinic or Hospital Emergency Department.
  • Occasionally patients complain of an unpleasant or decreased taste when eating.  This usually resolves but may take weeks or months.
  • Vomiting is quite common in the first few hours.  If it fails to settle it may require further treatment.
  • Jaw damage which can restrict jaw opening is rare, unless there are pre-existing problems.  Please tell your surgeon & Anaesthetist if you have problems with your jaw.
  • There may be a change in the pitch of the voice.  This is rarely more than mild, and is usually temporary.
  • Damage to teeth may occur: please draw attention to caps on the front teeth.

YOUR APPOINTMENT

If you think that you or your child may required tonsillectomy and / or adenoidectomy, please call 031 201 3118 for an appointment.

A complete history will be taken, and a thorough examination completed. Further management will be in keeping with best ENT specialist practice guidelines.

 

 

ADENOIDECTOMY

ADENOIDECTOMY

 

WHAT ARE ADENOIDS?

Adenoids are tonsil-like lymphoid tissue located behind the nose.

The Eustachian tube opens near the adenoids.  If adenoids are enlarged or chronically infected they can block this opening or be a source of infection travelling up the Eustachian tube into the middle ear.  The result may be recurrent ear infections.

If the adenoids are enlarged or chronically infected, they can also block the back of the nose, leading to nasal obstruction, mouth breathing, chronic nasal discharge, snoring and obstructive sleep apnoea.

Removal is indicated to relieve nasal obstruction, snoring, sinusitis and ear infections.

NOTE: adenoids usually shrink in size as children grow older: adenoid removal is less commonly done in patients over the age of 8 years.

GENERAL

  • Adenoid removal is always under general anaesthetic
  • Removal is done with an instrument passed through the mouth
  • It is usually a day case procedure

POST SURGERY

-Quiet activity for a few days – about 1 – 2 days off school

-Mild pain – relieved with Paracetamol

-A blocked nose may persist for immediately after surgery- this will clear over 1-2 weeks

 

POSSIBLE COMPLICATIONS

-Bleeding –this is a rare complication. If it does occur, it is usually mild and controlled with Otrivine nose drops. Contact me if lasts for more than 10 minutes or if bleeding is heavy, i.e. with blood clots.

-Occasionally there can be re-growth after removal (usually when removed at a young age- <18 months).

-Altered speech – mild, usually settles.  Very rarely, a congenital weakness of the soft palate may become apparent after adenoidectomy, causing ‘cleft palate’ like speech and nasal regurgitation of swallowed fluids.

-Damage to teeth may occur (rarely).  Please draw attention to caps on the front teeth.

 

SUMMARY

 

Adenoidectomy in children, either alone or in combination with a tonsillectomy or grommet insertion, may be extremely beneficial in treating nasal obstructive symptoms and middle ear problems.

 

 

YOUR CONSULTATION

 

If your child has a persistently blocked nose, is a mouth breather, and/or snores, he/she may have enlarged adenoids.

Please call 031 201 3118 or 031 581 2534 for an appointment. A full history will be taken, a complete ear, nose and throat examination will be performed, and if necessary, X-Rays will be requested.

Thereafter, a decision regarding the need for adenoidectomy will be taken in keeping with best ENT specialist practice guidelines.

 

 

 

FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS)

Most people who undergo endoscopic sinus surgery do so as part of the treatment of chronic sinus problems that have not responded to maximal medical therapy.

Symptoms of sinus disease include facial pain or pressure, a blocked nose, a decreased sense of smell, a persistent foul smell in the nose or nasal discharge.  Less commonly sinus problems cause headaches, hoarseness, cough and a variety of other symptoms.  For this reason sinus problems are frequently confused with other medical conditions.

Most people with sinus problems can be successfully treated medically, without the need for surgery.  Prolonged courses of antibiotics, often in association with Prednisone, nasal sprays, and saline irrigations, are frequently effective.

Treatment of underlying allergies and avoidance of exposure to environmental triggers such as cigarette smoking may also be helpful.  The medical treatment chosen will depend on my assessment of the cause.

If the above medical therapy fails or you have a problem which is clearly not amenable to medical therapy, then surgery may be required.

The operation

The operation will usually be performed under general anaesthetic.  General anaesthetic carries minimal risk in otherwise healthy patients.  You will have the chance to discuss this with your anaesthetist pre-operatively.

I will usually prescribe Prednisone and antibiotics around the time of the surgery as this improves the results.  In some cases the surgery can be performed on an outpatient basis without the need for nasal packing.

The surgery is done with the use of an endoscope. The principle of the surgery is to unblock the obstructed openings (ostia) of the sinuses, to allow drainage of secretions, and to allow air to enter the sinuses (i.e. for ventilation of the sinuses)- this returns the sinuses to normal health

General points – after surgery

  • There is usually mild pain only – Paracetamol and an anti- inflammatory should be sufficient in most cases.
  • Packing of the nose is usually required for the first night  postoperatively- the packing is removed the next morning.
  • A blocked nose is common for 2-4 weeks due to swelling and crusts, which improves after cleaning at the postoperative visit(s).
  • Healing takes approximately 6-12 weeks to be complete, longer if there is postoperative infection.
  • There is usually some bleeding for several days after surgery,  and after each cleaning.
  • Thick brown mucus may drain from the nose for 3-4 weeks or more.
  • Avoid hard nose blowing for 4-7 days following the surgery.
  • Saline irrigations will help to clear clots and mucous.  A syringe or saline squeeze bottle and advice regarding saline irrigations will be provided.
  • Take antibiotics and/or Prednisone as prescribed.
  • Usually patients require 7-10 days off work.
  • Avoid bending, lifting and straining for 3 weeks after surgery.  Exertion may precipitate bleeding.

 

A follow-up visit is arranged one to two weeks after the surgery to clean crusts from the surgical site.  Further follow-up visits are arranged at approximately weekly or fortnightly intervals until the area is healed at around 6 – 8 weeks.  At each of these visits and at subsequent follow-up examinations, any persistent scar tissue may be removed under local anaesthetic.

Results of Surgery

Sinus disease is usually due to a complex combination of structural, mucosal (lining) and environmental factors.  In general, FESS is successful in up to 80% of patients.

In some patients, there will be persisting disease, which requires ongoing medical treatment.  Allergic mucosa may require the permanent use of nasal corticosteroid sprays.  Severe polyposis with sinusitis has a high rate of recurrence (>50%).

Risks of Surgery

Although there are potentially very serious risks from surgery in this area, the incidence is very low.

 

Bleeding – Bleeding is a potential risk in all forms of sinus surgery.  Although the risk of bleeding appears to be reduced with the endoscopic technique, on occasion significant bleeding may require stopping of the procedure and placement of nasal packing.  Bleeding following surgery may also require the placement of packing and hospital admission.  Blood transfusion is very rarely required.

 

Post-operative discharge – Blood-stained nasal discharge may occur for approximately three weeks after the procedure.  This is normal and slowly improves.

Cerebrospinal fluid leak – This is a rare complication (<1% of all sinus surgery patients).All operations on the sinuses carry a risk of intra-cranial penetration, which may result in a leak of cerebrospinal fluid (or CSF, the fluid that surrounds the brain).  Should this rare complication occur, it creates a potential pathway for infection which could result in meningitis.  This would extend your hospitalisation as further surgery would be required for closure of the leak.

Visual problems– these complications are extremely rare, though double-vision and loss of vision have been reported in the literature

Other risks – Watering of the eye can occasionally result from sinus surgery or from sinus inflammation.  This is usually temporary but can be persistent and may require surgery to correct it.  Swelling or bruising around the eye may occur and blowing the nose in the post-operative period may result in a temporary collection of air under the skin causing facial swelling for a period of time.

 

Septoplasty – In some cases, it may be necessary to straighten the nasal septum at the time of surgery.  This is usually done to allow access to the sinuses during the operation.  A separate blog is available regarding this procedure.

A follow-up visit is arranged one to two weeks after the surgery to clean crusts from the surgical site.  Further follow-up visits are arranged at approximately weekly or fortnightly intervals until the area is healed at around 6 – 8 weeks.  At each of these visits and at subsequent follow-up examinations, any persistent scar tissue may be removed under local anaesthetic.

 

YOUR CONSULTATION

If you have troublesome sinusitis which has been resistant to medication, please call 031 201 3118 for an appointment.

A complete history of your problem will be taken, followed by a thorough examination of the nasal passages (including nasal endoscopy). A CT scan of the sinuses may be required for further information.

Further management will depend on the clinical findings, and will be in keeping with best ENT specialist practice guidelines.