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Nasal Airway Surgery

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.

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
I 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.”If u want u should tell me prior as it will be done by plastic surgeon at the same time.
• Sinus surgery is the widening of the sinus passages to allow for proper drainage to the nose

Why is nasal airway surgery perform?
I 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 infection.
• 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

How is nasal airway surgery performed?
Your nasal airway surgery will be performed in a hospital.
Surgical approaches to nasal airway surgery
• 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 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 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 as in case of tumor , huge angiofibroma.

Types of anesthesia that may be used -
I 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 anesthetist about your medical history and the type of anesthesia you will have.
• A surgical team member will start an IV.
• The 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.
• 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:
• Continued headaches
• 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
• Persistent symptoms
• 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.
• 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.
• Not eating or drinking 6 hrs 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.

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.some times two days also.
You may need to wear a nose splint for a few days to a week after your surgery if nose shaping is done. You may also have packing in your nose for a few (2) days after surgery. You should not touch the nasal packing unless instructed to do so .
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 for two to three days.
Initially there will be wet crustinig then they will be dry crust . u should wash u r nose two times a day by freshly pre pared solution of ALKALINE NASAL DOUCH two spoon in glass of water OR ONE MED SPOON SALT WITH PINCH OF BAKING SODA IN A GLASS OF WATER for one month . 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. I will treat your pain so you are comfortable and can get the rest you need.

When should I call U doctor?
It is important to keep your follow-up appointments after nasal airway surgery. Call me 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. Do not blow the nose forcefully.
• 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
• Sharp headache
• 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 on a regular basis to keep nasal allergies under control

          Dr. Prashant Manohar kewle © 2014
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