Introduction
The sinuses are cavities located in the forehead, cheeks, between and behind the eyes.
Functional endoscopic sinus surgery (FESS) involves opening the sinuses with various instruments through the nostrils without any incisions on the face. It is indicated when patients have symptoms due to chronically blocked sinuses or when patients suffer several acute sinus infections.
The goal of this surgery is to allow delivery of medications to the widely opened sinuses.
Before the Surgery
Reading Materials
Please read this page and the Royal Australasian College of Surgeons’ information sheet (“Functional endoscopic sinus surgery”) so you understand the procedure, the benefits and risks associated with this procedure and the expected outcomes of surgery. The information sheet will be given to you when booking your operation.
Blood Thinners
Please make sure you have informed me about any blood thinners or herbal medications you are taking, and that we have discussed a clear plan about when to cease and recommence blood thinners. These may include (but are not limited to): Advil, Asasantin, Aspirin, Astrix, Brufen, Cardiprin, Cartia, Clexane, Clopidogrel, Coumadin, Dispirin, Heparin, Ibuprofen, Indocid, Iscover, Marevan, Naprogesic, Naprosyn, Nurofen, Panafen, Persantin, Plavix, Pradaxa, Rafen, Viclofen, Voltaren, Warfarin and Xarelto.
The following natural or herbal medications can increase bleeding: fish oil, krill oil, garlic tablets, ginger, ginkgo biloba, ginseng and St John’s Wort.
CT Scans
If you are having sinus surgery, you will need to bring your scans with you – not just the report. The surgery may need to be rescheduled if you do not bring your scans on the day.
Smoking
Smoking places one at higher risk during anaesthesia and affects surgical wound healing. Within the nose, smoking damages the small hairs that are responsible for circulating mucus correctly.
For the best surgical outcome, ceasing smoking at least 1 month prior to surgery is strongly recommended.
Fasting
As you will be fasting before surgery, drink plenty of fluids and have a good meal before your fast begins.
After the Surgery
Recovery Room
Your listed contact will be called once you are fully awake in recovery.
Drip (intravenous cannula)
You will wake up with a drip in one of your hands. The needle of the drip has been removed and what is left is simply a plastic tube to deliver fluids or medications through this route - you can still move and use that hand gently.
It will be removed by nursing staff before you are discharged from the hospital.
Diet
Apart from avoiding hot (temperature) foods and drinks (which may increase the risk of bleeding) there are no specific dietary restrictions following this surgery.
Pain Relief
You may experience some pain in the nose. You may also experience headache, blocked ears or pain in the ears, teeth or face following the surgery – this is referred pain.
If you have a sore throat following the surgery, this is likely due to the breathing tube you had in your airway. This should resolve within one day.
Regular Panadol is very effective. If needed, you may also take Celebrex, Panadeine Forte (INSTEAD of Panadol), Tramadol or Endone (not usually required) after the surgery. These will be prescribed by my anaesthetist.
Bleeding
Nasal packing is uncomfortable, so I will try to avoid packing your nose. This does mean that you will experience some bleeding or ooze after nasal surgery.
How to minimise bleeding:
- Avoid dabbing your nose frequently if there is some ooze – it is better to wear the nasal bolster and allow any ooze to clot.
- Avoid hot (temperature) food, hot drinks and hot showers or baths for 2 weeks. You can have cooked meals but let them cool down to room temperature before eating them.
- Avoid straining, heavy lifting and exercise for 2 weeks.
- Avoid blowing your nose for the first 2 weeks – using the nose washes (below) will help you unblock your nose.
- Avoid bending over where your head goes lower than your chest – e.g. when tying your shoelaces, bend your knee and lift your leg up rather than bending your head right down.
- Avoid sleeping completely flat by using 2 to 3 pillows to keep your head elevated.
- Use Drixine nasal spray 3 times a day for the first 3-5 days. It is more effective if you use it after the nose washes (see below).
- Sneeze with your mouth open to reduce pressure building up inside your nose.
If bleeding persists you will need to:
- Use the Drixine spray or drops in both nostrils – it doesn’t matter if you used it just before the bleeding started.
- Close off the nostrils by pinching the soft part of your nose. Do not pinch the nasal bone at the top of the nose as this does not stop bleeding. Lean FORWARDS. Hold for 15 MINUTES without letting go (anything shorter than this will not allow your blood to clot properly).
- Suck a cube of ice – this can reduce nasal bleeding.
- If you have done all of the above and the bleeding is not slowing down, you need to go to your nearest hospital with an Emergency department. You may need to call an ambulance to take you there if you are worried. The hospital will then contact me.
Expected Recovery
You will be given 2 weeks off work/sport. This is because there is a chance of bleeding in the first 2 weeks after the operation, and physical exertion will increase this risk.
You might feel like your nose is congested following the surgery – this is often because of swelling and blood clots in the nose. This will improve when you start your nasal washes and when the swelling goes down – it takes about 2 weeks.
If you have silastic splints in your nose, these will be removed after about one week. They are secured in place with a stitch.
When you start your washes, you may experience some bleeding – this is normal. You may also notice one or two long black pieces of material come out the nose when washing – these are small dissolvable dressings.
Please do not make any travel plans during the first 3 weeks after surgery.
Postoperative Nose Care
Nasal washes are vital for a good recovery. Start your washes the day after surgery and perform these 4 times a day until I see you for follow-up (approximately 1 week). The washes can be done over a basin or in the shower. You do not need to boil the water – tap water is fine. Some water may come out the opposite nostril or your mouth when you wash.
Washing will remove blood clots, minimise crusting in the nose, help you breathe better and make cleaning your nose at your first postoperative visit much more comfortable.
Follow Up
The first follow up visit is usually 1 week after surgery – please contact my rooms to schedule this appointment.