Nasal Surgery: Functional Endoscopic Sinus Surgery - Essay Example

YM Leyson For: Unidentified Nasal Day Surgery 25 March, 2006 As a medium for respiration, the nose and the nostrils is the first body part to savorair and oxygen vital to cellular function in the human anatomy. It's frontal protrusion and projection enhances a person's body image, it also influences speech quality and the sense of taste. Ethnic cultures allow nose piercing for religious and cultural reasons. The current fad has also allowed nose piercing for sexual, spiritual reverence and ornamental purposes. Topinard's theory on nose shapes are divided into aquiline, straight, flat, hooked, and Semitic noses. Variations in nose shapes are also indicators of racial diversities. Many individuals are unhappy with their noses. Some disorders of the nose would require surgical interventions to correct defects most likely owed to congenital anomalies. Others opt to change its shapes and appearance for cosmetic enhancement. Still, others encounter serious accidents and injuries that necessitate immediate reconstruction on one of the body's first line of defense. Every surgery a considerable amount of risk and complication, the awareness serves to prepare patients and the health personnel to handle any emergency when the situation calls for such. Nasal surgery according to Guenter, "carries the aim of improving breathing by clearing airway passages of any obstruction". Krupp also pointed out "the need to correct congenital anomalies or acquired deformities and nasal injuries" as another reason for such surgical intervention. Yet, cosmetic reasons for "nose jobs" according to plastic surgeons have top most records of medically-advised corrective surgeries. Functional Endoscopic Sinus Surgery May involve septoplasty or not. Septoplasty in this case is the surgical correction of defects and deformities of the nasal septum or the partition between the nostrils. Such procedure may lead to correct a deviated septum or correct cleft defects that affect that nose and the nasal cavity as in cleft palates. Most of the above-mentioned cases are congenital anomalies or birth defects that require surgeries to promote airway clearance and full capacity of senses. Immediately following surgery, Dr. Luce stressed that the nose "will be blocked as a result of swelling from the surgery". For this reason, the patient should be advised to breath through the mouth during the entire procedure. Surgery usually last from 15-30 minutes but the patient is advised to stay in the Post-Anesthesia Care Unit (PACU) and Outpatient Day Surgery (ODS) under the watchful eyes of the Medical Team. Afterwards, the nurses and physicians would allow discharge. Dr Alford has been advised that in an Endoscopic Surgery, "No packing is allowed". A gel solution is used to coat the inner surfaces of the nose to prevent bleeding resulting from surgery. This gel dissolves itself with a saline nasal spray. The nasal septum however is straightened with thin sheets of Teflon that is sewn inside the nose while it is healing. Dr. Alford again advised "splint removal one-two weeks after surgery" and is a painless procedure. Immediately after the procedure, normal breathing process through the nose is encouraged to promote healing. Liberal use of saline nasal (salt water) spray in 10-20 puffs per hour is encouraged. However, immediately after surgery, such use is limited within 24 hours, as it tends to dissolve up any blood or mucus left in the nose after surgery. Swelling accompanies any major or minor procedure. In FESS, swelling after sinus or septal surgery is manifested through a stuffy or blocked airway passage. The amount of swelling depends on the person but the face has dramatic capacity to swell. However, the swelling in this procedure is usually dedicated around the eye area and will last for only a few days. Head elevation and staying vertical is therefore encouraged. The upper body is placed in an upright position. Thus it is unwise to remain in bed when sleep has eluded a patient. Bending should be avoided along with lifting of heavy things along with driving. During sleep, the head should be elevated at a 45 degree angle. Straining during bowel movement and exercise is also contra-indicated for at least one week. Sun exposure should also be limited without a higher sunscreen protection. Nasal Bleeding is expected immediately after surgery. A drip pad is therefore provided by the medical team. If active bleeding is noted after surgery, the Afrin or Neosynephrine spray may be used 4-6 times. Burrows advised the use of pain medication also helps to relieve any discomfort. Antibiotics are also prescribed to prevent infection. Sinus Surgeries and Polyp Removal This type of surgery involves the precise removal of diseased sinus tissues to create a pathway for infected material to drain from the cavity. Burton and Hodgkin reiterates that "this type of surgery is unlike other nasal surgeries where a diseased part is removed". Poor post-operative care usually develops several complications. Medicinenet has provided a concise article dedicated in sinus surgeries. Failure to effectively remove the polyp or the sinus infections will result in its recurrence and will require further aggressive surgery. Bleeding although rare may require blood transfusions. Chronic drainage of nasal fluids may promote excessive dryness and crusting of the nose. Damage to the eye and the associate structures may occur. "Damage to skull base with resultant meningitis; brain abscess; or leakage of spinal fluids; permanent numbness of upper teeth; palate or facial structure may occur. It is most important to entail necessary check-up with a specialist before and after the procedure. Pre-operative laboratory studies gives out adequate information to the surgeon before the actual procedure to study and minimize any complications. Aspirin is prohibited 10 days before surgery to prevent bleeding and hemorrhage. Immediately 6 hours prior to the procedure food and fluids are contraindicated as stomach contents may cause anesthetic complications. To reduce coughing, smokers should make every effort to stop smoking; secondary smoke should also be avoided. Alcohol, coffee and exposure to allergens should be avoided. If unavoidable, sneezing may be done with the mouth open to limit excessive pressure. A humidifier at home is the best working solution. Swelling is observed in the eyes, nose and will gradually go away with the aid of ice packs. Head elevations should be strictly maintained. Moderate bleeding is normal therefore a mustache dressing is placed but needs to be changed only when saturated. Ice packs can reduce swelling and bleeding. Like in FESS, saline sprays may also be used to remove crusts forming in the nostrils. Hot liquids, sun exposure should also be avoided for a few days. Vomiting once or twice may be noted but more is a cause for concern and should be reported to the doctor immediately. All prescribed medications should be religiously followed and all cosmetic and over-the-counter medications should be discontinued two weeks post-operatively. Eyeglasses should not be worn to prevent damage to the area. A softer toothbrush is advised during teeth brushing to prevent damage to the upper buccal cavity. Facial tanning and sun exposure is contraindicated for 6 months after surgery; however if unavoidable, a stronger sunscreen could prevent any skin burns and damage to the soft areas around the operation. Rhinoplasty Commonly, laymen would often refer to rhinoplasty as the "nose job". Dr. Rivkin in 2004 has developed an alternative to the surgical intervention with a non-surgical idea. "A relatively painless procedure can be done in just minutes and entails a lesser cost" as advertised by him. There are limitations to this procedure however which is its inability to correct major deformities and could not help patients seeking a smaller nose. Dr. Rivkin has further promoted that such procedure "saves the risks and expense of a permanent surgery." It may give patients the opportunity to test the procedure and its outcome at a fractional cost of the actual invasive surgery. With the aim of reshaping one's nose; narrow the span of the nostrils; change the angle between the nose and the upper lip; this "elective surgery" has been commonly adapted by most women seeking perfection. However, rhinoplasty can enhance one's appearance and boost self-confidence, but "does not necessarily provide you with the deal look" as stressed by Dr.Mitts. A careful discussion should ensue before the surgery to discuss on the ideal size and "look". Although inconceivable, some plastic surgeons actually provide the "best" results. A qualified surgeon should handle the procedure to minimize the risks of complications. Most common complications would include nose bleeding; infection; reaction to anesthesia or the implant or medications. Careful adherence to instructions should be adhered to minimize the risks and uncertainties. Blood vessels may burst and appear as tiny red spots on the skin's surface. Although minute, these "red spots" may be permanent. Scarring is not visible after the procedure. Before the procedure, it is best that all information should be shared by the health team to minimize complications and discontent. For person's electing a "nose augmentation", matters specially dealing on allergic reactions should be well discussed with the doctor. Rejection to implants has been noted and resulted to more secondary surgeries and in rare cases promoted ocular defects and anomalies. Lying on one's back with a 45 degree head elevation during sleep is best maintained although a nasal splint is placed to hold the nose in position. A dull headache is experienced after surgery; therefore activity should be minimized and/or should be limited. Medications are prescribed to control any pain or discomfort. Cold compresses will help reduce swelling around the nose and the eye area. A little bleeding is common during the first few days after the surgery which is common. However when the nose feels stuffy or starts to itch, blowing is prohibited. Avoidance of any allergic-causing elements like smoke and dust necessarily helps. Two weeks post-operatively, dressing, splints and stitches are already removed. Gradual return to normal activity is thereby encouraged. Osteotomies Aside from the use of implants, the American Society for Aesthetic Plastic Surgery statistics for 1999 "reported that more than 102,000 rhinoplasties were performed among its member plastic surgeons". For each of these procedures, 2-4 osteotomies are performed. Osteotomy operation is performed in which a bone is divided or a piece of bone is excised (as to correct a deformity. Osteotomy is conducted and performed when the anatomic findings of a high nasal dorsum that requires a "hump" removal or an "open roof" after the hump has been removed and a wide nasal base is observed. These factors require an understanding of the basic anatomy of the nose and the goals of rhinoplasty, particularly aesthetic rhinoplasty. Such procedure entails the same relevant complications stated in rhinoplasty as osteotomies practically involved the same elective and cosmetic surgery details with rhinoplasty. Commonly such procedure is done to correct the nasal "hump" or to resection the base of the nose to acquire a better profile. Nasal injuries Brawls, traffic accidents, sports are the often causative factors in nasal injuries. Such creates potential anesthetic and reconstructive problem. Plastic surgeons are often required to correct the deformities caused by accidental blow to the nasal area causing airway obstruction to a patient and dysfunctional image. Oftentimes, a more complex surgical intervention of otorhinolaryngology is required. When there is cervical trauma in accidents, Dr. Cheney added: "Lacerations of the oropharynx, foreign bodies in the oropharynx, fractures of the larynx, or uncontrolled cervical bleeding" is also noted. The physician assesses the likelihood of respiratory obstruction and perform a prophylactic endotracheal intubation or a tracheotomy to establish the airway. After assessing the damage through several procedures, corrective surgery is opted. The process does not entail a single operation and usually requires a series. Proper surgical procedure is required and a day surgery necessarily is not required. However if minimal damage is observed, constructive measures may refer to the same procedure for rhinoplasty and nasal reshaping including the broken cartilage. However, careful handling should be stressed due to the pain of the injured tissue brought about and accompanied by the blow. But the main aim of such is to promote airway clearance which exceeds the goal of reconstruction. The physician should be careful to note for any presence of cerebrospinal fluid (CSF) leaks which are a strong indicator of another deeper facial injury requiring medical attention. Works Cited Read More