What is Rhinoplasty with Sinus/Nasal Surgery?
Rhinoplasty is a surgical procedure performed to repair or reshape the nose. It can improve the size, shape, and angle of the nose and create a proportion with the rest of your face. It is also performed to solve problems with breathing caused by structural malformations in the nose. However, for some patients, breathing issues are caused by issues further into the airway, in particular with the sinuses. This is where rhinoplasty with sinus/nasal surgery becomes necessary to achieve the desired results. Rhinoplasty with sinus/nasal surgery is also used to permanently fix problems of persistent nasal congestion and drainage, frequent sinus infections, and other bothersome issues. In addition to rhinoplasty with sinus/nasal surgery, some individuals may need to undergo septoplasty to repair anterior septal deviation; spreader grafts to narrow the internal valves; techniques to address external valve collapse; and/or turbinate reduction to correct breathing issues.
Anatomy of the Sinuses
The sinuses are a system of hollow cavities in your skull bones. They are lined by mucous membranes which produce mucus to moisturize the nasal passages and prevent the entry of dust, germs, and allergens into the body through the nose. The sinuses drain into the nose through small openings which can become blocked through infection and swelling of the mucous membranes or abnormal growths.
Indications for Rhinoplasty with Sinus/Nasal Surgery
Conservative treatment is usually the first line of treatment for sinus problems. This includes decongestants, over-the-counter pain relievers, antibiotics, nasal corticosteroids to treat inflammation, as well as nasal sprays and possibly nasal irrigation. However, if conservative treatment has been ineffective and sinus problems continue to persist, it may be time to consider having rhinoplasty with sinus/nasal surgery. Some of the signs that would necessitate surgery include the following:
- Structural irregularities in the nose or sinuses
- Sinus infection that has spread to the bone
- Nasal or sinus polyps
- Sinus disease originating from a fungal infection
- Sinus cancer
- Chronic sinusitis
- And other conditions that block the sinuses, prevent drainage of mucus, and cause breathing difficulty
Preparation for Rhinoplasty with Sinus/Nasal Surgery
Preparation for rhinoplasty with sinus/nasal surgery may involve the following steps:
- A review of your medical history and a physical examination are performed by your doctor to check for any medical issues that need to be addressed prior to surgery. Your exam will include a full evaluation of your ear, nose, and throat, and may include allergy tests.
- Diagnostic tests such as routine blood work and imaging to help detect any abnormalities that could compromise the safety of the procedure.
- You will be asked if you have allergies to medications, anesthesia, or latex.
- You should inform your doctor of any medications or supplements that you are taking or any conditions you have such as heart or lung disease.
- You may be asked to avoid medications such as blood thinners or anti-inflammatories for a specific period prior to surgery.
- You are advised to abstain from smoking for a defined period before and after surgery as smoking may cause breathing issues during the surgery, as well as slow down the healing process.
- You should not consume any solids or liquids at least 8 hours before surgery.
- A written consent will be obtained from you after the pros and cons of the surgery have been explained.
Procedure for Rhinoplasty with Sinus/Nasal Surgery
With advancements in technology, rhinoplasty with sinus/nasal surgery is usually performed in a minimally invasive endoscopic approach. Functional endoscopic sinus surgery (FESS) is the most common type of sinus surgery. This surgery widens the drainage passages between your nose and your sinuses, removing bone or infected tissue so mucus trapped in your sinuses can be drained out. Your surgeon uses an endoscope to view the inside of your nose and sinuses and guide the surgery. An endoscope is a thin, long tube with a light and a tiny camera attached at the end that sends images to a computer screen for your surgeon to view the treatment area and perform surgery. In general, the procedure involves the following steps:
- You will be placed on the operating table in a way that gives your surgeon the best access to the portion of the area to be operated on.
- An intravenous (IV) line is started in the arm to introduce fluids and medicine during the procedure.
- The surgery may be performed under general anesthesia or monitored anesthesia (sedation) depending on your condition.
- A thin endoscopic tube attached to a lighted device and a high-definition video camera at its end is inserted through the nostril and moved up to the back of the nasal cavity.
- The endoscope relays images of the treatment area on a monitor, providing a magnified, high-resolution view of the treatment area and surrounding significant structures.
- Special miniature surgical instruments are passed alongside the endoscope to remove bone, diseased tissue, polyps, or other particles that may be blocking your sinuses and obstructing your breathing. A septoplasty may also be performed if necessary.
- Once satisfactory repair is achieved, the scope and instruments are withdrawn, and nasal packings are placed in your nose and sinuses to prevent bleeding and facilitate healing, which is usually removed in a week.
Postoperative Care and Recovery
In general, postoperative care instructions and recovery after rhinoplasty with sinus/nasal surgery will involve the following steps:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
- You may need to stay in the hospital a day or two before being discharged home. Arrange for someone to take you home as you will not be able to drive after surgery.
- You may experience pain, inflammation, nasal congestion, and discomfort in the operated area. Medications are prescribed as needed to manage these, along with antibiotics to address the risk of surgery-related infection.
- Avoid coughing, sneezing, or blowing your nose for the first few weeks after surgery. If you do sneeze, you may blow out bloody discharge or mucus. This may go on for a few weeks while your sinuses heal.
- Sinus irrigations are usually recommended twice a day during your recovery. Your doctor will give you instructions on how to perform them.
- Refrain from strenuous activities and lifting anything heavier than 5 pounds for at least a couple of weeks.
- Keep your follow-up visits as recommended to ensure a positive surgical outcome.
Risks and Complications
Rhinoplasty with sinus/nasal surgery is a safe procedure that can greatly improve your breathing and quality of life; however, as with any surgery, some risks and complications may occur, such as:
- Damage to adjacent structures
- Delayed healing
- Allergic/anesthetic reactions
- Airway obstruction
- Nasal discharge/crusting
- Altered sense of smell
- Leakage of cerebral spinal fluid (CSF)