The purpose of endoscopic sinus surgery is to open the passages of the sinuses allowing for improved drainage into the nose. It is called an endoscopic procedure because the physician uses an endoscope (a small, rigid tube with a light and a camera lens at the end) to view the inside of the nose. Small incisions or cuts are made to allow the scope to pass. The cuts are usually made inside of the nose. The physician may create new passages or open existing ones by removing polyps, cysts, or thickened mucous membranes.
Endoscopic Sinus Surgery Details:
- Endoscopic sinus surgery usually takes between one and three hours and is done in the operating room with the child under general anesthesia.
- Some children spend the night in the hospital, but some children may stay for only a couple of hours after surgery.
- Depending on the surgeon's preference and the needs of the child, endoscopic sinus surgery may be performed at the same time as another operation such as septoplasty, tonsillectomy, adenoidectomy or insertion of ear tubes.
Risks of the procedure:
- Continued infections
- Scarring inside the nose that may require further surgery
- Bleeding that may require packing inside the nose or rarely a transfusion
- Loss or decrease in sense of smell
- Double vision, loss of vision
- Spinal fluid leak
What to expect after Surgery:
- Your child will have intravenous (IV) fluids until he is ready to drink. Clear liquids for your child to drink are available in the post operative area.
- Your child may complain of a sore nose, not being able to breathe through the nose, and difficulty swallowing.
- A pain reliever may be given for pain. An antibiotic is occasionally prescribed to prevent infection.
- The head of the bed will be raised in the post-op area to help with swelling, breathing, and drainage. At home you should have pillows or a recliner chair available to help your child stay comfortable with his/her head elevated above the level of the chest.
- There may be packing in the nose to prevent bleeding. Sometimes, this packing is dissolvable. The physician may remove this packing in one or two days or it may dissolve on its own. If the packing needs to be removed, it may be done in the physician's office, or may be done in the operation room under anesthesia.
- If a septoplasty (straightening of the bone and cartilage in the center of the nose) is performed, then splints may be placed inside the nose at the end of the operation. These will be removed at the physician's office in one to two weeks and may cause some discomfort while they are in place.
- If packing is used, your child may be able to feel it in his/her nose. Your child should be told before surgery that they may feel like they have something in their nose when they wake up. If packing is not used, swelling may cause this feeling. Your child should know that he/she will not be allowed to forcefully blow his/her nose for a week or two.
- At first, there may be some bloody drainage from the nose. You may see a small piece of gauze taped under your child's nose. This is called a "drip pad." This is usually only needed for the first day, if at all. The drainage from the nose will probably be tinged with blood. Your child may cough or spit up some pink or brown mucus.
- Most children are fussy the first few hours after this procedure.
- Your child may begin normal play after several days, but may need to stay home from school until the discomfort improves. Consult your child's physician for more specific recommendations.
- Your child's physician may recommend the use of nasal ointment, salt water spray, or nasal steroid spray after surgery. Follow instructions carefully.
When to call your Child's Physician:
The following are some of the symptoms that may indicate a need for you to promptly contact your child's physician:
- Bright red bleeding from the nose or mouth
- Double or impaired vision
- A persistent leak of clear fluid from the nose
- If your child vomits bright red blood or a coffee ground-like material
- If your child develops a croupy (barky) cough/cry or wheezing
- If your child's temperature rises greater than 101.5º F rectally or greater than 100.5º F orally
- Vomiting (or if the vomiting becomes severe)
- Signs of dehydration (a child can become dehydrated when he/she has prolonged or severe vomiting and is not able to drink enough fluid)
- Severe pain not relieved by pain medication
A visit with your child's physician will be scheduled for one to two weeks after surgery and then again several more times in the months after surgery to make sure that the nose is healing properly. Consult your child's physician if you have any questions.