Septoplasty & Turbinate Reduction Patient Information

Anh Q. Truong, MD

Bellevue ENT

1231 116th Avenue NE, Suite 915

Bellevue, WA 98004

Phone: (425) 454 - 3938

What is a turbinate reduction and how is it performed?

Usually, only the inferior turbinates are targeted for surgery. On rare occasion, the middle turbinates can be enlarged due to aeration of the turbinate (called a concha bullosa). The concha bullosa of the middle turbinates can be removed if it is severely obstructing the nasal passage.

There are various techniques and instruments available to reduce the size of the inferior turbinates. Once you are under anesthesia, a small incision is made at the head of the turbinates. Using instruments such as a coblator, a microdebrider, or even sharp dissection with a knife and scissors, the thin bone and soft tissue under the mucosa (skin over the turbinate) is removed while the mucosa is preserved. Bleeding is usually minimal and no additional packing is needed.

What is a septoplasty and how is it performed?

The goal of a septoplasty is to straighten out the partition between the nostrils and to open up the nasal passage. The surgery is performed by making an incision on the septum inside the nostril and raising the mucosa that covers the septum. The crooked portion of the cartilage and bone is removed. A portion of the bone and cartilage is preserved to maintain the structural integrity of the nose. Once an adequate correction is achieved, the mucosa is sutured together and an internal splint is temporarily placed for 3-7 days.

What should I expect before surgery?

• No special medication is needed before a septoplasty and/or turbinate reduction.

• DO NOT TAKE THE FOLLOWING MEDICATIONS FOR AT LEAST 14 DAYS PRIOR TO SURGERY: aspirin, ibuprofen (Motrin/Advil), naproxen (Aleve), other non-steroidal anti-inflammatories (NSAIDS), vitamin E (multivitamin is OK), gingko biloba, garlic (tablets), and ginseng. These medications can thin the blood and create excessive bleeding. Tylenol is safe and may be taken any time up to the day of surgery. St. John's wort should also be avoided for 2 weeks prior to surgery because of possible interactions with anesthesia medications. If you take the blood thinner Coumadin or Plavix, you must discuss this with your surgeon so the medication can be discontinued before surgery and restarted appropriately.

• While our office will make every attempt to keep your primary care physician informed before and after your surgery, it is important that you personally inform him/her that you are planning to have surgery. If you have underlying medical conditions, your primary care physician may help to clear you medically for surgery. Most of the necessary preoperative testing will be performed at Bellevue ENT during your preoperative visit. This takes place approximately 1 week prior to your surgery if needed.

• Due to the frequently changing operating room schedule, the surgery center will usually call you one business day before your surgery date to inform you of your surgery time. You are usually expected to arrive two hours prior to your surgery to check in.

What should I expect during surgery?

Your surgical team will include your surgeon, an anesthesiologist, a scrub nurse, a circulating nurse, and additional supporting staffs dedicated to ensuring that your surgery is safe. A septoplasty and turbinate reduction is typically performed under general anesthesia and will usually last about one and a half hour.

An endoscope may be used to visualize the nasal cavity. Blood loss is usually minimal. If a septoplasty is performed, a flat internal septal splint may be placed for 3-7 days. On rare occasions which bleeding is anticipated after surgery, nasal packing may be placed.

What should I expect after surgery?

• After your surgery, you will spend approximately one hour in the recovery area. Approximately 30 minutes after you arrive in the recovery area, a family member or friend should be able to visit with you. Most patients feel well enough to go home the same day. You should not drive yourself home and you need to arrange for transportation prior to surgery.

• You can expect mild bleeding for 1-2 days after surgery. Pain can generally be controlled with over the counter Tylenol; however, narcotic (prescription) medication will be provided for additional control if needed.

• You may eat a regular diet.

• You will have return visits to the ENT clinic at approximately 1 and 6 weeks after surgery. At your first post-operative visit, the doctor will examine your nose and remove the internal septal splint if a septoplasty is performed. Usually, only one suture is removed. Please write down any questions you may have so that we can answer them at your appointment.

• You should plan on taking one week off from work and ideally have a half-day planned for your first day back.

• Please see the post-operative instructions for additional details.

What are the risks of a septoplasty and turbinate reduction?

As with any surgical procedure, a septoplasty and turbinate reduction have associated risks. With meticulous planning appropriate precautions, complications from nasal surgery are very rare. Although the chance of a complication occurring is very small, it is important that you understand the potential complications and ask your surgeon about any concerns you may have. These risks may include:

• Recurrence of obstruction: The goal of surgery is to alleviate your nasal obstruction. However, the turbinate may develop recurrent swelling and enlargement, particularly with severe allergy or with an upper respiratory infection. As a result, recurrent nasal obstruction can occur, requiring more aggressive reduction of the turbinate if the obstruction is persistent.

• Bleeding: Bleeding is usually minimal during surgery and after surgery. On rare occasions, nasal packing may be placed for more severe bleeding.

• Septal perforation: With meticulous techniques, the risk of a septal perforation (a hole in the septum) is minimal. Most patients do not have any discomfort from a septal perforation. A small septal perforation may produce a whistling sound when you breathe. A large septal perforation may lead to chronic crusting and epistaxis. In rare cases in which a septal perforation is bothersome, it can be repaired with a septal button or with surgery.

• Other risks: Other uncommon risks of surgery include alteration of the sense of smell and nasal deformity.

What restrictions will I have during the postoperative recovery period?

• DO NOT BLOW YOUR NOSE for the first week after surgery. You may sniff back. If you need to sneeze, do not suppress it but instead sneeze with your mouth open. After 1 week, you may blow your nose gently.

• No strenuous activity for one week after surgery. No straining or lifting more than 15 lbs. You should not bend over at the waist to pick things up. Instead, bend at the knees with your head up. Light walking and normal household activities are acceptable immediately after surgery. You may resume exercise at 50% intensity after one week, and full intensity at two weeks. You may drive the day after surgery if you are not requiring narcotic pain medication.

• If you are taking antibiotics and experience stomach upset, active culture yogurt or acidophilus tablets (available at health food stores) on a daily basis may help. If you develop diarrhea, stop your antibiotics and contact our office. Persistent diarrhea may require further medical evaluation.

• You should plan on taking one week off from work.

• Do not fly without your doctor’s clearance for 7 days after surgery.

Your surgeon is committed to providing you with the highest level of care in a comfortable and caring environment. We want you to have all of your questions answered and provide you with a complete understanding of your condition and treatment plan. Please feel free to ask questions about any aspect of your care. Learn more about septal deviation & turbinate hypertrophy or post-operative care for a septoplasty and/or turbinate reduction.