Monday, March 19, 2012

Sinus surgeries and consequent medical problems

Sinus surgeries and consequent medical problems

Sinus surgeries are never foolproof. There are chances of a number of complications, such as adhesions, anosmia, bleeding, crusting, epiphora, infection, neuropathic pain, osteitis and / or periorbital emphysema.

Adhesions are abnormally joined bands of scar tissues. Damage to the mucosa on surfaces adjacent to the surgery site leads to adhesions. To minimize adhesions, open the olfactory cleft and take extra care while handling mucosa to create space. Douching every day will also help. On completion of the surgical procedure, reexamine the patient after a week. Adhesions, a common complication of the surgery, develop if two different mucosal surfaces come in contact for a reasonable time after the surgery.
Anosmia means inability to smell. Damage to the olfactory mucosa during surgery may cause anosmia. Administer pre-operative oral steroids to avoid anosmia.
Bleeding may occur after the procedure is over. Blood may ooze from the nose or appear in cough. Raise the head of the patient, administer antibiotic and / or use a nasal pack to stop the bleeding.
If mucosa is fully damaged, cilia disappear and the mucus is not cleared. Due to mucus stagnation, crusts form. The surgeon shall avoid full-thickness damage to the mucosa as the cilia may take about a year to function again normally.  The stagnated mucus can cause infection that requires douching. Sniff up topical nasal mupirocin ointment after douching for more relief.
Epiphora refers to excessive production of tears. If the nasolacrimal duct or lacrimal sac is damaged during surgery, ephiphora may appear.  Due to damage, fibrous tissue grows around the duct, causing obstruction.
Stenosis means narrowing a structure. If the mucosa of the frontal recess is denuded, chances of the frontal recess stenosis are high. Therefore, surgeon shall take utmost care to preserve the mucosa. Do not pull out the loose pieces of the mucosa, as it will injure the mucosa further.
Due to exposed bone, localized inflammation of bone (Osteitis) may cause severe pain that may last for more than a week. Surgery or trauma may also cause neuropathic pain.
Periorbital emphysema is a condition in which air gathers in the soft tissues surrounding the eye. If the lamina papyracea is injured during the surgery and the patient sneezes or blows his/her nose within the four days of the surgery, intranasal pressure increases substantially. As a result, air fills into the soft tissues hemming the eye.  The emphysema will heal provided the patient completely avoids blowing the nose. A course of prophylactic antibiotics prevents formation of periorbital cellulites.
If the accessory and natural ostium are left unconnected during any of the sinus surgeries, recirculation of mucus may start. The patient may complain about a postnasal drip.  Injured natural mucus pathways and natural ostium, and trauma may also trigger the recirculation.

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