Post-Operative Instructions

for Nasal and Sinus Surgery

It is not unusual for patients who have received general anesthesia to have some nausea and occasionally vomiting, especially on the first night after surgery. Beyond this, please contact our office to see if any medication is indicated.

It is preferable to have clear liquids for the first meal, then thick liquids or a soft diet. A regular diet may be resumed the next day. Also, pain pills cause some nausea if taken on an empty stomach. It is preferable to take those pills with a piece of toast or some food.

Wound care and other information

1. Your child may need to sleep with the head slightly elevated for the first few days after surgery. Head elevation reduces bleeding and swelling. It is okay to use an ice pack over tissue or a washcloth for 15 minutes at a time for 2 days after surgery, to reduce these effects.
2. Your child may spit up specks of blood or may feel it dripping down the back of their throat in the first 48 hours after surgery, this is okay. In about 2% of patients there is some bleeding after 6 or 8 days. If this happens, do not become excited, for this bleeding is usually slight and stops spontaneously. Have the child drink iced water, or suck on ice chips and remain quiet. If the bleeding does not stop within 15 minutes or multiple episodes occur, please call our office to speak with your surgeon or the on-call surgeon. In the unlikely event that a doctor is not available and bleeding continues, please take your infant go to the nearest Emergency Room and have them contact our office. Please, also call our office the next morning to notify your surgeon of such bleeding. Please note, bleeding may be increased if you eat hard, sharp foods as it removes the healing covering on the wound.
3. It is also not unusual to have some mild oozing of blood from the anterior nose after a turbinate reduction/septal or sinus surgery.
4. You may clean the entrance to the nose with a Q-tip soaked in hydrogen peroxide or water. Do not pull on any sutures if seen. Your surgeon will also let you know when to begin gently rinsing the nose out with saline drops to remove any dried blood or crust. (e.g. Ayr nasal spray or ocean spray. The generic versions are also appropriate)
5. Showers are allowed with lukewarm (not hot) water beginning on the day after surgery. Please make sure to provide assistance even with adolescents, especially the first night as the pain medications often makes patients drowsy and occasionally dizzy.
6. Do not remove any packing or splints if present. Your child may have to breathe from the mouth if the splints get occluded with mucous or blood clots. This may cause a dry mouth. It is therefore very important to drink a lot and maintain adequate hydration. You may also use a humidifier in their room at night.
7. If your child has a splint (usually after a fractured nose) - Do not get the splint on the nose wet (the face may be washed around the splint). The hair may be washed on the second day after surgery if you can do without lowering the head below the heart.

General information and instructions

*Children should be kept indoors and relatively quiet for the first few days after surgery. Indoor play is allowed, as is use of the swimming pool as long as there is no strenuous activity.

*Patients may return to school or daycare 1 week after surgery, though some patients may need a limited physical activity schedule in week 2.

*Fever - Most children experience a low grade temperature after surgery. This is usually caused by dehydration. Encourage fluid intake and if needed, use Tylenol (NOT ASPIRIN). If the temperature goes above 102.2 (39.0 Celsius) and does not respond to Tylenol, or if the child refuses to drink, then IV fluids may be required. Please call our office or go the closest Emergency Room.

*Do not use any ibuprofen (Motrin) related products for 2 weeks, unless cleared by your surgeon, as it increases the possibility of bleeding

*Please do not allow your child to participate in any heavy lifting, exercise or physical contact for at least two weeks unless cleared by one of your surgeons. These activities increase the risk of bleeding. Usually, travel is not recommended within two weeks of surgery.

*If your child develops an upper respiratory infection, especially with coughing, please start Robitussin DM elixir, if over the age of six years. Call our office, if there is no resolution in 48 hours, or for infants less than six years old, as this may also increase their risk of bleeding.

Care after removal of packs or splints

Ideally, limit nose-blowing for at least TWO weeks from the day of surgery. Running, aerobic exercise and weight lifting may be resumed after 4 weeks. Avoid any sport that may involve contact to your nose for 3 months. These activities will increase the likelihood of nasal bleeding.

If they have to sneeze, please advise doing it with the mouth open. This prevents excessive pressure build-up and bleeding from the nose.

For five days after the removal of the nasal splints or packs, use over-the-counter Afrin 0.05% (or generic Oxymetazoline 0.05%), two to three times daily, in both nostrils, if there is bleeding.

Otherwise, use saline spray (Ocean Spray, Ayr, Nasal Sea Mist, generic normal saline) 6 to 8 times daily to keep the mucosa moist and to help loosen the crusts for the first 2 weeks then decrease to 2-3 times per day.

If excessive bleeding occurs, try spraying the nose with Afrin spray to constrict the vessels.

Medications

An antibiotic is usually prescribed following the surgery. Use as directed. If a rash or diarrhea occurs, this may represent an allergy, please stop the medication and contact your surgeon during office hours. If there is any difficulty breathing, please contact your surgeon as this may require being seen in the nearest Emergency Room.

Regular children's Tylenol may be used for pain. The dose is usually titrated based on weight (10mg/kg) and may be alternated with codeine. You may also receive a prescription for painkillers in the form of Tylenol with codeine elixir (Tylenol #3). Use as directed.

The codeine may cause somnolence, drowsiness and constipation. It is okay to use prune juice or over the counter laxatives for brief periods.

Occasionally, if nausea or vomiting is severe beyond the first day after surgery, you may need to call the office for a prescription for anti-nausea medications.

Follow-up

Please schedule an appointment to be seen in the office in one-two weeks. PHONE: 310-657-6420

Note, it is difficult to refill pain prescriptions after hours, so please call during office hours and ask to speak with our nurse or medical assistant.

If your child has significant bleeding from the nose or mouth, develops high fevers or develops the worst headache of their life that is not relieved by the pain-killers, please call our office for the doctor on call or visit the nearest Emergency Room.