Mr Ben Hunter | Patient Information
Tel: 020 7760 7561
Email: enquiries@mrbenhunter.com
Fax: +44 (0) 207 760 7222
107 Harley Street, London W1G 6AL

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Copyright Ben Hunter. 2013.

Septoplasty
Mr Ben Hunter FRCS (ORL-HNS)

What is Septoplasty?
The septum is the partition wall inside the nose, made up of bone and cartilage. Septoplasty is carried out to straighten this partition.

Aims of surgery.
• To improve the breathing through the nose.

• To straighten the inside of the nose without altering the external appearance.

• As an additional procedure in sinus surgery to allow adequate access to the sinuses.
• To unblock the nose which may improve snoring.

The operation.
This is usually carried out under general anaesthesia. Cuts are placed inside the nose to allow access to the bone and cartilage of the septum.

On the rare occasions, when there are very marked abnormalities, a small incision at the base of the nose may be required. The operation takes between 40 to 60 minutes.

It may be carried out as a day case procedure, but usually an overnight stay in hospital is recommended. It is uncommon to have nasal packing after the operation.

After the operation.
The nose will be very congested (like a heavy cold) for 10 to 14 days. There will be some bloody watery discharge from the nose for up to 7 days. There will not be significant bruising or external nasal swelling. Flying and exercise should be avoided for 10 days.

Discharge advice.
• Your nose will need time to heal and you will generally need to recuperate for about 1 to 2 weeks.

• Pain following this surgery is unusual but you may have some discomfort. Please avoid any painkillers containing aspirin, including Disprin, Codis or cold or flu medication such as Lemsip. You may have been prescribed a painkiller whilst you were in hospital - if so, please take this as directed. If not, provided you are not allergic to it, we would recommend you take soluble Paracetamol as directed.

• Because you will be sleeping with your mouth open, you will become very dehydrated so drink plenty of fluids. If it is awkward to drink you may find a straw helpful.

• Please avoid crowded, smoky atmospheres as these may irritate your nose. Also avoid smoking, hot baths or very hot drinks for the first week.

• do not exert yourself for about 10 days or undertake heavy manual work such as gardening, stooping or lifting heavy items.

• You are advised not to travel far for 2 weeks after surgery - although post-operative bleeding is rare, it does remain a possibility.

• If you should have a nosebleed, do not panic. We would advise the following:
¬ Sit up and tilt your head forwards.

¬ Place a bag of ice-cubes or something frozen from your freezer to your forehead (wrap this in a cloth to prevent an "ice burn").

¬ If you feel blood dripping down the back of your throat, spit it out, as it can make you feel nauseous if swallowed.

• In the vent of a post-operative nosebleed, please also call your surgeon - either via the secretary during office hours or on the emergency number given to you whilst in hospital outside office hours.

• The inside of the nose will remain swollen for some weeks following nasal surgery and the blockage will make it difficult to sleep - extra pillows on the bed for the first few post-operative nights may be helpful.

• It is usually best to avoid going to the gym for 4 weeks after surgery.

• Remember, if you have any worries or concerns, it is always best to call your surgeon.

Complications.
• There is a small risk of nose bleed requiring readmission to hospital.

• Nasal infection is uncommon but may require antibiotics.

• Occasionally perforations may develop in the septum after surgery. These are usually symptom free but, if troublesome, can be repaired.

 


Nasal Turbinate Surgery

Mr Ben Hunter FRCS (ORL-HNS)

The nasal turbinates are swellings inside the nose that are responsible for warming and humidification of air going through the nose. Particular irritants (allergy, environmental pollution) may cause the turbinates to become overly large causing nasal blockage. The mainstay of reducing turbinate swelling is with nasal sprays. However, occasionally surgery is indicated.

Aims of surgery.
• To reduce the size of the turbinates and improve nasal breathing.
• To reduce mucus production in the nose.
• To unblock the nose which may help with snoring.

Type of operation.
Many techniques are employed to reduce turbinate swelling and obstruction. The specific technique is determined by the underlying problem. Your surgeon will explain fully what is involved but the following techniques are commonly used:

• Submucosal diathermy involves coagulating the blood vessels in the turbinate lining to cause shrinkage. This is not always a permanent solution, so Mr Hunter favours the turbinoplasty below.

• Turbinoplasty involves a limited surgical reduction of the bulk of the turbinate, so that the swelling does not affect the airway. This has been found to give lasting relief to this kind of nasal obstruction.

What to expect.
The surgery is carried out under general anaesthesia. Turbinate surgery alone can be carried out as a day case procedure. It is not painful. Initially there is worsening of the nasal congestion as the nose heals. This may take 2 weeks to return to normal. Some discharge and crusts from the nose are common. Exercise and flying should be avoided for 1 week.

Complications.
• There is a small risk of a nose bleed require admission to hospital.
• Nasal infection is rare but antibiotic cream in he nose or tablets by mouth may be required.
• Persistent crusting in the nose can occur on rare occasions.

 



Functional Endoscopic Sinus Surgery (FESS)
Mr Ben Hunter FRCS (ORL-HNS)

Functional Endoscopic Sinus Surgery is:

• Performed to relieve symptoms of sinusitis and/or nasal polyps.
• Minimally invasive surgery.
• Individually tailored to the findings in each patient.
• Usually reserved for patients who have not improved with nasal sprays or antibiotic tablets.

The Operation
• Endoscopic Sinus Surgery is performed through the nostrils, usually under general anaesthesia.
• There are no scars on the face.
• The areas of thin bone and inflamed lining in the narrow nooks and crannies of the nose and sinuses are removed along with any polyps.
• Small, specially designed shaped instruments are used to remove diseased tissues. This leads to less scarring in the nose and a more rapid return to work.
• Sinus draining channels may also be opened to restore function

Recovery and follow-up

Your nose:
• May feel blocked for up to 2 weeks after surgery.
• May occasionally bleed and crusts may appear in the throat.

You:
• May feel slightly unwell or tired during this time and may need about a week off work.
• May need antibiotic and steroid tablets after FESS to help the healing process.
• Will be seen about 1-2 weeks after FESS in the clinic and may need further visits until the sinuses have healed - it is important to keep these appointments as this aftercare is an important part of the surgical procedure.

Discharge advice
• Your nose and sinuses will need time to heal and you will generally need to recuperate for about 1-2 weeks.
• Pain following this surgery is variable. If you surgeon has prescribed painkillers whilst in hospital, please take these as directed. Otherwise please avoid any medication containing aspirin, including Disprin, Codis or cold or flu medication such as Lemsip. Provided you are not allergic to it, we would recommend you take soluble Paracetamol as directed.
• Following surgery, the nose may well be swollen up inside and you will find that sleeping with you mouth open makes you very dehydrated. It is important that you drink plenty of fluids - this will help you avoid headaches and will also clear mucus and stale blood that may accumulate in the throat. You may also find it helpful to have extra pillows on your bed.
• Please avoid crowded, smoky areas as this may irritate your nose. Also avoid smoking, very hot baths or very hot drinks for the first week.
• Do no exert yourself for about 10 days or undertake heavy manual work, such as gardening, stooping or lifting heavy items.
• You are advised not to travel far for 2 weeks - although significant post-operative bleeding is rare, it does remain a possibility. However, if you should have a nosebleed, do not panic. We would advise the following:

• Sit up and tilt your head forwards.
• Apply continuous pressure by squeezing the flesh part of your nose for 10-15 minutes.
• Place a bag of ice-cubes or something frozen from your freezer to your forehead (wrap this in a cloth to prevent an "ice burn").
• If you feel blood dripping down the back of your throat, spit it out, as it can make you feel nauseous if swallowed.

• In the event of a post-operative bleed or severe pain, you are also advised to call your surgeon - either via the secretary during office hour or, if outside these hours, on the emergency number given to you whilst in hospital.
• Remember, if you have worries or concerns, it is always best to call your surgeon.

Results and complications
Surgery successfully improves symptoms in over 80% of patients. The sinuses are separated from the eye socket, tear duct and brain by thin bone. Damage to these structures has been reported in studies from the UK, Europe and the USA. The risk of a significant complication related to these structures is less than 1%.

Rhinoplasty (nasal reshaping)
Mr Ben Hunter FRCS (ORL-HNS)

What is Rhinoplasty?
Rhinoplasty is the term used to describe a number of operations designed to re-shape the nose. the nose may be straightened, or a hump reduced in size. The tip of the nose may be altered. Dips and depressions on the bridge of the nose may be corrected. Abnormalities inside the nose causing twisting or blockage may be corrected.

Aims of surgery.
• To improve the nose cosmetically and to maintain or improve function.
• To produce a nose that is in harmony with the face.
• To produce a result that has a natural, non-operated appearance.

These aims are achieved through a careful pre-operative assessment of the individual to ensure that the surgical plan is tailored for each patient.

Limitations.
It is not possible to choose a new nose. The existing nose and any abnormalities will dictate what can be achieved. Age, ethnic origins and skin type influence the possible final result. The effects of healing cannot always be predicted.

Before the operation.
One and sometimes two consultations are required. Pre-operative digital photographs will be taken and an indication of the desired outcome may be demonstrated on the computer. The operative plan will be discussed in detail so that both patient and surgeon have realistic expectations.

The operation.
Rhinoplasty is usually carried out under general anaesthesia. Cuts are placed inside the nose where they cannot be seen. Occasionally a small cut is placed underneath the tip of the nose. The skin is lifted off the underlying bone and cartilage, which can then be adjusted to create the desired shape. The nasal bones often have to be broken to produce a straight nose. Occasionally a dressing is placed inside the nose to prevent bleeding.

After the operation.
A small splint is placed on the outside of the nose, which should be kept dry. This is removed 7 days post surgery. Some bruising will occur around the eyes which will settle in 7 to 10 days. The nose may produce small amounts of blood and crusts for 1 week and will be blocked for 2 to 3 weeks. It is advisable to avoid vigorous nose blowing. The nose may feel stiff or numb especially around the tip. Contact sports should be avoided for 6 weeks. Exercise and flying should be avoided for 2 weeks. Obvious swelling will settle in 2 weeks; however, subtle changes can be expected for several months.

Discharge advice.
• Your nose will need time to heal and you will generally need to recuperate for about 1 to 2 weeks.
• Pain following this surgery is unusual but you may have some discomfort. Please avoid painkillers containing aspirin, including Disprin, Codis or cold or flu medication such as Lemsip. You have been prescribed a painkiller whilst you were in hospital - if so, please take as directed. If not, provided you are not allergic to it, we would recommend you take soluble Paracetamol as directed.
• Because you will be sleeping with your mouth open you will become very dehydrated, so drink plenty of fluids. If it is awkward to drink, you may find a straw helpful.
• Please avoid crowded, smoky atmospheres as this may irritate your nose. Also avoid smoking, hot baths or very hot drinks for the first week.
• If you have a plaster splint on your nose, please try to avoid getting this wet. If you do need to wash your hair, ask someone to help wash it with your head backwards (as in hairdressers), as stooping forwards can cause discomfort and nosebleeds.
• Do not exert yourself for about 10 days or undertake heavy manual work, such as gardening, stooping or lifting heavy items.
• You are advised not to travel far for 2 weeks after surgery - although post-operative bleeding is rare, it does remain a possibility.
• If you have a nosebleed, do not panic. We would advise the following:
• Sit up and tilt your head forwards.
• Place a bag of ice-cubes or something frozen from your freezer to your forehead (wrap this in a cloth to prevent an "ice burn").
• If you feel blood dripping down the back of your throat, spit it out, as it can make you feel nauseous if swallowed.
• In the event of a post-operation nosebleed, please also call your surgeon - either via the secretary during office hours or on the emergency number given to you whilst in hospital outside office hours.
• The nose will remain swollen for some weeks following nasal surgery and the nasal blockage will make it difficult to sleep - extra pillows on the bed for the first few post-operative days may be helpful.
• Were a rhinoplasty has been undertaken (to change the shape of the nose) the plaster splint will normally be removed after 1 week. The nose will still appear swollen at that stage and the surgeon will want to see you again in about 6 weeks to check your progress. It is fine to wear glasses once the plaster is off but you are advised not to expose the face to the sun for a few weeks after surgery, as the skin around the nose will be more susceptible to burn - wear a hat! In cold weather the nose may be tender, so it is a good idea to protect it with a scarf. It is usually best to avoid going to the gym for 4 weeks after surgery.
• Remember, if you have any worries or concerns, it is always best to call your surgeon.

Complications.
• There is a small risk of suffering a nose bleed that requires further treatment.
• There is a very small risk of nasal infection.
• 5% of patients request revision surgery