Outpatient Visit at One Week Debridement

In the early days of endoscopic sinus surgery, debride-ment was advocated in the first few days after surgery. This has not been shown to help, and patients dislike it (Fig. 13.5a-d). We do as little suction and instrumentation to patients as possible as they find it very uncomfortable. It is our practice to see patients after one week and not to remove any eschar unless adhesions are starting to form between two adjacent surfaces. Under these circumstances, the nasal airway is anaesthetized with a topical local anesthetic and the adhesions are divided; the patient is encouraged to douche more frequently and enthusiastically. We find

Hydrogen Peroxide Douche
Fig. 13.3 A patient with a persistent, purulent discharge who needs weeks, if not months, of douching and medical treatment.
Fig. 13.4 Residual mucosal disease at 2 weeks. We emphasize the importance of taking regular topical nasal steroids.

that inserting cotton wool soaked in cophenylcaine for 3 minutes and then gradually advancing it is a good way to anaesthetize the nose and clear the eschar with a minimum amount of bleeding. Sometimes huge casts of altered blood can be removed to the satisfaction of the patient, as their airway is immediately improved. A further appointment in the following week may be indicated if there are concerns that adhesions may reform, so that any fibrinous strands can be cleared. Normally a further appointment at 6-10 weeks is given to check the state of the mucosa.

We reinforce the need for douching and advise that patients should continue this until their airway feels clear and they have not irrigated out any debris for several days. We are happy for patients to blow their nose after approximately 4 days. Patients with ciliary disorders will have been told preoperatively that they will need to douche in the long term.

Olfactory Cleft Endoscope
Fig. 13.5a-d Postoperative appearance of the left nasal airway and olfactory cleft in the same patient at 7 days, 14 days, 3 weeks, and 2 months.
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