Endoscopic sinus surgery is done to open the passages of the sinuses. This allows for proper drainage to the nose. It is called an endoscopic procedure because the doctor uses an endoscope (a small, rigid tube with a light and a camera lens at the end) to view the inside of the nose. Small incisions or cuts are made to allow the scope to pass. The cuts are usually made inside of the nose. The doctor may create new passages or open existing ones by removing polyps, cysts, or thickened mucous membranes.
Endoscopic sinus surgery usually takes between one and three hours. It is done in the operating room. The child is under general anesthesia.
Most young children spend the night in the hospital. Some older children may stay for only a couple of hours after surgery, once they are stable.
If needed, endoscopic sinus surgery may be done at the same time as another operation, such as septoplasty, tonsillectomy, adenoidectomy, or insertion of ear tubes.
Your child will have intravenous (IV) fluids until they are allowed to go home. Your child may be given clear liquids to drink in the Post Anesthesia Care Unit (PACU), also called the recovery room.
Your child may complain of a sore nose, not being able to breathe through the nose, and difficulty swallowing.
A pain reliever may be given for pain. An antibiotic is sometimes prescribed to prevent infection.
The head of the bed in the PACU will be raised to help with swelling, breathing, and drainage. At home you should have pillows or a recliner chair available to help your child keep his or her head elevated above the level of the chest.
There may be packing in the nose to prevent bleeding. Sometimes, this packing is dissolvable. The doctor may remove this packing in one or two weeks or it may dissolve on its own. If the packing needs to be removed, it may be done in the doctor's office for older, cooperative children, or may be done in the operation room under anesthesia.
If a septoplasty (straightening of the bone and cartilage in the center of the nose) is done, then splints may be placed inside the nose at the end of the operation. These will be removed at the doctor's office in 1 to 2 weeks and may cause some discomfort while they are in place. If packing is used, your child may be able to feel it in his or her nose. Your child should be told before surgery that they may feel like they have something in their nose when they wake up. If packing is not used, swelling may cause this feeling. Your child should know that he or she will not be allowed to forcefully blow his or her nose for a week or two.
At first, there may be some drainage from the nose. You may see a small piece of gauze taped under your child's nose. This is called a "drip pad." This catches any drainage from the nose, which should gradually decrease, and is usually only needed for the first day, if at all. The drainage from the nose will probably be slightly colored with blood. Your child may cough or spit up some pink or brown mucus.
Most children are fussy the first few hours after this procedure.
Your child may begin normal play after several days, but may need to stay home from school until the discomfort improves. Talk with your child's health care provider for more specific instructions.
Your child's health care provider may recommend the use of nasal ointment, salt water spray, or nasal steroid spray after surgery. Follow instructions carefully.
If your child has any of these symptoms, you should contact your child's health care provider right away:
Bright red bleeding from the nose or mouth
Seeing double, or having trouble seeing
A continued leak of clear fluid from the nose
Vomiting bright red blood or a coffee ground-like material
A croupy (barky) cough, cry, or wheezing
A fever greater than 101.5 degrees rectally or greater than 100.5 degrees orally
Vomiting (or if the vomiting becomes severe)
Signs of dehydration (a child can become dehydrated when he or she has prolonged or severe vomiting and is not able to drink enough fluid)
A visit with your child's health care provider will be scheduled for one to two weeks after surgery. Many additional follow-up appointments will be needed in the months after surgery to make sure that the nose is healing properly. Talk with your child's health care provider if you have any questions.