Rhinoplasty - PostOp Concerns

[tsytsma]

I recently had surgery and now I have some concerns. Let me start with some background information...

Over the years I have broken my nose several times from a variety of activities ranging from accidents, street football and martial arts. Naturally this has created issues such as a deviated septum and so forth. I knew the septum was deviated and finally after fracturing it again in december, I started to have the left side of my nose collapse with heavy inhalations. Looking up my nose you could see that the left side was very narrow to begin with while the right side was wide open.

I went to the doctor and found out that I also had excess tissue growth in my sinus on that left side so all in all I had the following things planned for surgery..

1. Septoplasty
2. tubinectomy (both sides)
3. removal of excess tissues

I was informed that this could alleviate other issues I had such as frequent sinus infections, sinus headaches and post nasal drip. The doctor also recommended that I speak with their plastic surgeon for bone reconstruction as some of them were misaligned. I met with him and he planned on

1. Open nasal reduction
2. Shaving of the hump
3. Nasal graft (piece of septum cartilage into collapsing side)

During surgery the second surgeon discovered that the septum bone was actually fractured and fixed that as well. I didn't have traditional packing, what I did have were plastic stents placed inside and then a splint on the outside. They also used some sort of dissolvable material to prevent scarring.
(see first reply for part 2)

[Howard Rosenberg, MD]

Internal swelling causing temporary nasal obstruction can last a month or more after surgery.  It is far too early to evaluate the results of your procedure.  Your treating physicians are in a much better to position to examine and discuss the internal status of your nasal passages as well as the success of the surgery.  Without an examination, it would be impossible to comment on your procedure.

[tsytsma]

The first week post surgery was as expected though I had some side effects from the levaquin and vicodin, so i stopped them a bit early. My week followup, the nurses first removed the splint which was naturally painful but very relieving. Just before the first doctor came in to check me out I had actually started laughing from something my wife said and blew out the stent on the left side.. OMG I could actually breath perfectly clear out the left side for the first time in years.

When the doctor came in he looked inside and I have no recollection of him actually removing the stent on the right side, but I do know I felt what felt like the sinus/side being flushed out with either air or water (I really couldn't tell -- maybe it was water in with a vac to suck out) and it was extremely painful. I thought for sure he blew the stent into my sinus and I could feel it jostling as the high pressured water/air was blowing in. Then he proceeded to do the left side which was slightly uncomfortable but not painful.

He asked how I felt expecting that I would be relieved to be able to breathe finally. I told him it felt like something was still in that right side and he cleansed it out again and ouch it hurt and felt like something was in there. I was allowed to gently blow my nose and while nothing much came out of the left side, the right side had some fresh blood.

He then told me that I had a lot of swelling there and that it should go away after several days and all would be well. He also said that I could expect to see things that look like blood, clots, tissue, bits of plastic as I blow my nose for the next week or so and it was normal.

When I met up with the second doctor, I told him that I felt he blew the stent into my sinus and it seriously felt like something was lodged in there. He joked that he always had to clean up the first doctor's mess and took a look. He said that everything looked normal but that there was a lot of swelling and a huge clot back in there on that right side. He took his time to look around and then proceeded to cleanse out both sinuses like the first doctor did. Even pulled out what my wife said looked like a chunk of chicken fat from the left side. He also said I should give it some time for the swelling to go down and I should be able to breathe out that side again.

Now why am I concerned? Well my right side was my good side and it was a huge wide open airway and I could breathe like a champ through, where as the left side was quite narrow and was hard to breathe through. Now almost 48 hours after my follow up visit I still have the following...

1. Right side feels very congested
2. It is almost imposssible to breathe out the right side (if I close the left side and use a bit of pressure air will go in/out).
3. Looking up my nose the left side (the bad one) is WIDE OPEN and CLEAR) while the right side is a narrow slit.
4. The right side appears to be swollen from the inside (by the upper (bony) septum) and even though I wasn't supposed to I slid my pinky up there and that bulge is hard and I am concerned it is the septum and not swelling (I can't tell).
5. All of that on what was my good side yet what was my bad side is a clear as a whistle and if it wasn't for the right side being so blocked, I wouldn't have to breathe through my mouth any more.


So is it too early for me to be concerned?
Could that (what feels hard) be actual swelling and not the bone?
Is it odd that I can't breathe out what was my good side?
Is there anything I could test/check out?
How long should I wait before really becoming concerned?

I tried a gentle cleanse and I can't even get enough fluid through that side to do a flush.

Thanks for any advice/help/suggestions.