• Reduction of nasal fractures may be done by a closed manipulation with external casting in the office or by open surgical technique in the operating room• Repair and stabilization of other maxillofacial fractures usually require an operating room procedure for wiring or plating
• Nasal septal reconstruction involves resection or removal of cartilaginous (or bony) septum followed by reconstruction of all parts of the septum that may produce nasal airway obstruction
• Submucous resection of the septum is an operation in which cartilaginous and/or osseous portions of the septum that lie between the flaps of the mucous membrane and perichondrium are removed or straightened to establish a midline partition between the right and left nasal cavities to provide a clear nasal airway
• Involves changing the noses external appearance• Grafted cartilage or bone harvested from other parts of the body may be used• A septorhinoplasty may be done when there are external and internal nasal deformities
• Functional endoscopic sinus surgery (FESS) – done with rigid endoscopes and long-handled forceps working through the nose to widen the natural sinus ostia and to facilitate the natural sinus drainage patterns.• Polyps and other small intranasal growths can be removed endoscopically
• The packing used after FESS is very small, filling only the area adjacent to the sinus ostia, so is not visible except for a retrieval string extending outside the nasal ala
• Other traditional approaches to the sinuses: – Caldwell-Luc procedure opening under lip to enter maxillary sinus and strip out diseased mucosa) – nasoantral window (creating an opening between the maxillary sinus and the anterior inferior nose)
– external or internal ethmoidectomies, with their historically extensive postoperative nasal and sinus packing, are now used only in selected complicated cases
• If a fracture or trauma has occurred, head of bed should be raised to promote drainage, lessen edema, and make patient more comfortable.• Intermittent cold compresses and pain medications should be utilized as ordered.
• Antibiotics may be used to reduce bacterial colonization of nose and sinuses.• The patient should be advised that a sensation of pressure may be felt in the nasal area during surgery if done under local anesthetic.
• The patient should be told about the use of nasal packing to effect hemostasis and the appearance of facial or periorbital ecchymosis (bruising) that may be present and will subside over a course of weeks.
• The patient should avoid use of aspirin, nonsteroidal anti- inflammatories, and drugs that may affect platelet function before surgery.