M Nasal surgery
Nasal surgery is often performed to restore the caliber of the nasal airway or for cosmetic purposes. Whether for rhinoplasty, septoplasty, or septorhinoplasty, the nasal cavity can be anesthetized by placing 4% cocaine–soaked pledgets up each nostril for 5 to 10 minutes. To ensure vasoconstriction and minimize bleeding, the site is infiltrated with 1% lidocaine and 1:100,000 epinephrine. A hypertensive technique may also be initiated to control bleeding.
An incision is made in the septum down to the cartilage with elevation of a submucoperichondrial flap. This may be repeated on the contralateral side. Bone and cartilaginous deformities may be resected or weakened on the face. They may also be removed first, shaped, and then replaced. When the surgeon is satisfied with the resection, the incision is closed with an absorbable suture. In rhinoplasty, depending on the area needing work, the nasal contours can be remodeled by tip remodeling, humps can be reduced, bone osteotomies can be performed to shape the contour of the nose, or combinations thereof can be done. After surgery, both nasal cavities are packed, and external splints may be used.
2. Preoperative assessment and patient preparation
Generally, these procedures are elective and can be performed on an outpatient basis. It is important to identify patients with obstructive apnea. These patients often have chronic airway obstruction, redundant pharyngeal tissues, or both. Such patients, as well as patients with asthma, should undergo arterial blood gas and pulmonary function testing. Ketorolac and acetylsalicylic acid should be avoided in patients who also have nasal polyps because they often are hypersensitive to acetylsalicylic acid, a condition that can precipitate bronchospasm.
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