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Nasal Polypectomy A nasal polypectomy is an operation to remove polyps from within the nose

Indications: Relief of nasal obstruction secondary to nasal polyps, which have not responded to medical therapy. A secondary indication may be where a patient refuses more extensive surgery for chronic sinus disease.

Side -effects Common: • Nasal Obstruction: because of dry blood and crusting causing a blocked nose for the first few weeks. • Bleeding: A small amount of bleeding immediately after polypectomy surgery is quite common. Do not take aspirin or Warfarin, or if have a history of bleeding problems, then tell surgeon before the operation. Occasional: Infection: sometimes swelling in the sinuses immediately after the operation can cause infection. • Return of symptoms: polypectomy surgery may not cure your symptoms permanently. In fact nasal polyps often recur, but how fast is often unpredictable. Rare risks: Because some of the sinuses (where the polyps often arise) are separated from eyes by only a very thin layer of bone, there is a very small risk of causing injury to eye. In the worst case, this could cause blindness or double vision. Similarly, some of the sinuses are very close to brain. There is a small risk of causing infections in or around brain or of a brain fluid leak through the nose. Loss of sense of smell: Often polypectomy surgery will improve a loss of smell, but rarely it can cause a loss of sense of smell.

Procedure

Pre procedure planning Preoperative assessment with computed tomography imaging is the criterion standard. Some surgeons also use intraoperative computed tomography imaging or neuronavigational equipment to help identify landmarks and/or during revision cases to further augment patient safety

Patient preparation Lidocaine with epinephrine may be injected into the septum, sinus anatomy, and polyps. General anesthesia is used during the procedure. Positioning The patient is positioned supine on the operating room table.

Technique There are 2 main techniques for nasal polypectomies. The technique chosen depends mostly on where the polyps are located in the nose. If they are easily seen and reached from the front of nose, then “intranasal polypectomy” is done using small graspers. Sometimes, however, small telescopes are used to get a better view in the nose if the polyps are smaller and located in the roof of the nose or in the sinuses

Monitoring and follow up Following surgery, a large portion of patients require continued medication use to avoid relapse and limit inflammation. Nasal irrigation with isotonic nasal saline is performed beginning 1-3 days following surgery and should be performed multiple times each day. Postoperative visits with nasal endoscopy and debridement are performed until the nasal mucosa has healed and any crusting or synechia has resolved. Follow-up regimens vary from weekly to every 3 weeks. Long-term follow-up is recommended to assess and treat any polyp recurrences