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Postoperative management of chronic paranasal sinusitis

Clinical success of sinus surgery for sinusitis depends primarily on meticulous postoperative management. Generally, no packing is used. However, should minimal nasal packing be needed, it should be removed within 24 to 48 hours to avoid unexpected toxic shock syndrome. Long-term antibiotic therapy is considered when the operative field has been in a severely infected sinus. Corticosteroids are administered in suspected minor or major orbital injury, eyelid swelling, or diffuse polypoid rhinosinusitis. Topical nasal decongestants may, however, cause serious histologic changes in the nasal mucosa. To prevent polyps or pseudocysts, short-course steroid therapy is recommended. We give irrigation or spray of normal saline to patients with persistent discharge or nasal allergy. Granulation tissue or polypoid changes are managed with contact or non-contact laser. Incomplete healing may be attributed to several factors, eg, excessive granulations, resulting scar tissue, and failure of restoration of mucociliary transportation.