As each day passes, things seem to feel somewhat better. This morning the pain is still coming and going, but the Vicodin seems to be keeping it in check. I am still not sleeping very well, and there is still some residual swelling on the left side of my face, so I am continuing to ice / cold washcloth my face to help ease the swelling. There has been a lot of goop coming out of my nose, and down the back of my throat, but this is to be expected. My ears are still continuing to ring, but not as loud as it used to be.
Me being in a rush, I forgot to take my painkillers before the procedure. Note to self you idiot, why would you do that?
Well today was my first of three follow up appointments for my sinus surgery. I met with my ENT’s NP for this appointment, my next appointment I will be seeing my ENT whom did the procedure. My wife drove us down to the appointment. Once there, we were brought back to a room. I gave the biggest hug I possibly could to the NP thanking her for all her hard work and just basically being fucking awesome.
As the procedure started, they sprayed the numbing spray into both nostrils and waited for it to take effect. After about 5 minutes, she started to suction and dig out a lot of nasty crap out of my sinuses. About 10 minutes into it, she started going deeper and deeper. The pressure and pain just went through the roof. The room started to spin, and my entire body just went sweaty. I told her that I was starting to pass out, she immediately tilted the chair back, and I went out for probably 3 minutes. She rushed away to get me 2 Capri Sun juice bags to help me get through the nausea, pain, and just overall my bodies reaction to “This fucking sucks”.
She gave me about a 15 minute break, came back in, and continued digging, and suctioning. After about 5 minutes, she was done. Wow. What an experience. At least I know what to expect next time, as I didn’t expect that. From her evaluation, I am clotting correctly, and cannot see any leftover scar tissue from the surgery. I will return May 31st for the next clean out session. I am to continue doing saline rinses up to 3 times per day (which I am already doing).
As for the pathology of everything that was removed, including Fred, will result in about 10 days. She was pretty positive about what was taken out would be highly unlikely to be cancerous, however, we want to make 100% certain that we are done monkeying around in my head. After the procedure, she explained a few things to the wife (I was in another world), and then she asked me how I’m doing.
I unloaded 🙁
I am in so much pain, on top of that I cannot sleep. At all. At most I am averaging 3-4 hours a night. So my NP being the awesome person she is, gave me more Dilaudid (of which is the best for breakthrough pain relief), as well as upped my dosage of Ambien to 2 pills before bedtime. I really hope I can sleep tonight, I am just exhausted.
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Operative Report
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DATE OF SURGERY: 4/20/2019
PREOPERATIVE DIAGNOSES: Chronic maxillary sinusitis, chronic ethmoid sinusitis, chronic frontal sinusitis, and frontal sinus osteoma involving the left orbit and left frontal sinus posterior wall.
PROCEDURES:
- Excision of left frontal benign neoplasm.
- Left endoscopic frontal sinusotomy.
- Left endoscopic total ethmoidectomy.
- Left endoscopic maxillary sinusotomy with tissue removal.
- Left medial orbital decompression.
- Stereotastic surgical navigation.
ANESTHESIA: General endotracheal
TIME OF SURGERY: Over 4 hours, which was extensively long as this is not the usual sinus operation.
DISPOSITION: To recovery room in stable condition.
INDICATIONS FOR PROCEDURE: John is 39 and has been struggling with multiple medical problems, not the least of which is chronic sinus infections and face pain and pressure, as well as headaches mainly situated about the left frontal part of his cranium. Imaging and other workup have been accomplished as well as extensive recent medical care. Ultimately, we discovered John has a large osteoma involving his left frontal sinus and surrounding sinus inflammation through much of the other nasal sinus cavities in the left side of his nose, so we are coming to definitively extirpate this today with image guidance.
PROCEDURE DESCRIPTION: The patient was brought to the the operating room and placed supine on the table. General anesthesia was induced. An oral endotracheal tube was placed. When sufficient anesthesia had been accomplished, the nasal cavity was treated with Afrin-soaked cottonoids, which were later removed. The face was then prepared and draped in the usual semi-sterile fashion and local anesthetic was infiltrated into the sidewall and midline structures of the nose. Nasal endoscopy ensued. The image guidance system was calibrated using 0, 45, and 90-degree probes with the root man square through the surgical field of less than 2 mm. The probe was almost immediately to identify the inferior aspect of the osteoma in the superior ethmoid roof on the anterior aspect of the left nasal cavity. This was seem more directly by removal of the uncinate process, ethmoidal bulla, and other septations and fenestration of the middle turbinate basal lamella, so that the posterior ethmoid region could be cleared of polypoid matter. The natural ostia of the maxillary sinus were opened widely in the left side wall of the nose and polypoid matter and thickened secretions were removed from the maxillary sinus.
The frontal sinus was then viewed and seen to be obstructed by a large osteoma. The margins of this were identified and drilling began with 70-degree diamond and cutting burs and ultimately after approximately 3 hours of drilling from what inside the lesion, its shell was visualized from within and detached in piecemeal fashion from the underlying bone, particularly involving the left superior and medial orbital walls. Certain parts of the periorbita were exposed as this had been where the tumor seemed to have originated, although its originating bone was removed that it would not recur and hence this has returned a medial orbital decompression. This was done with great care to preserve the periorbita and not lacerated, so at no time was any orbital fat seen. After the tumor was removed from the orbital walls, it was removed from the posterior wall of the frontal sinus and under Valsalva maneuvering, no CSF examinations were seen to come through this and it was confirmed by image guidance that had been removed in its entirety. The whole nasal cavity on the left side was lavaged several times and the patient was suctioned. He was awakened from anesthesia, extubated, and brought to the recovery room in satisfactory condition.
Electronically signed by the best ENT in the world
39.7392358-104.990251
Denver, CO, USA
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