(g) Record the vital signs of the patient.
(h) Reassure the patient if awake.
d. Operative Procedure. The operative procedure will vary with the individual
surgeon. A general review of most procedures is as follows:
(1) The nostril is opened with a speculum. An incision is made through the
mucoperichondrium and mucoperiosteum of the septum with a knife, blade number 15.
The tissues are separated and elevated, using a Freer knife.
(2) The cartilage is incised with a knife, and the mucous membrane is
elevated with a septal elevator; part of the septal cartilage is excised with a Ballenger
knife; deviated cartilage and bony, thickened structures are removed with a septum
punch and a nasal cutting forceps.
(3) The mucous membrane is freed from the bony septal base by means of
a chisel, gouge and mallet, or punch forceps. Bleeding is controlled by cotton sponges;
suctioning is used to expose the field.
(4) The perpendicular plate of the ethmoid may be removed, as well as the
vomer, by means of the S-retractor, chisel and mallet, and a suitable septum-cutting
(5) The incision may or may not be sutured with silk #3-0 fused to a small
1/2-circle taper-point needle on a Crile needle holder.
(6) Nostrils are packed with petrolatum gauze in order to keep the septal
flaps in a midline position. The face is cleansed with both moist and dry compresses.
e. Specimens. Excised tissue is processed as a specimen.
1-31. OTHER NASAL OPERATIONS
The specialist assigned to scrub or circulate for the operations duties are similar
to those described for submucous resection. The specialist is to check local policy
carefully concerning instruments, sutures, and other items in the setup for the operation
to be performed.
a. Excision of Nasal Polyps. Polyps are soft, benign tumors of the nasal
mucosa caused by chronic nasal allergy (see figure 1-10).