layer of the turbinated bones, and those veins lying just beneath the mucosa
anastomose (communicate) freely. Dilatation of the superficial veins may cause the
turbinated bone mucosa to swell, whereas contraction of these vessels may cause the
mucosa to shrink.
1-29. PREP, POSITION, DRAPE, ANESTHESIA, AND LIGHTING
All procedures performed prior to the start of surgery must be explained to the
patient to avoid fright and apprehension.
a. The male patient shaves his face prior to surgery. The immediate
preoperative prep may include clipping the hairs within the nostrils using small tenotomy
scissors. The specialist is to coat the blades of the scissors with a film of vaseline so
that the patient will not aspirate the nasal hairs. The patient's face is then washed with
antibacterial detergent and sponged dry. His eyes should be protected during this
procedure with damp gauze compresses. No solution is applied inside the nose.
b. The patient is placed in either the supine position or the reclining position.
For procedures done using local anesthesia, the reclining position enables the patient to
expectorate any fluid collecting in his mouth and thus helps keep the operative area free
c. A large drape sheet is placed lengthwise over the front of the patient and is
secured bib-fashion. Suction tubing is pinned to the sheet. Sterile towels may be
wrapped around the patient's head and secured with towel forceps, leaving his face
exposed but his eyes covered. Another method of draping the head is to cover it with a
small fenestrated sheet through which the nose and mouth are exposed.
d. Local anesthesia is usually employed for nasal surgical procedures on adults.
The method of administration is a combination of topical (nasal packs) and infiltration
anesthesia. The specialist assists the surgeon as necessary in packing the nose. Use
of local anesthesia enables the patient to cooperate with the surgeon and avoids the
complication of vomiting.
e. Illumination is provided by either of two methods: the electric head lamp or
the overhead light. The two devices are sometimes used in conjunction.
1-30. SEPTECTOMY, OR SUBMUCOUS RESECTION
a. General. Septectomy, or submucous resection (SMR) deviations of the nasal
septum may result from faulty development of the septum or from injury to the nose.
The patient's symptoms include inadequate or difficult nasal breathing or obstruction of
nasal drainage. Septal deviations tend to cause sinus disease and the formation of polyps.
The operation consists of removing the bent parts of the nasal septum that lie between
the flaps of mocous membane to establish a straight partition.