But every care should be taken to purify the surgeon’s hands, sterilize all instruments, and see that no contamination takes place during the operation. This is assisted by having the patient’s head surrounded by a carbolized towel, and his face, moustache, and beard well washed, for the surgeon’s hands and instruments come in frequent contact with these parts.
AFTER-TREATMENT
After all intranasal operations everything should be avoided which interferes with the drainage, ventilation, and natural repair of the region. Protective dressings cannot be employed, and we have in most cases to aim at healing under a blood-clot. Tags of semi-detached tissue and loose clots of blood are removed, but otherwise the parts are disturbed as little as possible. For the first two or three days the nose may be left alone, and if there be no bleeding the patient is encouraged to breathe through it. When there is much formation of thick mucus, or blood-clots or sloughs are loosening, a tepid alkaline lotion can be used. The pain of stiffness or dryness in the nose is relieved by an ointment or an oily spray.
Adhesions are apt to form between the septum and the outer wall when opposing surfaces are injured by the galvano-cautery. They may occur in narrow cavities after cutting operations. If an adhesion be seen to be threatening in the first few days, it should be broken down with a probe, and strips of gauze or plates of white celluloid introduced daily until healing takes place. If it forms later, it is wiser to wait until the fleshy bridge becomes less vascular and contracts, when it may be divided with a knife or the galvano-cautery at a white heat, and the opposing surfaces are then kept apart as described.
All post-operative conditions in the nose and throat will heal more rapidly and pleasantly if the patient be freely exposed, day and night, to abundance of fresh air; and while fatigue is generally to be avoided, the sooner the patient is out of bed and in the fresh air, the better for him. Our inability to operate under aseptic conditions should make us more careful to raise the resistance of the individual by general care, and to protect him from external dangers.
CLEANSING THE NOSE
The simplest and safest method of cleansing the nose is by blowing it,—one nostril at a time. Sometimes it is required to hawk any discharge backwards and expel it through the mouth.
Watery lotions are frequently required to assist in cleansing the nose. Strong antiseptics and astringents must be avoided. All nose lotions should be alkaline, and isotonic with the blood plasma. These requirements are met by prescribing one or more alkalis (bicarbonate of soda, borax, salt, &c.), in the strength of about 5 grains to the ounce. They may be rendered more pleasant by the addition of white sugar or glycerine. The addition of a small amount of some mild antiseptic—menthol, thymol, oil of eucalyptus, carbolic, sanitas, listerine, &c.—may give a pleasant flavour. But all antiseptics have a slight irritant action which is disagreeable if there be an intact mucosa, although they may be more helpful in certain cases of ulceration or intranasal sepsis. When the Schneiderian membrane is more or less damaged, when there are foreign bodies, sloughs, necrosis, &c., in the nasal chambers, these or similar antiseptics can be employed, though always with an alkaline basis.
All nose lotions should be employed tepid. They may be sniffed, irrigated, sprayed, or syringed into the nostrils. Crusts, scabs, and sloughs may have to be removed from the nose with forceps, after its sensitiveness has been deadened with cocaine; peroxide of hydrogen will help to detach them.