Bechara Y. Ghorayeb, MD.  8830 Long Point, Suite 806.  Houston, TX 77055.  Tel: (713) 464 2614
Diet
*Patients who have had this procedure for the removal of a pituitary tumor are usually kept in the neuro intensive care unit (NICU) and an appropriate diet is served. 
*If the procedure is performed for a sphenoid sinus lesion, there is no need for intensive care.  In this case, it is preferable to eat a bland light meal or a liquid diet on the first day after the surgery.  Regular diet may be resumed the next day. 
*Please remember that trans-sphenoid procedures are performed through a sublabial incision.  This causes pain on chewing or moving the upper lip.  Also, read information below about dentures.

Wound care and other information
1. Elevate the head at all times. Sit in a recliner or use two or three pillows when sleeping. Head elevation reduces bleeding and swelling.
2. The upper lip may be slightly swollen and numb.  You may also experience numbness of the upper front teeth. 
3. You may take a shower with lukewarm (not hot) water. Make sure you have someone with you in the house in case you feel drowsy or fainty from taking pain killers.
4. Do not remove packing or splints if present. You may have to breathe from your mouth if the splints get occluded with mucus or clots. This may cause a dry mouth. It is therefore very important to drink a lot and maintain adequate hydration.
5. Bleeding is expected for two to three days after surgery. Just change the drip pad as needed and keep the nostril clean. Clean the dried blood and secretions from the nostrils with hydrogen peroxide 3% and Q-tips.

Care after removal of packs or splints
1. Do not blow your nose for at least one week from the day of surgery. Avoid heavy lifting or straining. These activities will increase the likelihood of nasal bleeding.  Also straining could cause a CSF leak in patients who had a pituitary tumor removal.
2. If you have to sneeze, please do it with your mouth open. This prevents excessive pressure build-up and bleeding from the nose.
3. Do not take Aspirin or products containing acetyl salicylic acid. Aspirin prevents clotting and increases the bleeding.
4. For five days after the removal of the nasal splints or packs, use over-the-counter Afrin 0.05% ( or generic Oxymetazoline 0.05%), two to three times daily, in both nostrils. After five days, use
normal saline spray (Ocean Spray, Ayr, NaSal, Sea Mist, generic normal saline) 6 to 8 times daily to keep the mucosa moist and to help loosen the crusts.
5. If excessive bleeding occurs, try spraying the nose with Afrin to constrict the vessels.
6. Sublabial sutures dissolve and do not need to be removed.  Please do not pick at suture line with your tongue or with a toothbrush.
7. You may use the mouth wash of your choice.  Please do not force the mouthwash between the lips and the gums, this may rupture the sutures.
8.  If you have dentures, make sure to bring them with you to the operating room.  In this case, the incision is made in the gum.  The dentures are placed over the sutures while you are still asleep.  Please keep the dentures in place and do not remove them for ten days.  This prevents your gum from swelling, otherwise, you will need to have new dentures made.

Medications
*An antibiotic is usually prescribed for seven to ten days following the surgery. You may also receive a prescription for painkillers in the form of codeine or hydrocodone. These products cause somnolence, drowsiness and constipation.
* Patients who had a pituitary tumor removed may experience an increased urinary output and may require additional medications.

Follow-up
Please schedule an appointment to be seen in the office in seven to ten days. PHONE: (713) 464 2614
We are unable to refill your medications on weekends or after hours. We do not refill painkillers over the phone.  For prescription refills, please call during office hours: Monday-Thursday: 9:00 am - 4:30 pm
Friday: 9:00 am - 3:30 pm 

                                                                                                                         
Visit Dr. Ghorayeb's website http://www.ghorayeb.com
POSTOPERATIVE INSTRUCTIONS
TRANS - SPHENOID PITUITARY SURGERY
(This information also applies to sublabial  trans-septal sphenoid sinus surgery)