Iowa Head and Neck Protocols

return to Home

Search the Protocols

Searching Iowa Head and Neck Protocols

Home

Citing the Iowa Protocols

Mission Statement

List of Donors 

KLS Martin, LP

Hemostatix Medical Technologies, LLC

Boston Medical Products Inc.

Lumenis

KeyPentax

Synovis Micro Companies Alliance, Inc

Tom Benda, JR., M.D.

The Potash Family

UIHC Melanoma and Sarcoma Tissue Bank

Karl Storz-Endoskope

Heartland Regional Chapter of SOHN

Jon and Veda Foster

The Department of Otolaryngology and the University of Iowa wish to acknowledge the support of those who share our goal in improving the care of patients we serve. The University of Iowa appreciates that supporting benefactors recognize the University of Iowa's need for autonomy in the development of the content of the Iowa Head and Neck Protocols.

HaN Admin Pages

Versions Compared

Key

  • This line was added.
  • This line was removed.
  • Formatting was changed.
Comment: Migrated to Confluence 4.0

Postoperative Care Map for Skull Base Surgery

return to: Otology - Neurotology

  1. POSTOPERATIVE CARE (TL AND MCF)
    1. Surgical Intensive Care Unit
      1. Overnight Neurological monitoring for intracranial bleed.
      2. No narcotics used except codeine IM.
      3. Droperidol, Zofran used for nausea.
      4. Control blood pressure to prevent intracranial bleed.
      5. Carefully assess facial nerve function as soon as patient can give reliable exam.
        1. Facial function may decline postoperatively secondary to swelling.
        2. Good function immediately postoperatively generally implies complete return of function if the nerve does not suffer a delayed paralysis.
    2. Postoperative Day 1
      1. Transfer from surgical intensive care unit to general floor
      2. Change dressing daily
        1. x 5 days for BG patients,
        2. qod x 4 days for MH patients.
      3. Remove Foley catheter, arterial lines, supplemental oxygen, EKG leads
      4. Hemoglobin level if extensive blood loss intraoperatively
      5. Up to chair
      6. Clear liquids when nausea is under adequate control
        1. may then advance diet as tolerated
      7. Ambulate with assistance
      8. Assess facial function and hearing status if MCF (tuning fork exam)
      9. The patient should be asked daily if he or she has a salty taste in mouth, or has noticed any dripping from nose
    3. Postoperative Day 2
      1. Remove abdominal Penrose drain (TL only)
      2. Ambulate with assistance x 6 times
      3. Patient receives a total of 6 doses of antibiotics and steroids
        1. If delayed facial paresis develops, the steroids + an antiviral are continued for 10 days
    4. Postoperative Day 3
    5. Reservoir test for CSF rhinorrhea x 3 minutes
    6. Discharge planning may start as early as POD3
      1. Criteria
        1. Tolerating PO intake
        2. Ambulating independently
        3. Has had bowel movement (is not absolute requirement)
        4. No CSF leak or fevers
  2. Discharge instructions
    1. No heavy lifting above 15 pounds for four weeks
    2. No bending below the waist for four weeks
    3. No nose blowing
    4. Sneeze through open mouth
    5. No strenuous activity or bearing down for four weeks
    6. May wash hair after dressing is removed
      1. No salon treatments until 1 month postop
    7. Patient may resume driving when they feel able
  3. If patient develops CSF leak
    1. Place lumbar drain for 5 full days
      1. BG: full bedrest
      2. MH: may clamp x15 min for ambulation 3 x daily
    2. Clamp on the morning of postoperative day 6
    3. Test reservoir at least 8 hours after clamping
    4. If negative, remove drain and observe for 24 hours until discharge
    5. If positive, revision surgery indicated to close leak
      1. Approach depends on hearing status
      2. After translab, do subtotal petrousectomy: obliterate mastoid and eustachian tube, close off EAC
      3. If hearing present, revise MCF and place more fat, fascia, and muscle into the IAC defect; make sure no air cells are unwaxed
      4. Place lumbar drain for 5 full days postoperatively
  4. After discharge
    1. Remove stitches
      1. 7-10 days for BG patients
      2. 10-14 days for MH patients
      3. Delay suture removal if CSF effusion is present
    2. Follow-up appointment at four weeks postoperatively
      1. MRI with gadolinium
      2. Test hearing if MCF approach
      3. Document facial function
      4. Release to return to work

...