Dark Green Mucus with Blood Tinges After Rhinoplasty: Infection Management
Dark green mucus with blood tinges 2 weeks after rhinoplasty suggests a possible sinus or graft infection that requires antibiotic treatment, especially if accompanied by other symptoms like pain, nasal obstruction, or foul smell.
Assessment of Post-Rhinoplasty Mucus
Green-colored mucus, particularly when dark green, is concerning for bacterial infection. At 2 weeks post-rhinoplasty, this presentation requires careful evaluation:
Concerning Signs:
- Dark green mucus (suggests bacterial colonization)
- Blood tinges (common after rhinoplasty but concerning when combined with green mucus)
- Timing at 2 weeks (typical timeframe for postoperative infections to manifest)
According to guidelines, postoperative sinus or graft infections typically present between the third and seventh days after surgery, but symptoms may occur within the first 2 weeks or even after a few months 1.
Clinical Significance
The presence of green mucus with blood tinges could indicate:
- Sinus infection (sinusitis)
- Graft infection
- Blockage of sinus drainage
- Normal healing with mild inflammation
Common symptoms of sinus/graft infection include:
- Local tenderness
- Nasal obstruction
- Pain
- Swelling
- Purulent discharge
- Foul smell and taste 1
Management Approach
1. Initiate Antibiotic Treatment
Given the presentation, antibiotic therapy is warranted:
- For community-acquired infection (most likely in this case):
- Amoxicillin/clavulanic acid 1g three times daily OR
- Amoxicillin 1g three times daily + metronidazole 400mg three times daily 1
2. Monitoring and Follow-up
- Evaluate response within 3-7 days
- If symptoms persist beyond 3 weeks despite antibiotic therapy, further evaluation is needed:
- CT scan or sinus endoscopy to evaluate maxillary sinuses
- Possible surgical intervention if infection continues 1
3. Additional Measures
- Nasal saline irrigation to help clear mucus
- Head elevation to reduce congestion
- Avoid blowing nose forcefully
- Monitor for worsening symptoms (increased pain, fever, spreading redness)
Important Considerations
Infection Risk
Post-rhinoplasty infections are relatively rare (overall incidence <2%) but can have significant consequences if not properly managed 2. The incidence of grafted sinus infection specifically ranges from 0% to 7.4% 1.
Caution
Avoid assuming this is normal post-surgical drainage. While some blood-tinged mucus is expected after rhinoplasty, dark green coloration suggests bacterial colonization that requires intervention.
Pitfalls to Avoid
- Delaying antibiotic treatment while waiting for cultures
- Using aminoglycosides (poor penetration into sinus spaces)
- Assuming symptoms will resolve without intervention
- Failing to recognize signs of worsening infection requiring surgical intervention
If symptoms persist beyond 3 weeks despite appropriate antibiotic therapy, surgical intervention with partial or total removal of any graft material may be necessary 1.