Is dark green mucus with blood tinged and a swollen left ethmoid sinus normal 2 weeks after rhinoplasty?

Dark Green Mucus with Blood and Swollen Ethmoid Sinus After Rhinoplasty: Evaluation and Management

Dark green mucus with blood tinges and a swollen left ethmoid sinus 2 weeks after rhinoplasty likely indicates a sinus infection that requires antibiotic treatment. This presentation suggests a post-surgical infection rather than normal healing.

Clinical Assessment of Post-Rhinoplasty Nasal Discharge

Normal vs. Abnormal Post-Rhinoplasty Findings

• Normal findings within 2 weeks post-rhinoplasty:

  • Clear to light yellow mucus
  • Minimal blood-tinged discharge (decreasing over time)
  • Mild swelling that gradually improves

• Abnormal findings requiring intervention:

  • Dark green mucus (indicates bacterial infection)
  • Persistent blood-tinged discharge after 2 weeks
  • Localized swelling of sinuses, particularly ethmoid 1
  • Foul smell or taste
  • Worsening pain or pressure

Significance of Dark Green Mucus with Blood

The combination of dark green mucus and blood-tinged discharge 2 weeks post-rhinoplasty is concerning for several reasons:

1. Green color indicates neutrophil activity against bacterial infection

2. Blood-tinged discharge at 2 weeks post-op is less common and may indicate:

   • Ongoing inflammation
   • Possible infection
   • Disruption of healing tissue 2

3. Swollen ethmoid sinus suggests:

   • Localized infection
   • Possible obstruction of sinus drainage 1
   • Retained secretions that may become colonized with pathogens

Management Approach

Immediate Antibiotic Treatment

• Start antibiotic therapy promptly targeting common sinonasal pathogens:
  • First-line: Amoxicillin-clavulanate 875/125 mg twice daily for 7-10 days
  • Alternative (if penicillin allergic): Levofloxacin 500 mg daily for 7-10 days 1

Adjunctive Measures

1. Saline nasal irrigation:

   • Use isotonic saline solution twice daily
   • Helps remove mucus, bacteria, and inflammatory mediators 1
   • More effective than nasal sprays for distributing solution to the maxillary sinus and frontal recess

2. Nasal decongestants:

   • Short-term use (3-5 days maximum) to reduce swelling
   • Avoid prolonged use to prevent rebound congestion

3. Follow-up evaluation:

   • Schedule within 7 days to assess response to treatment
   • Consider nasal endoscopy to evaluate sinus drainage and healing

Warning Signs Requiring Urgent Attention

• Worsening pain or swelling
• Fever
• Orbital symptoms (eye swelling, vision changes)
• Severe headache
• Persistent symptoms despite 48-72 hours of antibiotics

Potential Complications if Left Untreated

• Spread of infection to adjacent structures
• Development of chronic sinusitis
• Scarring of sinus drainage pathways
• Impaired healing of surgical site
• Need for revision surgery 1

Prevention of Future Complications

• Complete the full course of antibiotics
• Continue saline irrigation for 4-6 weeks
• Avoid allergen exposure if allergic
• Avoid nose blowing, straining, or heavy lifting for 2 more weeks
• Sleep with head elevated

The presence of dark green mucus with blood and a swollen ethmoid sinus 2 weeks after rhinoplasty represents an abnormal finding that requires prompt intervention. Early treatment with appropriate antibiotics and supportive measures will help prevent more serious complications and ensure optimal healing.