Is dark green mucus with a blood tinge normal 2 weeks after functional rhinoplasty with left ethmoid sinus swelling?

Dark Green Mucus with Blood Tinge 2 Weeks After Functional Rhinoplasty

Dark green mucus with blood tinge two weeks after functional rhinoplasty with left ethmoid sinus swelling is concerning for postoperative sinusitis and requires prompt medical attention and possibly antibiotic treatment.

Evaluation of Post-Rhinoplasty Nasal Discharge

The presence of dark green mucus with blood tinge at 2 weeks post-rhinoplasty, particularly with ethmoid sinus swelling, suggests several possible conditions:

Likely Diagnosis: Postoperative Sinusitis

• The green color of mucus indicates the presence of neutrophils and potential bacterial infection
• Ethmoid sinus swelling further supports an inflammatory/infectious process
• Blood tinge is common after rhinoplasty but should be diminishing by 2 weeks

Normal vs. Abnormal Post-Rhinoplasty Findings

• Normal findings in early post-rhinoplasty period (1-2 weeks):

  • Mild clear or blood-tinged mucus
  • Moderate nasal congestion
  • Mild facial pressure

• Abnormal findings (requiring attention):

  • Dark green or yellow mucus (indicates infection)
  • Persistent swelling of sinuses after 2 weeks
  • Foul smell or taste
  • Increasing pain or pressure

Management Recommendations

1. Immediate medical evaluation by the surgeon who performed the procedure

   • Endoscopic examination to assess the surgical site and sinus drainage

2. Antibiotic therapy

   • First-line: Amoxicillin/clavulanic acid 1g three times daily for 7-10 days 1
   • Alternative: Levofloxacin 400mg twice daily if penicillin allergic 1

3. Adjunctive treatments

   • Saline nasal irrigation to improve sinus drainage 1
   • Temporary addition of nasal decongestant to intranasal corticosteroid treatment can be considered for severe blockage 1
   • Avoid prolonged use of decongestants alone (>5-7 days) due to risk of rebound congestion

Pathophysiology and Complications

The European Position Paper on Rhinosinusitis (2020) indicates that post-surgical sinusitis can occur due to:

• Blockage of normal sinus drainage pathways 1
• Disruption of mucociliary clearance
• Bacterial colonization of surgical site
• Pre-existing sinus conditions exacerbated by surgery

Potential Complications if Untreated

• Progression to chronic sinusitis
• Spread of infection to adjacent structures
• Graft infection (if grafts were used in rhinoplasty)
• Impaired surgical outcome and nasal function

Follow-up Recommendations

• If symptoms persist beyond 3 weeks despite antibiotic therapy, CT imaging or sinus endoscopy is indicated 1
• Persistent infection may require surgical intervention to establish drainage 1
• Monitor for improvement in:
  • Color and consistency of nasal discharge
  • Reduction in ethmoid swelling
  • Improvement in nasal breathing

Prevention of Further Complications

• Continue saline nasal irrigation to promote drainage and healing 1
• Avoid activities that increase nasal pressure (bending, heavy lifting)
• Complete the full course of prescribed antibiotics
• Follow post-operative instructions meticulously

Green mucus with blood tinge at 2 weeks post-rhinoplasty with ethmoid swelling represents a deviation from the normal healing process and should prompt medical evaluation to prevent more serious complications that could affect both the functional and aesthetic outcomes of the surgery.