Nose leaking clear fluid out of one nostril more than a month after rhinoplasty.

Question

Hello! I had a rhinoplasty on July 15, 2016 for a bump on my nose. No bones were broken, just the bumps were shaved, tip was made smaller and a muscle between my lip and nose was sniped. My only problem is, I still am getting constant headaches everyday, usually ones inbetween my eyes. Recently, my eyes have been sensitive to light as well. I also felt like I had allergies, but one nostril has been leaking clear fluid for the past few days. It is always very runny. is this a CSF leak?

Ian MacArthur, MD, FRCSC · Answer

Thanks for your question. If you did not have any nasal osteotomies (cuts in the nasal bones) it would be unlikely to have a spinal fluid leak following surgery, especially one that starts a few weeks post-operatively. That being said, it is very important that this possibility is ruled out by your operating surgeon. While the fluid drainage may just be due to allergies, I would suggest that you contact your plastic surgeon with your concerns and to make sure that nothing more serious is going on.

William Marshall Guy, MD · Answer

Hello softhrowaway,To develop a CSF leak following a rhinoplasty is extremely rare.  If all you had was a hump shaved and some tip work performed, then you could not develop one.  It also tends to appear immediately after the surgery with a constant drip that increases when you bear down.  Usually what you are seeing is persistent allergies or a possibly a cold.  However, the safest thing to do is be seen by your surgeon to evaluate your nose and make sure it is not the more dangerous CSF leak.I hope this helps and good luck.

Mark Loury, MD, FACS (retired) · Answer

Any time there is clear watery fluid from just one nostril it is spinal fluid until proven otherwise. It can occur after intranasal surgery such as septoplasty if a fracture occurs in the upper part of the nose where the septum attaches to the skull base. There is now communication between the nose and the cranial cavity potentially leading to meningitis (estimated 8% chance per year). Spinal fluid has a unique protein, beta 2 transferrin, so collected fluid can be analyzed. I would bring this to your surgeon's attention, collect some fluid in a sterile specimen cup (even if it takes several days to get enough), and have it assessed at a hospital lab. If it's negative then allergy, vasomotor rhinitis, or tears are the source.  Hope this answer helps.

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