Nasal Cavity Adhesion (Synechia) - Definition, Causes, Symptoms and Treatment
Nasal Adhesion (Intranasal Synechia)
Definition of Nasal Synechia
Adhesion (synechiae) can occur after surgery or after intranasal packing in the nasal cavity. These adhesions, which usually occur between the inferior turbinate and the nasal septum, are most commonly seen after nasal surgery. These adhesions resulting from mutual mucosal injury in the nasal cavity are called "Nasal Adhesion (Nasal Synechia)".Causes of Nasal Synechia
• Surgical applications that increase mucosal injury in the nasal cavity, traumatic surgery and the emergence of damaged mucous membranes on mutual surfaces
• Packing application to increase mucosal damage in the nasal cavity
• Inadequate cleansing of shells and potholes in the nasal cavity after nose surgery
In general, nasal cavity surgery, endoscopic sinusitis surgery and minimally traumatic techniques and packings that reduce mucosal injury in turbinate operations are used.
During the turbinate radipofrequency procedure, performing procedures that cause too much damage to the turbinate mucosa increases the risk of adhesions.
During turbinate radiofrequency, in order to reduce the volume of the nose, it is usually inserted into the probe of the radiofrequency devices to reduce the heat damage and the recovery time of the tissue volume. It is usually convenient to place a nasal pad that serves as a barrier and intercepts after simple local anesthetic infiltration.
During the turbinate radipofrequency procedure, performing procedures that cause too much damage to the turbinate mucosa increases the risk of adhesions.
During turbinate radiofrequency, in order to reduce the volume of the nose, it is usually inserted into the probe of the radiofrequency devices to reduce the heat damage and the recovery time of the tissue volume. It is usually convenient to place a nasal pad that serves as a barrier and intercepts after simple local anesthetic infiltration.
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Nasal adhesion synechiae after endoscopic hypophysis tumor resection |
Above is the left endoscopic nasal examination photograph of a patient who underwent endoscopic pituitary surgery for the treatment of pituitary tumor in a different clinic two years ago. The patient presented with the complaints of increasing left nostril congestion and left ear congestion after the operation. As seen in the photograph, a large intranasal adhesion area is seen. Intranasal adhesion cutting operation was planned for the patient.
Symptoms of synechia
Diagnosis of intranasal synechia
In patients with a history of trauma or previous surgery, septum and nasal mucosal pathologies should be investigated if nasal obstruction is present. In patients with intranasal synechia (adhesion), however, the history of trauma is not always obvious. The first step after the anamnesis for the diagnosis of intranasal synechia is anterior rhinoscopy. After evaluating the condition of the septum and lower turbinates, the middle turbinate, middle meatus and nasopharynx are evaluated by flexible endoscopic examination and the pathology is clearly determined. It is important to evaluate mucosal pathologies by nasal endoscopic examination in patients with persistent nasal obstruction after nasal surgery.
Treatment of Nasal Synechia
Treatment of nasal adhesions is usually quite straightforward, and placement of a material (about 1 week in length) sufficient for surgical intervention and surgical cutting in office conditions is sufficient. Usually after the injection of a spray containing a local anesthetic into the nose and a local anesthetic injection is made, the adhesion is discontinued. A nasal pad (usually internal silicone splint is preferred) is placed in the nasal cavity for at least 1 week. The operation is terminated. This technique can be modified endoscopically, or laser assisted or electrocautery assisted. In the presence of septal synechia, the treatment is surgical removal of the adhesion and prevention of reciprocal areas of mucosal damage. For this, merocele, extrafor, or splint buffer may be preferred. It has been published in the literature that it is the easiest to insert and remove the pads used by putting them in the glove finger.![]() |
Nasal Cavity Adhesion - Intranasal Synechia - Nasal Adhesion - Nasal Synechia |
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Nasal Cavity Adhesion - Intranasal Synechia - Nasal Adhesion - Nasal Synechia |
Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul
Private Office:
Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
Appointment Phone: +90 212 561 00 52
Appointment Phone: +90 212 561 00 52
Fax: +90 212 542 74 47
Hi I have nasal adhesion left sided after polyp surgery 6 months ago, I now suffer from chronic dryness around that area & inflammation with quite bad pain in left side of my face. Would you recommend removing the adhesion to stop the dryness & obstruction? It’s between the inferior turbinate and septum . any advice please. Thank you
ReplyDeleteHello, intranasal adhesions (synechiaes) can cause changes in airflow directions in the nose, increase in nasal air resistance and nasal congestion. In the treatment, it may be recommended to cut the adhesion areas and place a material (internal nasal silicone Splint, sponge, silicone shield ...) that can act as a barrier between the septum and turbinate for a week. When the air gap is increased by cutting the synechiaes, the complaint of nasal congestion may decrease, but; As intranasal airflow velocity will increase, intranasal dryness may increase. For definitive interpretation, endoscopic nasal examination photographs and, if necessary, evaluation of paranasal sinus tomography for the differential diagnosis of chronic sinusitis may be required. Greetings from Istanbul, Dr. Murat Enoz
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