Nasal Cavity Adhesion (Synechia) - Definition, Causes, Symptoms and Treatment

Nasal Adhesion (Intranasal Synechia)

Nasal synechia, also referred to as intranasal synechia, is a medical condition characterized by the adhesion or fusion of the nasal tissues inside the nasal cavity. These adhesions can lead to various symptoms, such as nasal obstruction, nosebleeds, and reduced airflow, depending on their severity and location within the nasal passages.

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

In the tomography section above, the area of adhesion (adhesion, synechiae) between the posterior parts of both inferior turbinates and the nasal septum can be seen.

The factors that increase the risk of adhesions in the nasal cavity after nasal surgeries can be listed as follows:

• 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.

Nasal synechia, the adhesion or fusion of the nasal tissues, can result from various causes. Some common factors include:

Post-operative Healing: After nasal surgery, such as rhinoplasty or septoplasty, synechia can form during the healing process if the tissues bond together.

Trauma or Injury: A direct blow to the nose or repeated trauma can lead to adhesions in the nasal cavity.

Infection: Chronic or severe sinus infections can cause inflammation and tissue adhesion in the nasal passages.

Nasal Packing: The use of nasal packing following surgery can increase the risk of synechia.

Scarring: Excessive scarring during the healing process may lead to tissue fusion.

Inflammatory Conditions: Conditions like Wegener's granulomatosis or sarcoidosis can result in nasal synechia.




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.

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  nasal synechia

If you are wondering what the cause is if your nose shows adhesions, "you often do not notice, and most often you have a nasal congestion and a decrease in your nose". Patients with nasal adherence in excess and in different areas are more likely to complain of nasal obstruction.

Nasal synechia, or adhesions in the nasal cavity, can cause a range of symptoms, which may include:

Nasal Obstruction: One of the most common symptoms, where the adhesions can block airflow through the nasal passages, making it difficult to breathe.

Nasal Congestion: A feeling of stuffiness or congestion in the nose due to the obstruction.

Frequent Nosebleeds: The fragile adhesions can lead to frequent nosebleeds, especially during dry or cold weather.

Reduced Sense of Smell: Adhesions can affect the ability to smell, as they may interfere with the olfactory function.

Headache: Nasal congestion and reduced airflow can cause headaches and facial pain.

Sinus Infections: Recurrent or chronic sinus infections may occur due to impaired nasal drainage.

Snoring: Nasal obstructions from synechia can lead to snoring during sleep.

Difficulty Breathing through the Nose: A general feeling of difficulty breathing through the nose, especially noticeable during physical activity.

Postnasal Drip: An increased production of mucus and postnasal drip can result from nasal adhesions.

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.

Diagnosing intranasal synechia, or adhesions in the nasal cavity, typically involves a combination of medical evaluation and diagnostic procedures. Here's an overview of the diagnostic process:

Medical History: Your healthcare provider will begin by taking a detailed medical history, including any past nasal surgeries, nasal trauma, chronic sinus infections, or other relevant conditions. This information helps in understanding your risk factors for synechia.

Physical Examination: A thorough physical examination of the nose and nasal passages is conducted. The healthcare provider will use a specialized nasal speculum to visualize the inside of the nose.

Endoscopy: Nasal endoscopy involves using a thin, flexible tube with a light and camera (endoscope) to examine the nasal cavity and identify the presence of adhesions. This allows for a detailed and magnified view of the nasal tissues.

Imaging Studies: In some cases, imaging studies like a CT scan may be recommended to assess the extent and severity of nasal adhesions. This can help in planning the treatment approach.

Symptom Assessment: The presence and severity of symptoms, such as nasal obstruction, nosebleeds, and reduced sense of smell, are assessed to determine their impact on your daily life.

Ruling Out Other Conditions: The healthcare provider may need to rule out other conditions that can cause similar symptoms, such as nasal polyps, sinusitis, or anatomical abnormalities.

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 Adhesion Lysis: This procedure involves breaking the adhesions using specialized instruments under local anesthesia. It is a common approach for mild to moderate synechia.

Endoscopic Surgery: Endoscopic techniques can be used to separate adhesions while preserving the surrounding tissues. This is often the preferred method for more complex cases.

The photograph above shows the endoscopic nasal examination photograph of a patient who underwent turbinate radiofrequency procedure in another clinic and whose chine was detected between the right inferior tubinate and the lower part of the nasal septum. It was observed that the synechia was longer than about 1 cm. The synechia was cut under local anesthesia. You can see the photo below >>

In the above photograph, the synechia between the inferior turbinate and nasal septum in the right nasal cavity was cut with scissors after local anesthetic was injected, and the incision was cauterized with a silver nitrate stick. After this procedure, an antibiotic-impregnated sponge was placed between the right inferior turbinate and the nasal septum in order to prevent tissue adhesion.

Nasal Cavity Adhesion - Intranasal Synechia - Nasal Adhesion - Nasal Synechia

Nasal Cavity Adhesion - Intranasal Synechia - Nasal Adhesion - Nasal Synechia

Nasal Cavity Adhesion - Intranasal Synechia - Nasal Adhesion - Nasal Synechia

Source link >> The role of different materials for prevention of synechiae ...

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Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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