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

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.



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  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.

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.

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 ...

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

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