How adhesions form
The nasal mucosa is covered with thin ciliated epithelium, which cleans and moisturizes the air. If this layer is simultaneously damaged on two contacting surfaces, for example on the septum and on the nasal concha, healing occurs with the formation of common connective tissue. A bridge is formed, which becomes dense over time. It disrupts the normal flow of air, interferes with cleansing and drainage from the sinuses, and creates areas of mucus stagnation. The wider the area of damage and the longer the surfaces are pressed against each other, the denser the fusion.
- Damage to the mucosa on two contacting surfaces
- Healing with the formation of total tissue
- Thin filmy and dense fibrous adhesions
- Impaired air flow and nasal clearance
- Difficulty draining from the sinuses
- Possible complete obstruction of the nasal passage
Causes and risk factors
The most common cause is interventions in the nasal cavity: septoplasty, operations on the turbinates, removal of polyps, as well as cauterization of blood vessels during nosebleeds, especially if it was performed on both sides of the septum. Prolonged tamponade, nasal trauma, burns, foreign bodies in children, as well as severe inflammatory and atrophic processes contribute to the formation of synechiae. The risk is higher in people with healing disorders, diabetes, and frequent uncontrolled use of vasoconstrictor drops.
- Operations in the nasal cavity
- Cauterization of septal vessels
- Prolonged tamponade after bleeding
- Injuries and fractures of the nose
- Foreign bodies, more often in children
- Atrophic rhinitis and severe inflammation
- Diabetes mellitus and healing disorders
Symptoms
The main symptom is persistent difficulty in nasal breathing, usually on one side, which is not relieved by vasoconstrictor drops. Due to impaired air flow, dryness, crust formation, and periodic bleeding occur when they are removed. The sense of smell and exercise tolerance may decrease, sleep may deteriorate, and snoring may increase. If the outflow from the sinuses is disrupted, heaviness in the face, discharge and recurring sinusitis occur. Sometimes synechiae are found by chance during examination in a person without expressed complaints.
- Persistent unilateral nasal congestion
- Lack of effect from vasoconstrictor drops
- Dry and crusty nose
- Periodic nosebleeds
- Decreased sense of smell
- Snoring and poor sleep
- Recurrent sinus inflammation
Diagnostics
The doctor examines the nasal cavity, but thin or deep-lying adhesions are not always visible with conventional rhinoscopy. Therefore, the main method is endoscopy of the nasal cavity: it allows you to examine the entire cavity, assess the location, extent and density of the bridges, as well as accompanying changes - deviated septum, enlarged conchae, polyps. In case of recurring sinusitis or a planned operation, a computed tomography scan of the paranasal sinuses is prescribed, which shows the condition of the anastomosis and the extent of the intervention.
- Examination by an ENT doctor with rhinoscopy
- Endoscopic examination of the nasal cavity
- CT scan of the paranasal sinuses with concomitant sinusitis
- Nasal breathing assessment
- Rule out other causes of congestion
- Examination after previous operations
Treatment and prevention
Adhesions do not resolve on their own, and medications do not resolve them. If breathing is impaired, the bridges are cut: thin ones - on an outpatient basis under local anesthesia, dense and widespread - endoscopically. The key point is to prevent re-union, so separating silicone plates or tampons are installed between the surfaces for several days. After the intervention, rinsing with saline solutions and agents that moisturize the mucous membrane are prescribed. Prevention consists of careful operations and avoidance of simultaneous cauterization on both sides.
- Dissection of synechiae under endoscopic control
- Installation of silicone separating plates
- Rinsing the nose with saline solutions
- Moisturizers and crust care
- Simultaneous correction of the septum and conchae if necessary
- Control examinations during the healing period
- Refusal of uncontrolled use of vasoconstrictor drops
