Nasal Adhesions: An Overview

Introduction

The disorder known as nasal adhesion, or synechiae, is typified by the development of scar tissue that joins the lateral nasal wall to the nasal septum. This illness can result from numerous symptoms, including breathing difficulties, sinus infections, and nasal blockages. To effectively manage and enhance the quality of life for those impacted by nasal adhesion, it is imperative to comprehend the causes, symptoms, available treatments, and prevention actions.

What Are Nasal Adhesions?

Adhesion (synechiae) may develop in the nasal cavity following intranasal packing or surgery. Most often observed following nasal surgery, these adhesions typically arise between the nasal septum and the inferior turbinate. "Nasal Adhesion (Nasal Synechia)" refers to these adhesions that develop in the nasal cavity due to reciprocal mucosal damage.

What Are the Causes of Nasal Adhesions?

The adhesion or fusing of nasal tissues, or nasal synechia, can result from several factors, such as:

• Post-Operative Healing: As they fuse, Synechia may form as tissue repair after nasal procedures, such as rhinoplasty or septoplasty.

• Trauma or Injury: Adhesions inside the nasal cavity may result from a single blow to the nose or repeated injuries.

• Infection: Nasal passageway inflammation and tissue adhesion can result from severe or persistent sinus infections.

• Nasal Packing: Applying nasal packing following surgery may increase the development of synechia.

• Scarring: Tissue fusion may arise from excessive scarring during the healing phase.

• Inflammatory Disorders: Sarcoidosis (growth of inflammatory cells in different parts of the body) and Wegener's granulomatosis (inflammation of blood vessels) are two disorders that can exacerbate the development of nasal synechia.

Sometimes nasal surgery raises the possibility of adhesions in the nasal cavity, including:

• Traumatic surgery and damage to mucous membranes on mutual surfaces are examples of surgical techniques that result in mucosal injury.

• Use of nasal packing increases the risk of harm to the nasal mucosa.

• Inadequate cleaning of the nasal pockets and shells following surgery.

Recently, turbinate operations typically use packings that reduce mucosal injury, minimally traumatic techniques, endoscopic sinusitis surgery, and nasal cavity surgeries. Adhesion risk may increase if turbinate radiofrequency operations cause excessive damage to the mucosa.

What Are the Symptoms of Nasal Adhesions?

Adhesions inside the nasal cavity, known as nasal synechia, can cause a range of symptoms, such as:

• Nose Obstruction: A common symptom in which breathing becomes difficult due to adhesions obstructing the airflow through the nose passages.

• Nasal Congestion: A feeling of stuffiness or congestion brought on by the blockage in the nose.

• Recurring Nosebleeds: In dry or cold weather, fragile adhesions may give rise to recurring nosebleeds.

• Diminished Smell: Adhesions can affect the sense of smell by interfering with olfactory function.

• Headache: Face discomfort and headaches can be brought on by nasal congestion and restricted airflow.

• Impaired Nasal Outflow: Chronic or recurring sinus infections can result from adhesions, leading to reduced nasal outflow of air.

• Snoring: During sleep, nasal blockages brought on by synechia may be a factor in snoring.

• Challenges Breathing Through the Nose: a common feeling of difficulty breathing through the nose, particularly when engaging in vigorous activity.

• Postnasal Drip: Nasal adhesions can increase mucus production and post-nasal drip.

How to Diagnose Nasal Adhesions?

When nasal obstruction is present in individuals with a history of trauma or previous surgery, it is critical to investigate septum and nasal mucosal diseases. However, a clear history of trauma may not always be apparent in situations with intranasal synechia (adhesion).

After evaluating the medical history, anterior rhinoscopy is the first diagnostic procedure for intranasal synechia. Then, using a flexible endoscopic examination, a thorough assessment of the middle turbinate, middle meatus, lower turbinates, and nasopharynx is carried out to ascertain the disease precisely.

Using a nasal endoscopic examination to evaluate mucosal diseases is crucial to patient care, especially when there is ongoing nasal obstruction after nasal surgery.

When diagnosing intranasal synechia, the following steps are usually taken:

• Medical History: To identify risk factors for synechia, a thorough evaluation of prior nose surgeries, nasal injuries, chronic sinus infections, or related disorders must be performed.

• Physical Examination: Extensive assessment of the nose and nasal passages with internal tissues visualized with a nasal speculum.

• Endoscopy: A flexible endoscope fitted with a light and camera carefully examines the nasal cavity for adhesions, giving a magnified and detailed image of the nasal tissues.

• Imaging Studies: To help with treatment planning, imaging studies like computed tomography (CT) scans may be suggested in specific situations, such as when the degree and severity of nasal adhesions need to be clarified.

• Symptom Assessment: It involves determining how symptoms like nosebleeds, nasal blockage, and diminished sense of smell affect the patient's quality of life.

• Dismissing All Other Conditions: Exclusion of other disorders that may present with symptoms similar to those of sinusitis, nasal polyps, or anatomical anomalies to guarantee a precise diagnosis.

What Is the Treatment for Nasal Adhesions?

The treatment of nasal adhesions is usually simple. It consists of placing a substance strong enough to require surgery, which takes approximately a week, and performing in-office surgical cutting. The adhesions are removed following the injection and spraying of a local anesthetic into the nose.

A nasal pad, typically an internal silicone splint, is placed into the nasal cavity and left there for at least a week to aid in healing. Endoscopic, laser-assisted, or electrocautery-assisted procedures can modify this technique.

The adhesion must be surgically removed to treat septal synechiae, and more mucosal injury must be prevented in nearby locations. This could entail using splint buffers, extras, or merocele. According to reports in the literature, putting pads on a glove's finger is the simplest way to put them on and take them off.

• Nasal Adhesion Lysis: Often used for mild to moderate cases of synechia, this technique involves breaking the adhesions with specialized equipment while under local anesthesia.

• Endoscopic Surgery: In more complicated cases, endoscopic procedures are recommended since they can separate adhesions while protecting adjacent tissues.

Conclusion

Nasal adhesion is a condition marked by the growth of scar tissue inside the nasal passages. It can cause symptoms like breathing difficulties, nasal blockage, and recurrent sinus infections. Even though nasal adhesions can be difficult to cure, several solutions are available to enhance nasal function and reduce discomfort, including surgery. Preventive actions and prompt medical attention can also help lower the chance of developing nasal adhesion and support the best possible health and well-being of the nose