Nasal synechiae are fibrous scar tissue bands that develop inside the nose and form an abnormal bridge between structures that should remain separate. These internal nasal adhesions most commonly link the nasal septum to the turbinates or the lateral nasal walls, leading to long-term nasal breathing restriction and persistent discomfort. In some cases, nasal synechiae are minor and cause few symptoms, while in others they can significantly impair nasal function and quality of life.
At Centre for Surgery in London, we specialise in the assessment and treatment of nasal adhesions, internal nasal scarring and nasal airway obstruction caused by synechiae. Understanding what nasal synechiae are, how they form, and what options are available for treatment is essential for anyone who has had rhinoplasty, septoplasty, sinus surgery or nasal trauma.
What Are Nasal Synechiae?
Nasal synechiae are abnormal internal connections formed when damaged mucosal surfaces inside the nasal cavity heal together instead of independently. Normally, when tissue heals after injury or surgery, the surfaces on opposing sides of the nasal airway should recover separately, leaving the passage open. When postoperative swelling or the natural inflammatory response causes two raw surfaces to come into contact during the healing phase, the body’s repair mechanisms can cause them to fuse, creating a band of fibrous tissue that bridges across the nasal cavity.
Regardless of their size, nasal cavity adhesions can restrict airflow, disrupt nasal physiology and alter the internal structure of the nose. Even slender bands of scar tissue can significantly narrow the available airway. In more advanced cases, the adhesion may become broad and substantial, creating near-complete obstruction of one or both nasal passages.
Causes of Nasal Synechiae
The most common cause of nasal synechiae is previous nasal surgery. Procedures such as rhinoplasty, septoplasty or endoscopic sinus surgery involve repositioning tissues, trimming cartilage and bone, and healing through an inflammatory process. If postoperative swelling or tissue movement brings raw mucosal surfaces into contact with opposing surfaces, nasal adhesions may form during the healing phase. This risk is one of the reasons that many surgeons use splints or spacers inside the nose following surgery — to keep adjacent surfaces physically separated while healing occurs.
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Nasal trauma is another significant cause. A fracture or injury that disrupts the nasal lining can expose opposing mucosal surfaces and allow adhesions to form as part of the wound healing response. Chronic inflammation — as seen in poorly controlled allergic rhinitis, nasal polyp disease, or recurrent infections — can also damage the lining and trigger adhesion formation over time. Dry, crusting conditions within the nose, and foreign bodies lodged in the nasal cavity, are rarer but recognised causes in certain patients.
Symptoms of Nasal Synechiae
The most common and prominent symptom of nasal synechiae is persistent nasal blockage that does not improve with standard treatments such as decongestants or steroid sprays. Because the adhesion is a physical obstruction rather than swelling or mucus, medications that work on the nasal lining alone are unlikely to provide meaningful relief. Patients often describe the sensation as a constant feeling of being blocked on one or both sides, regardless of the time of day or season.
Nasal dryness is also frequently reported, as air turbulence within the affected nasal cavity is disrupted by the adhesion, sometimes resulting in inadequate humidification of the inhaled air. This can lead to uncomfortable crusting. A reduced sense of smell is another common complaint, as restricted airflow limits the amount of odour molecules reaching the olfactory receptors higher up in the nasal cavity. Sleep disruption, mouth breathing, and snoring may also occur where the obstruction is sufficiently severe to impair nighttime breathing.
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Diagnosis of Nasal Synechiae
Accurate diagnosis of nasal synechiae requires expert assessment by a specialist with experience in nasal airway conditions. A thorough history of previous nasal surgery, trauma, or chronic inflammatory conditions is a key starting point. Nasal endoscopy — a procedure in which a fine, flexible or rigid camera is passed into the nose — is the most reliable method for identifying internal adhesions and assessing their extent and location. This examination provides a detailed view of the internal nasal structures, including the septum, turbinates and lateral walls, allowing the surgeon to identify the precise site and nature of the adhesion.
Nasal endoscopy also helps differentiate nasal synechiae from other potential causes of nasal blockage, such as turbinate swelling, nasal polyps or untreated septal deviation. In some cases, imaging such as a CT scan may be used to provide a more comprehensive picture of the nasal anatomy, particularly where surgery is being planned.
Treatments for Nasal Synechiae
Treatment of nasal synechiae is surgical in the vast majority of cases, as fibrous scar bands cannot be dissolved or removed through medication. The aim of surgery is to divide the adhesion, restore nasal airflow, and put in place measures to prevent the adhesion from reforming during the healing process.
During surgery, the adhesion is carefully divided using fine instruments or endoscopic tools. The approach used depends on the location and extent of the synechiae. A narrow, accessible band can sometimes be addressed under local anaesthesia in a clinic setting, while more complex adhesions that involve deeper structures or affect both sides of the nose will typically require a short general anaesthetic as a day case procedure.
Following division of the adhesion, silicone splints or internal nasal spacers are often placed between the separated surfaces and left in position for several days. These act as a physical barrier, preventing the raw surfaces from coming back into contact during the early healing phase. Postoperative irrigation with saline rinses and careful follow-up monitoring are also important elements of a successful outcome.
Long-Term Outlook After Treatment
The long-term outlook for nasal synechiae is excellent when they are identified accurately and treated appropriately by an experienced surgeon. Many individuals experience dramatic relief from long-standing nasal blockage following surgical division of the adhesion, with improved airflow, better sleep quality, stronger exercise performance and a restored sense of smell among the most commonly reported benefits.
Recurrence is the main risk following treatment, and this is why the postoperative period is so important. Adherence to saline irrigation, the use of any prescribed sprays, and attendance at all follow-up appointments reduce the likelihood of adhesion reformation. Where recurrence does occur, further treatment is possible, though the surgical approach may be more challenging the second time due to the presence of more established scar tissue.
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FAQs
Can nasal synechiae resolve without treatment?
They do not usually disappear on their own because they consist of fibrous scar tissue, which is stable and does not respond to the body’s normal resolution processes. Without surgical intervention, the adhesion typically remains in place and may gradually become firmer and more fibrous over time.
Can nasal synechiae affect smell?
Yes. Restricted airflow through the nasal cavity reduces the ability of odour molecules to reach the olfactory receptors located in the upper part of the nose. Patients with nasal synechiae often report a diminished or altered sense of smell, which frequently improves following successful treatment.
How can recurrence be prevented?
Splinting to physically separate healing surfaces, consistent moisture control with saline irrigation, and careful postoperative follow-up are all essential. Your surgeon will advise on the specific aftercare protocol most appropriate for your case, including the duration of splinting and the frequency of clinic reviews.
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Why Choose Centre for Surgery
Centre for Surgery is one of London’s most established specialist hospitals for nasal airway surgery, treatment of intranasal adhesions and advanced nasal reconstruction. Our functional nasal surgery specialists have extensive expertise in complex internal nasal obstruction, including the surgical management of nasal synechiae in both primary and revision settings. We provide a comprehensive assessment service, individualised surgical planning, and close postoperative support to ensure the best possible outcome for every patient.
To book a consultation, contact Centre for Surgery on 0207 993 4849 or email contact@centreforsurgery.com. Our clinic is located at 95–97 Baker Street, London W1U 6RN.
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