Removal of adhesions in the sinuses. The method of laser excision of synechia of the nasal cavity. Recovery after removal of polyps in the nose

03.09.2016 14904

Synechia and atresia of the nasal cavity are adhesions (connective tissue, cartilage or bone) that completely or partially block the lumen in the nose. The disease can be congenital or acquired. It is a complication after an infection.

Synechia of the nose is often formed after an unsuccessful surgical intervention.

Symptoms of the disease

Symptoms of synechia are practically no different from other diseases of the nose. Among them:

• reflex cough;
• snoring at night;
• breathing difficulties;
• nasal and rude voice;
• noise in the ear;
• decreased olfactory function;
• crust formation.

In the presence of synechia and atresia, neuralgic diseases can also often appear.

Reasons for the development of synechia and atresia

The causes of synechia are numerous. Adhesions often occur as a result of previous diseases - diphtheria and syphilis, measles and typhoid, lupus and scleroma, and mucosal injuries.

Synechia of the nasal cavity appear on those surfaces where there is no epithelium. After the appearance of exudate, the adhesions are attached to each other.

Synechia may appear as a result of ulcerative processes occurring in the nasal cavity. Surgery and coagulation (surgery using a laser) also provoke the occurrence of adhesions.

The connecting process, as a rule, occurs at the beginning of the nasal passage. In this regard, passing channels are blocked. When adhesions form in the middle of the nose (between the concha and the septum), synechia provokes blockage of the air supply to the pharynx.

1. medical foil,
2. celluloid,
3. or glove rubber.

These materials will reduce the likelihood of new adhesions. For wound healing, a skin flap on a leg is used, which is attached with tampons or hair sutures.

The most difficult to treat are atresia and synechia of the choanal type.

Adhesions formed at the beginning of the nasal passage are diagnosed by an ENT doctor. The doctor examines the patient's nasal cavity and draws appropriate conclusions.

Pathologies in the middle and upper parts are detected using rhinoscopy. The type of extensions is diagnosed by probing with a bellied probe. To exclude all inflammatory processes, the doctor will prescribe laryngoscopy, pharyngoscopy, otoscopy and studies that reveal the patency of the Eustachian tube.

Artesias and synechias have a high percentage of relapses, since they can reappear after surgery. Each time the situation can only worsen (the nose is deformed, breathing difficulties appear).

To prevent the onset of the disease, one should treat infectious diseases and inflammations in time, immediately consult a doctor after injury to the nose, and carefully choose the operating surgeon. With proper surgical intervention, the likelihood of new growths is small.

Folk remedies for therapy

It is possible by means, but only after consulting a doctor and along with taking medication.

After surgery on adhesions, a protective layer is applied to the resulting wound. To do this, form turundas and dip them in pumpkin, almond oil, as well as grape seed oil. Use only herbal remedies. Ethers are not suitable for these purposes. So, 2 drops are dripped onto the turunda and gently applied to the wound, trying not to touch the mucous membrane.

Good for treating wounds after surgery on synechia pork fat. This product is known for its similarity to human fat. The agent is melted in a pan and injected into a clean dish. The resulting wounds are soaked with fat. Store the medicine in the refrigerator.

Treatment of synechia at home is carried out with the help of decoctions of herbs. The tool is instilled daily into the nose. For these purposes, use a decoction of chamomile. The plant is known for its disinfectant and anti-inflammatory effect. Dilute synechia at home, of course, this will not help, but it will allow you to disinfect the wound after the operation.

Lotions with potato juice will help cure nasal adhesions. For this, a turunda is dipped in freshly squeezed juice and applied to the synechiae, trying to gradually stretch them.

A tincture of calendula will help with splicing in the nose. The product is prepared independently or purchased at a pharmacy. The tincture is applied to the wound after the operation.

Of the drugs that are used after surgery, Mesogel is actively used. The medicine is applied to the turundas and applied to the wound in the nasal cavity. The course of treatment is determined by the doctor.

Health to you and your loved ones!

A very simple and understandable thing, so I will not say much. In the nasal cavity, air passes through the common nasal passage between the septum and the turbinates. The distance between these structures is small, with edema, hypertrophy of the shells, or with a curvature of the nasal septum, there is a touch of opposite surfaces. Since all structures of the nasal cavity are covered with a mucous membrane, under normal conditions, the contact of the surfaces does not lead to problems. But if the mucosa is inflamed or there is a wound on it, then upon contact, the opposite sides first “stick together”, and then grow together altogether. Original bridges or jumpers are formed between the partition and the sink. They are called "spikes" or "sinechias". Adhesions are formed most often in the postoperative period of rhinoplasty, septoplasty and other intranasal operations. What is the risk? For most patients, nothing. Of course, it all depends on the size and location of the synechia. Large, prolonged adhesions can make nasal breathing difficult, and mucus can accumulate in the area of ​​synechia. But, as a rule, with single small synechias, there is no big trouble. There is enough space in the nasal cavity for air to pass above or below the commissure. Some scientists even suggest specially creating synechiae to normalize aerodynamics in the nasal cavity. I'm not sure if this is correct, but indirectly confirms that there is no great harm in them. It is unlikely that you will hear this from ENT doctors. You will definitely exaggerate and offer to eliminate the synechia, convincingly substantiating this. After all, the operation is very simple and the result is obvious - there is no synechia. For the prevention of synechia of the nasal cavity, regular postoperative monitoring is necessary in the first 2-3 months after surgery. Usually, while the patient is in the hospital, they climb into his nose every day with aspirator tubes and turundas, although this is not particularly necessary. And then the person is discharged, he is out of control and after 3-4 weeks a spike forms in the nasal cavity. By itself, postoperative control, of course, does not prevent the appearance of adhesions, but if the resulting synechia is detected on time, it can easily be torn right there on examination with a probe, tweezers or a suction tube. Later, one has to resort to a small surgery - a dissection or, as some insist, "excision" of this adhesion. This can be done with scissors, a conchotome, or a scalpel. More justified is the use in this case of any "high-energy" method - a coagulator or a laser. The coagulation scab formed at the site of the dissection serves as a kind of gasket, preventing the mucous membranes from sticking together again. Someone manages to cut, someone - to cut, that's not the point. The key is follow-up. If the synechia is persistently formed after repeated dissection, then it is necessary to temporarily install a special silicone strip in the nasal cavity so that the surfaces do not touch. And further increase the space between the surfaces by moving the sink or partition. Sometimes synechias are useful and we even create them on purpose. Usually this concerns adhesions between the middle turbinate and the nasal septum after endoscopic sinusotomy. This adhesion holds the middle concha in a medial position, preventing it from closing the operated sinuses. Synechia that occurs after endoscopic sinusotomy between the middle concha and the lateral wall of the nasal cavity is a defensive reaction of the body, trying to compensate for the removed uncinate process and limit the flow of air into the sinuses during inspiration. If these adhesions do not interfere with the cleansing of the sinus, and as a rule they do not, then it is better not to touch them. Although synechiae, as already mentioned, do not cause much harm, I usually dissect them, just so as not to leave the ground for the comments of the next doctor.

Nasal synechia is diagnosed in children and adults; this is a problem that may appear during fetal development or due to various pathologies. Neoplasms in some cases do not bring any discomfort, but sometimes they make it difficult for oxygen to enter the body and cause severe complications. Adhesions in the nose can only be treated surgically, they do not resolve on their own. To choose the right method for the operation, the doctor must evaluate the clinical picture and all the features of the disease.

Why Do Spikes Occur?

Synechia in most cases appear in the nose from injury or severe infectious diseases. There are also cases of abnormal intrauterine development of the fetus. Infection with syphilis or the presence of a specific gene can lead to this disorder. If a person acquired the disease already in adulthood, and scarring of tissues became a provoking factor, there are such reasons for this:

• chemical and thermal burns of the mucosa;
• syphilis;
• typhus;
• scarlet fever;
• systemic lupus erythematosus;
• diphtheria;
• scleroma;
• persistent nosebleeds;
• surgical interventions in the nasal cavity.

Varieties

There are synechiae of the nasal cavity depending on their location and the type of tissue from which they are formed. If the growths are formed on the eve of the nasal cavity, they are called anterior. The adhesions located between the turbinates and the nasal septum are median. Neoplasms in the choanal region - posterior synechia - can completely or partially block the air supply from the nose to the throat.

Synechia in the nose are formed from different types of tissues. Distinguish connective tissue cysts, they appear most often in adults, have a soft texture and lend themselves well to dissection with a scalpel.

More dense cartilage and bone neoplasms are the cause of congenital pathology and require serious surgical intervention to eliminate.

How to recognize a violation

With the formation of synechia, the connective tissue fuses with adjacent walls. They can be thin and soft, like threads, which in a small amount do not impede breathing and do not interfere with a person. However, if the adhesions are dense and there are many of them, the patient feels unpleasant symptoms indicating a violation:

The presence of synechia of the nasal cavity causes serious complications, as adhesions block the passage for inhalation of air. It is due to the nasal mucosa that cleansing from dust and dirt, warming. When this process is disturbed, severe consequences appear in the form of inflammation of the upper and lower respiratory tract. The paranasal sinuses are not sufficiently ventilated, which creates an ideal environment for the reproduction of infections. Pathologies also affect the ears, since the auditory tube is located near the nose.

Diagnostic methods

If you find any problems with the ENT organs, you need to go to see a doctor. You can diagnose synechia by examining the patient (rhinoscopy), with the naked eye you can see the middle and posterior adhesions.

It is possible to determine what tissue the growths are made of, using a bellied probe, they probe neoplasms. Bakpose and swabs taken from the pharynx and nose help to identify the true causes of the violation.

Concomitant inflammatory processes can be detected using the following diagnostic methods:

• pharyngoscopy;
• laryngoscopy;
• study of the patency of the auditory tube;
• otoscopy;
• magnetic resonance imaging, computed tomography, radiology and ultrasound (performed to examine the paranasal sinuses).

The doctor is also interested in the presence of other chronic diseases in the patient, since the dissection of synechiae is a serious operation, to which there may be contraindications.

Blood and urine tests are required for laboratory testing and other preparatory activities are carried out. Only after a full study of all the features of the disease and the patient's body, the doctor decides how best to eliminate adhesions.

Elimination Methods

It is possible to treat adhesions in the nasal cavity only with the help of surgical intervention, no medicines and folk remedies will help get rid of them. The operation can be carried out using different instruments and devices. Depending on the type of synechia, the methods most suitable for their elimination are selected.

The doctor may prescribe one of the following procedures:

Preventive measures

A patient with synechia cannot always get rid of the disorder once and for all. The disease tends to relapse. When performing several operations in a row, the deformation of the nose occurs, which leads to even greater problems.

To avoid complications and prevent the recurrence of adhesions, the following preventive measures must be taken:

• seek medical attention in case of injury to the nose;
• choose only qualified surgeons for operations;
• treat infectious diseases of the respiratory tract on time and to the end;
• follow all the recommendations of the doctor during the rehabilitation period to prevent tissue scarring.

conclusions

Synechia can appear in the nose for various reasons, which can only be identified by a qualified specialist. Drug treatment is not used to eliminate the disorder, only surgical intervention is effective. Despite the fact that the disease tends to recur, it can be prevented if preventive measures are taken correctly.

August 21, 2015

Basically synechia are connective tissue. But there are also congenital pathologies in the form of bone and cartilage growths.

Normative international document ICD 10 keeps records of the incidence of the population. It has classifications of various diseases associated with the nasal cavity, which are assigned codes from J00 to J99. In the ICD 10 document, synechia of the nose is not yet classified under a separate code.

Causes of synechia of the nose

Congenital synechia of the nose are formed as a result of improper formation of the facial skull in the fetus. Also, the cause of the appearance of connective tissues may be congenital syphilis. Most often, congenital nasal deformities occur in the back of the nasal cavity near the choanae.

Acquired synechia can be formed due to various negative factors:

• Injuries to the nose (contributing to the formation of scars and granulations in the nasopharyngeal cavity);
• Burns of thermal or chemical origin;
• Damage to the body by infectious diseases (diphtheria, scarlet fever, syphilis, scleroma, etc.);
• After coagulation in the nasal cavity (to stop bleeding);
• After removal of polyps, tumors, correction of the nasal septum, etc.

Synechia can be localized in one half of the nose or be bilateral.

Symptoms of synechia of the nose

If the connective tissues do not take up much space in the nasal cavity, then patients practically do not feel them. But, if synechia covers a significant area of ​​​​the nasal passages, then they can be accompanied by serious symptoms:

• Difficulty in nasal breathing

When blocking the access of air to the nasal canals, synechia leads to impaired air circulation in the nasal cavity. As a result, the air is poorly warmed, filtered and humidified. A person has a nasal voice, the mucous membrane can become inflamed, infections quickly penetrate the body. A frequent symptom is nasal congestion, loss of smell, the formation of dry crusts, the inability to blow the nose normally.

• Development of chronic diseases

Blocking the access of air to the paranasal sinuses, synechia contribute to the fact that a person develops sinusitis, sinusitis or frontal sinusitis. Over time, these inflammatory processes flow into a chronic form. If a bacterial infection joins the inflammation, the patient will be disturbed by purulent sinusitis, which can cause dangerous diseases.

• Damage to the lower respiratory system

The constant violation of air circulation, insufficient moisture and filtration contributes to the fact that a person develops an inflammatory process not only in the nasal cavity. Unpurified air penetrates into the lower sections, affecting the pharynx, trachea, bronchi and lungs. As a result, the patient may develop very serious infectious diseases such as bronchitis and pneumonia.

If the synechia is congenital, then the children will not be able to eat breast milk normally, they will experience discomfort when breathing through the nose. The complete blockage of the nasal passages leads to the fact that at birth, children do not have a normal cry and breath, cyanosis of the face may appear. The child will be restless, irritable.

Diagnosis of synechia

If the connective tissues are located in front of the nose, they can be easily identified by the ENT when examining the patient with a rhinoscope. An examination is also carried out and synechia, localized in the middle or back of the nasal cavity. To determine the type of tissue of the connective formation, synechiae are probed with a special tufted probe.

If it is necessary to diagnose inflammation that arose as a result of the formation of synechia, then pharyngo- and laryngoscopy is performed. In cases where there is suspicion of a lesion of the Eustachian tube, it is necessary to conduct a study on the patency of the auditory canal using otoscopy.

To diagnose the condition of the paranasal sinuses, fluoroscopy, CT or MRI are performed. Bacterial examination of smears taken from the nasal cavity and pharynx will help to establish the causes of inflammation.

If the fusion of soft, cartilaginous, bone tissues does not cause significant negative changes during nasal breathing, then there is no need to carry out a surgical correction. This is due to the fact that after surgery, scars can form in the nose, which can cause even more serious consequences than synechia.

The operation is indicated in cases where connective tissue formations interfere with nasal breathing. Congenital synechiae may require urgent surgical removal if they pose a threat to life to a newborn baby.

Removal of synechia can be carried out by various methods:

• Dissection of synechia mechanically

The operation is performed under local anesthesia. The dissection of adhesions is done with a scalpel, a bone chisel (for bone synechia) or a conchotomy (to remove cartilage tissue). As a rule, surgical intervention is performed using an endoscope, which makes it possible to control the entire process of dissecting synechiae in any place of their localization. Endoscopic operations reduce the risk of complications, reduce the recovery period, and do not allow injury to healthy tissues.

After the operation, special materials are introduced into the nasal cavity to prevent the re-formation of synechiae. To do this, use rubber or foil, which is removed only after the wound has completely healed (maybe even a few months after removal).

• Dissection of synechia with a laser

The operation is performed under local anesthesia. To excise adhesions, different types of laser (semiconductor, argon) can be used. During exposure to a laser beam, a coagulation film is formed on the synechia, so blood loss during surgery will be minimal.

After the operation, the nasal cavity is treated with antibacterial ointments that have an anti-inflammatory effect. Thus, the wound heals quickly and relapses practically do not occur.

There are also alternative methods for dissecting synechiae: radioknife, ultrasonic radiation.

Prevention of synechia

In order to reduce the risk of recurrence of synechia in the postoperative period, it is necessary to strictly follow the instructions of the surgeon, carry out all the prescribed procedures and be regularly examined by an otolaryngologist.

It should be noted that relapses of synechia are a fairly common problem. In addition, after surgery, patients may develop an even larger fusion that can deform the nose. To avoid severe postoperative consequences, an ENT should be shown every 3 months, rhinoscopy and rhinospirometry should be performed.

Video - operation excision of synechia of the nose:

As a preventive measure, it is important to eliminate any inflammatory processes in a timely manner, and after injuring the nose, immediately contact a specialist.

The postoperative period of septoplasty is associated with some inconvenience for the patient.

• Firstly, after the intervention, the nose does not breathe,
• secondly, the bandage on the face interferes,
• thirdly, not the most pleasant sensations appear: from tingling and itching to pain.

You need to be prepared for all this. But still, it is worth knowing when postoperative breathing difficulties are the norm, and when it is already worth consulting a doctor. What can interfere with normal breathing?

Bandage

The plaster or thermoplastic bandage that the doctor will apply at the end of the operation can only be removed after 6-7 or even 14 days, depending on the complexity of the septoplasty. And all this time, the bones and cartilage must be tightly fixed to avoid displacement. Special devices - splints - are installed in the nasal cavity for 1-2 weeks. They help to fix the tissues in the desired position and prevent the appearance of synechia - adhesions. Although the bandage is unusual for the first time after the operation, it does not cause significant discomfort.

Tamponade

With tamponade, the nasal passages are completely tightly filled with bandage strips to prevent or stop postoperative bleeding. At the same time, patients may be disturbed by weakness, headache, a feeling of pressure and fullness in the nose, dizziness. To alleviate the condition, it is necessary to limit physical activity and the use of hot and alcoholic drinks, use painkillers and antipyretic drugs.

Tamponade can cause complications: uncontrollable sneezing, lacrimation, and even the development of a severe psychotic reaction due to the inability to breathe through the nose. The use of tampons with ointments and antibiotics can lead to the formation of nasal oleogranulomas. In addition, the patient may accidentally inhale poorly fixed tampons (covered with mucus, they become more mobile). Prolonged tamponade can cause toxic shock syndrome and even death. Therefore, doctors prescribe tamponade with caution and carefully monitor the patient's condition.

Edema

In the first days after the operation, severe swelling will interfere with normal nasal breathing. Fortunately, it remains strong for a week, and then gradually decreases, and by the end of the month it most often disappears completely. Every day the patient will feel that the nose breathes better and better.

You can speed up the process by doing the following:

• keeping calm
• application of ice packs
• taking drugs that strengthen the vascular wall, and antiallergic drugs
• visits to physiotherapy procedures (UHF therapy)
• use of vasoconstrictor drops and nasal sprays
• indoor air humidification

In some cases, swelling of the nose can persist for 6-8 and even 12 months after surgery, and can also be observed only under certain conditions (for example, in wet weather).

crusts

After septoplasty, the patient for some time cannot carry out hygiene of the nasal cavity in sufficient volume.

You can not blow your nose strongly, pick crusts and even sneeze.

Therefore, the crusts and films that form on the healing wound surface also become the reason why the nose does not breathe. At the same time, if the patient visits the doctor regularly, he will avoid this problem. During consultations, the specialist will clean the nasal cavity daily, treat it with emollient and regenerating drugs, and conduct a “nasal shower” in order to resume function faster.

Sinusitis

It can develop as a complication of surgery with insufficient irrigation and poor drainage, or it can be an exacerbation of a chronic process. With sinusitis, the patient experiences pain, pressure in the sinuses, headaches, stuffy ears, he develops a cough, and the temperature rises.

With such symptoms, you should immediately consult a doctor. The specialist will prescribe antibiotics and symptomatic treatment, and if necessary, surgery.

Perforation

Perforation of the nasal septum is one of the complications of septoplasty.

If your nose does not breathe or makes a whistling sound when you breathe, you experience dryness in the nasopharynx, or vice versa, you observe purulent discharge, you need to urgently see a doctor.

Such symptoms may indicate a violation of the integrity of the nasal septum. Most often, this complication is associated with malnutrition of the cartilage. If this condition is not treated, the nose will become deformed, become saddle-shaped, and breathing difficulties will only increase.

Treatment of perforations is surgical. The doctor will close the defect with a cut flap from neighboring tissues and carry out the necessary treatment of the damaged cartilage.

Synechia

After septoplasty in the nasal cavity, peculiar “lintels”, adhesions between the walls of the nasal passages, may form. These cords block the lumen of the nasal cavity and interfere with the normal passage of air. As a result, the patient complains that his nose does not breathe, he is nasal, snores at night and experiences dry mouth. Synechia, in addition to inconvenience to the patient, increases the risk of infectious complications after septoplasty.

Treatment for synechia is only surgical. Under anesthesia or local anesthesia, the doctor will remove the cords with a scalpel or laser and install special splints (splints or silicone strips) that will prevent the appearance of synechia in the future.

Anatomical defects

Various changes in the structure after septoplasty can cause a violation of nasal breathing. Such defects can be:

1. Excessive narrowing of the bony arch
2. Incomplete elimination of curvature of the nasal septum
3. Excessive narrowing and deformation of the cartilages of the nose
4. Weakness or excessive excision and narrowing of the wings of the nose

In this case, the patient will experience not only breathing difficulties, but also headaches, dryness of the throat, loss of smell and taste. In this case, the patient is indicated for secondary rhinoplasty to correct defects in the internal nasal valve.

Postoperative care

To reduce the risk of complications, after septoplasty, you need to follow a number of rules and recommendations.

1. In the first 48 hours after the operation, you need to apply cold compresses, wash your face with cold water, without wetting the bandage. This will help reduce swelling and prevent it from spreading too much.
2. During sleep and rest after surgery, you should raise the head end of the bed by 30-40 degrees. You can use several pillows for this purpose. It also helps reduce swelling.
3. On the first day, you can eat only liquid and not too hot food.
4. It is necessary to monitor nasal discharge and body temperature, especially on the first day after septoplasty. Allocations should not be intense, only a slight tint is allowed. The temperature may rise, but not higher than 38 with normal healing.
5. You should refrain from playing sports, physical activity, drinking alcohol and hot drinks, visiting saunas, swimming pools and taking baths for at least 2 weeks. You can usually return to work 1-2 weeks after the intervention, with the permission of the doctor.
6. Do not use drugs that can cause bleeding, such as aspirin.
7. You can not sneeze with your mouth closed and blow your nose for 4 weeks, so as not to provoke excess pressure in the nasal cavity.
8. You can not wear glasses to prevent deformation of the cartilage and bones, at least a month after the operation.
9. It is necessary to avoid sunlight, use a cream with a protection factor of at least 20.
10. It is necessary to monitor hygiene, use special sprays with sea water to moisten and rinse the nose, apply softening ointments and oils to avoid overdrying of the mucous membrane.

By following these simple recommendations, the patient can protect himself from unnecessary and rather serious complications. If you follow all the doctor's advice, the function of the nose will recover faster, and the rehabilitation process will be much easier.