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Bilateral massive nasal synechiae: a rare presentation of a common condition

Andr

Intranasal synechiae are a relatively common finding in an otolaryngology practice. Fre-quently, the scar is focal and due to mucosal trauma. We present an unusual case of mas-sive bilateral intranasal scarring, with nega-tive etiologic studies except for the anteced-ent of an old nasal fracture. Differential diag-noses are discussed, as well as its manage-ment. A 41-year-old male consulted with a long-term history of rhinorrhea, facial pain and nasal congestion. Physical examination re-vealed complete bilateral obstruction of the nasal fossae with fibrous synechiae. We performed an endoscopic microdebrider-assisted resection of the synechiae connecting the septum to the lateral nasal wall, up to the choanae and soft palate. The posterior margin of the bony septum was resected to increase the transversal area at the choanae. Silicone stents were placed postoperatively to minimize the formation of new synechiae. Massive bilateral scarring is infrequent and sev-eral differential diagnoses must be considered. Its management is difficult and not well stand-ardized. Microdebrider-assisted resection may be considered in these cases.