Removal of Nasal Adhesions

Surgery Overview

Removal of nasal adhesions is a procedure to separate scar tissue within the nose that has become connected, or fused. Fused tissue is called an adhesion. Adhesions in the nose are also called synechiae. Adhesions are a common, usually minor, complication of nasal or sinus surgery and nasal packing. They also may develop because of trauma (for example, nose-picking or cocaine use) and such conditions as syphilis, tuberculosis, lupus, or sarcoidosis.

Adhesions form when two moist, opposing surfaces inside the nose heal together, causing a scar. They often form between the septum, which separates the nostrils, and one of the wavy structures inside the nose (inferior turbinate). Adhesions can make breathing difficult.

The procedure to remove adhesions usually is done in the doctor's office under local anesthesia. The doctor may apply an anesthetic to the skin, using spray or cotton, and inject local anesthetic. In rare cases, general anesthesia may be used.

The doctor may use a thin, lighted instrument (endoscope) to see into the nasal passages. He or she may use surgical scissors, a laser, or an instrument called a microdebrider to separate the fused tissue. The microdebrider has a rotating tip that shaves and removes inflamed tissue.

What to Expect After Surgery

Your nose should heal in 7 to 10 days.

After surgery, a spacer or splint may be placed in your nose for a few days to several weeks. This helps prevent another adhesion from forming. You should avoid blowing your nose while the spacer or splint is in place. Your doctor will probably suggest you use an ointment, such as bacitracin/polymyxin (for example, Polysporin), to keep your nose moist and prevent infection while the splint is in place.

A small amount of bleeding or drainage is normal. Your doctor will tell you how to clean your nasal passages using a saltwater (saline) solution. Sneezing is common after nasal surgery, especially if you have allergies. You may be given an antihistamine (one that will not make you sleepy) to reduce the sneezing. These medicines also may reduce swelling and the likelihood that adhesions will return.

You also may use a nasal anti-inflammatory (corticosteroid) spray. Although there is little evidence about the use of these sprays, some doctors think they may help prevent another adhesion from forming.

Why It Is Done

The procedure removes debris and tissue that have formed adhesions in the nose.

How Well It Works

This procedure removes adhesions that form in the nasal passages.

Risks

The most serious risks are heavy bleeding and infection. Call your doctor if pus drains from your nose, because this is a sign of infection.

Streptococcus and staphylococcus bacteria appear normally in some people. Packing the nose after surgery in people who have these bacteria increases the risk of toxic shock syndrome. Call your doctor immediately if you have any of the following symptoms:

• A fever of 101°F (38.3°C) or higher
• A headache
• Vomiting
• Diarrhea
• A rash that looks like sunburn
• Chills
• Signs of very low blood pressure, such as dizziness or fainting

There also is a risk that adhesions could return.

What to Think About

This procedure is more likely to succeed if you follow your doctor's instructions for postsurgery care.

A doctor needs special training to use a laser.