BILATERAL MASSIVE NASAL SYNECHIAE: A RARE PRESENTATION OF A COMMON CONDITION

Intranasal synechiae are a relatively common finding in an otolaryngology practice. Frequently, the scar is focal and due to mucosal trauma. We present an unusual case of massive bilateral intranasal scarring, with negative etiologic studies except for the antecedent of an old nasal fracture. Differential diagnoses are discussed, as well as its management. A 41-year-old male consulted with a long-term history of rhinorrhea, facial pain and nasal congestion. Physical examination revealed 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 several differential diagnoses must be considered. Its management is difficult and not well standardized. Microdebrider-assisted resection may be considered in these cases.