Incidence of Synechiae after Conventional Septoplasty Without Internal Splint: A Prospective Cohort Study

Abstract

Background: Intranasal synechiae are common complications following septoplasty and can cause significant postoperative morbidity. While internal nasal splints are widely used to reduce this risk, they are often associated with patient discomfort and an increased risk of infection.

Objective: To evaluate the incidence of synechiae formation following septoplasty performed without the use of intranasal splints.

Study Design: A prospective observational cohort study was conducted on 100 patients undergoing conventional (non-endoscopic) septoplasty at two hospitals in Tripoli, Libya, between 2018 and 2024. All procedures utilized a standard hemitransfixion incision and concurrent inferior turbinate surgery. Short-duration glove-finger nasal packing (12–24 hours) was applied, and no internal nasal splints were used. Postoperative endoscopic assessment for synechiae was performed at 2 weeks, 4 weeks, 3 months, 6 months, and 12 months.

Results: Out of 100 patients (95 primary, 5 revision cases), only one patient (1%) developed synechiae, which required minor division in an outpatient setting. No recurrences were observed. The observed incidence was significantly lower than the commonly reported literature rate of approximately 10% ($p < 0.0001$; 95% CI: 0.18–5.45%).

Conclusions: In this prospective cohort, septoplasty without internal splints was associated with a remarkably low rate of postoperative synechiae when combined with meticulous surgical technique and short-duration nasal packing. These findings suggest that routine splinting may not be necessary for all patients and support a reconsideration of their use in evidence-based postoperative care.v