Postoperative Nasal Synechia as a Source of Severe Delayed Epistaxis After Closed Reduction of a Nasal Bone Fracture

Delayed severe epistaxis after closed reduction of a nasal bone fracture is uncommon, and postoperative nasal synechia is rarely considered as a bleeding source. A 19-year-old woman developed recurrent severe epistaxis 5 weeks after closed reduction and intranasal packing. Bleeding recurred immediately after pack removal despite repeated packing. Emergency endoscopic exploration showed bilateral adhesions between the septum and inferior turbinate, with active bleeding directly visualized from right-sided synechial tissue. Suction coagulation and synechiolysis achieved hemostasis. Hemoglobin decreased from 13.7 to 7.9 g/dL, but transfusion was not required, and no recurrence occurred during 159 days of follow-up. Postoperative nasal synechia should be considered in unexplained delayed epistaxis after nasal fracture management, particularly when bleeding repeatedly recurs after pack removal; early endoscopic evaluation may identify and control a focal structural source.