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Endoscopic posterior nasal neurectomy

  • N Ahilasamy (a1) and K Rajendran Dinesh (a2)

Abstract

Background

Surgical techniques for resistant chronic rhinitis (rhinorrhoea) vary, ranging from vidian neurectomy to post-nasal neurectomy. The techniques vary mainly on the basis of instrumentation, and the avoidance of post-operative epistaxis, transient hypoesthesia of the soft palate and dryness of the eye. Endoscopic visualisation, and cauterisation or resection of posterior nasal nerve branches, can prevent such complications.

Method

The technique and surgical steps of endoscopic posterior nasal neurectomy are presented.

Results

The critical steps include: bilateral sphenopalatine nerve blocks, transnasally or transorally via the greater palatine foramen; vertical incisions made behind the posterior fontanelle; and elevation of the mucoperiosteal flap. The sphenopalatine foramen and artery is identified. The posterior nasal nerve is located 4–5 mm inferior to the sphenopalatine artery, and is resected or cauterised. The flaps are repositioned back into place. No post-operative nasal packing is required. The same procedure is performed on the opposite side for effective results.

Conclusion

This technique provides consistent, robust results, with long-term relief of allergic and vasomotor rhinitis related nasal symptoms, without risk of complication.

Copyright

Corresponding author

Author for correspondence: Dr Rajendran Dinesh Kumar, Department of ENT and Head-Neck Surgery, Hinduja Sindhi Hospital, Bengaluru 560027, Karnataka, India E-mail: dinuraj1186@gmail.com

Footnotes

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Dr R D Kumar takes responsibility for the integrity of the content of the paper

Footnotes

References

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1Golding-Wood, PH. Observations on petrosal and vidian neurectomy in chronic vasomotor rhinitis. J Laryngol Otol 1961;75:232–47
2Kikawada, T. Endoscopic posterior nasal neurectomy: an alternative to vidian neurectomy. Oper Tech Otolaryngol 2007;18:297301
3Ikeda, K, Yokoi, H, Saito, T, Kawano, K, Yao, T, Furukawa, M. Effect of resection of the posterior nasal nerve on functional and morphological changes in the inferior turbinate mucosa. Acta Otolaryngol 2008;128:1337–41
4Kobayashi, T, Hyodo, M, Nakamura, K, Komobuchi, H, Honda, N. Resection of peripheral branches of the posterior nasal nerve compared to conventional posterior neurectomy in severe allergic rhinitis. Auris Nasus Larynx 2012;39:593–6
5Toma, S, Hopkins, C. Stratification of SNOT-22 scores into mild, moderate or severe and relationship with other subjective instruments. Rhinology 2016;54:129–33
6Ogawa, T, Takeno, S, Ishino, T, Hirakawa, K. Submucous turbinectomy combined with posterior nasal neurectomy in the management of severe allergic rhinitis: clinical outcomes and local cytokine changes. Auris Nasus Larynx 2007;34:319–26
7Malcomson, KG. The vasomotor activities of the nasal mucous membrane. J Laryngol Otol 1959;73:7398

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