Endoscopic posterior nasal neurectomy: An alternative to vidian neurectomy

Abstract

Vidian neurectomy is a proven surgical treatment for the symptoms of allergic and nonallergic rhinitis. However, complications such as dry eye, cheek and dental numbness, disturbance of eye movements, and even blindness remain. I describe a method for endoscopic resection of the posterior superior and inferior nasal nerves. My approach exposes postganglionic parasympathetic nerve fibers (the posterior superior nasal nerve) at the sphenopalatine foramen to allow resection of a segment of the nerve under direct vision. The surgeon is able to control intraoperative bleeding without resection of the sphenopalatine artery and achieve the effectiveness of vidian neurectomy without the complications. Vidian neurectomy is a proven surgical treatment for the symptoms of allergic and nonallergic rhinitis. However, complications such as dry eye, cheek and dental numbness, disturbance of eye movements, and even blindness remain. I describe a method for endoscopic resection of the posterior superior and inferior nasal nerves. My approach exposes postganglionic parasympathetic nerve fibers (the posterior superior nasal nerve) at the sphenopalatine foramen to allow resection of a segment of the nerve under direct vision. The surgeon is able to control intraoperative bleeding without resection of the sphenopalatine artery and achieve the effectiveness of vidian neurectomy without the complications.