Summary Endoscopic Endonasal Neurectomy of the Vidian Nerve and the Posterior Nasal Nerve for Intractable Perennial Nasal Hyperreactivity

Abstract

There are a number of patients of perennial allergic rhinitis and vasomotor rhinitis whose symptoms are severe and resistant to conservative treatment. So far, there are only a few treatments that can control the symptoms effectively in these patients. Vidian neurcctomy has been one of the choices of surgical treatment. However, vidian neurectomy has been applied to a very limited number of cases because of its side effect (dry eye) and technical complexity. In this article, a new endonasal vidian neurectomy for intractable perennial nasal hyperreactivity is described. The advantages of this technique include : 1) The technique is simple and causes patients less stress than previous techniques ; 2) The vidian nerve is approached through the middle meatus and can be easely accessed even in children ; 3) There is no risk of bleeding from the sphenopalatine artery during the surgery because the vidian nerve is exposed subperiosteally through a control hole, not through the sphenopalatine foramen. Additionally, in this article, our new surgical treatment—transnasal endoscopic resection of the posterior nasal nerve-is reported. This surgery entails less manipulation and less risk, and is expected to be an effective treatment for controlling all symptoms of severe perennial allergic rhinitis and vasomotor rhinitis without side effects.