A New Method of Identifying the Posterior Inferior Nasal Nerve

Eren, Erdem; Zeybek, Gülşah; Ecevit, Cenk; Arslanoğlu, Seçil; Ergür, İpek; Kiray, Amaç

doi:10.1097/scs.0000000000001504

Cited by 12 publications

(11 citation statements)

References 12 publications

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“…According to the previous report, postoperative bleeding is frequently encountered in the cases conducted PNN compared to the cases conducted inferior turbinoplasty only [22]. However, the posterior inferior nasal nerve was consistently found posterior to the sphenopalatine artery in another previous study [23]. Therefore, in most cases, the sphenopalatine artery is difficult to preserve and must be resected along with the posterior nasal nerve to ensure that the latter is cut.…”

Section: Discussionmentioning

confidence: 89%

Long-Term Effects of Combined Submucous Turbinectomy and Posterior Nasal Neurectomy in Patients with Allergic Rhinitis

Ogi

Manabe²,

Kimura

et al. 2019

SN Compr. Clin. Med.

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Submucous inferior turbinectomy (ST) can be combined with posterior nasal neurectomy (PNN) to treat intractable allergic rhinitis (AR) and vasomotor rhinitis (VR). This study assessed the long-term effects and complications of this surgical intervention. We enrolled 127 patients who had undergone combined ST and PNN. We mailed these patients card questionnaires. Of these questionnaires, we excluded the 5 patients with VR and 26 patients who had undergone concomitant endoscopic sinus surgery (ESS), because they had both AR or VR and sinusitis. Then, we assessed the questionnaire score of 31 patients with AR who had undergone combined ST and PNN. Postoperative bleeding was investigated in 127 subjects by medical records. Moreover, we compared the incidence of numbness in the palate, cheeks, or teeth between patients who had undergone PNN and those who had not. We found that 77.4% of the AR patients were satisfied with the improvement of their nasal symptoms after the operation. Although seven patients had been receiving medical treatment from an otolaryngology clinic every month before the operation, none needed any such treatment after the operation. One year postoperatively, all symptom scores were statistically decreased. However, the scores increased over time, although there was a significant improvement in nasal obstruction more than 3 years after the operation (P < 0.01). Five patients (3.9%) among 127 patients who had undergone PNN were treated for postoperative bleeding. Patients who had undergone PNN did not differ significantly from those who had not in terms of postoperative numbness in the palate, cheeks, or teeth. Endoscopic ST combined with PNN is an effective treatment for intractable AR. Further studies are required to elucidate the efficacy of this intervention.

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Section: Discussionmentioning

confidence: 89%

Long-Term Effects of Combined Submucous Turbinectomy and Posterior Nasal Neurectomy in Patients with Allergic Rhinitis

Ogi

Manabe²,

Kimura

et al. 2019

SN Compr. Clin. Med.

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“…However, as 12 subjects were lost to follow‐up at the 1‐year mark, we feel that a larger long‐term cohort would be needed to definitively characterize long‐term benefits of cryotherapy. We do believe that the duration of treatment benefit of this procedure may exceed that described in historical trials of cryoneurolysis, owing to more precise anatomic localization of treatment by endoscopy, and standardization of the duration and amount of cryotherapy application …”

Section: Discussionmentioning

confidence: 94%

“…Cryoablative techniques have been used in the head and neck region for a number of different applications . Cryotherapy offers the advantage of ablating soft tissue and nerve with predictable depth of penetration, while preserving arterial vascular supply to the region, hence minimizing the risk of necrosis.…”

Section: Discussionmentioning

confidence: 99%

Cryosurgical posterior nasal tissue ablation for the treatment of rhinitis

Hwang

Lin

Weiss³

et al. 2017

Int Forum Allergy Rhinol

109

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BackgroundEndoscopic posterior nasal nerve (PNN) resection has been described as an efficacious surgical treatment of allergic and nonallergic rhinitis, but the requirement for surgery under general anesthesia has limited its acceptance. We report the first series of patients treated for chronic rhinitis using a novel device designed for office‐based cryosurgical ablation of the PNN.MethodsTwenty‐seven patients with chronic rhinorrhea and/or nasal congestion for >3 months were recruited (allergic or nonallergic rhinitis), with minimum rhinorrhea and/or congestion subscores of 2 as part of the Total Nasal Symptom Score [TNSS]). Under local anesthesia, the cryotherapy device was applied endoscopically to the posterior middle meatus and was used to freeze the PNN region bilaterally. Patients were followed up after 7, 30, 90, 180, and 365 days to assess TNSS.ResultsThe procedure was successfully completed in 100% of patients, with no complications; 74% reported no or mild discomfort by the first postprocedure day. TNSS was reduced significantly at 30 days (mean ± standard deviation: 6.2 ± 0.5 at baseline, 2.6 ± 0.3 at 30 days, n = 27, p < 0.001), with continued reduction at 90 (2.7 ± 0.4, n = 24, p < 0.001), 180 (2.3 ± 0.5, n = 21, p < 0.001), and 365 days (1.9 ± 0.3, n = 15, p < 0.001). Both rhinorrhea and congestion subscores decreased significantly at 30, 90, 180, and 365 days compared to baseline (p < 0.001). Allergic and nonallergic subcohorts both appeared to benefit from treatment.ConclusionOffice‐based cryotherapy of the PNN region is safe and well tolerated. Symptom scores were significantly decreased by 7 days postprocedure and remained lower at 30, 90, 180, and 365 days.

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“…The posterior nasal nerve emerges from the SPF and is distributed to the inferior turbinate mucosa following the branches of the sphenopalatine vessels. Innervation of the parasympathetic component increases the secretomotor function, and innervation of the sensory component regulates the sensitivity of the nasal mucosa [ 4 , 9 ]. By resection of the posterior nasal nerve at this point, we can expect modifying the hyperreactivity of the neural network that augments the allergic reaction.…”

Section: Discussionmentioning

confidence: 99%

Management of Intractable Nasal Hyperreactivity by Selective Resection of Posterior Nasal Nerve Branches

Takahara

Takeno

Hamamoto

et al. 2017

International Journal of Otolaryngology

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The posterior nasal nerves emerge from the sphenopalatine foramen and contain sensory and autonomic nerve components. Posterior nasal neurectomy is an effective method to remove pathological neural networks surrounding the inferior turbinate that cause unregulated nasal hypersensitivity with excess secretion in patients with severe allergic rhinitis (AR). We describe the sophisticated endoscopic surgical procedure that allows feasible access to the confined area and selective resection of the nerve branches with the preservation of the sphenopalatine artery (SPA). We retrospectively analyzed the cases of 23 symptomatic severe AR patients who failed to respond to standard medical treatment and underwent surgery. There have been no major complications after surgery including nasal bleeding or transient numbness of the upper teeth. The mean total nasal symptom scores (TNSS) were decreased by 70.2% at 12 months after the procedure. Our comparison of the clinical effectiveness based on the number of severed nerve branches revealed that the improvement of the TNSS was significantly higher in patients with >2 branches. We conclude that this minimally invasive technique that preserves the SPA is clinically useful and decreases the rate of postoperative complications. This trial is registered with UMIN000029025.

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A New Method of Identifying the Posterior Inferior Nasal Nerve

Abstract: Instead of finding PINN around the sphenopalatine foramen, PINN can be located more easily posterior to the sphenopalatine artery where the inferior turbinate attaches to the lateral nasal wall without cauterizing the sphenopalatine artery.

Cited by 12 publications

References 12 publications

Long-Term Effects of Combined Submucous Turbinectomy and Posterior Nasal Neurectomy in Patients with Allergic Rhinitis

Long-Term Effects of Combined Submucous Turbinectomy and Posterior Nasal Neurectomy in Patients with Allergic Rhinitis

Cryosurgical posterior nasal tissue ablation for the treatment of rhinitis

Management of Intractable Nasal Hyperreactivity by Selective Resection of Posterior Nasal Nerve Branches

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