Effect of resection of the posterior nasal nerve on functional and morphological changes in the inferior turbinate mucosa

Ikeda, Katsuhisa; Yokoi, Hidenori; Saito, Tatsuya; Kawano, Kenji; Yao, Toru; Furukawa, Masayuki

doi:10.1080/00016480801935525

Cited by 51 publications

(86 citation statements)

References 15 publications

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“…Recent study conducted by Ikeda et al demonstrated the denervation effect of nasal mucosa. (Ikeda et al 2008) Morphological analysis of the inferior turbinate mucosa before and after nerve resection showed an apparent decrease in nasal gland acinar cells after surgery, but the vascular structure of the mucosa seemed to be unchanged. Morphometric analysis of the density of the nasal gland showed a significant reduction, whereas no significant change was recognized in the density of the vessels.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Vidian Neurectomy: The Anatomy Consideration and Preoperative Images Analysis

Su¹,

Liu²,

Wang³

2012

Computed Tomography - Clinical Applications

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IntroductionAlthough surgery is not a primary treatment for manaing rhinitis, it can have some adjuvant benefit in patients with significant nasal congestion or poor pharmacologic response. It is usually performed by surgical approaches to the inferior turbinate, and the more aggressive procedures such as the vidian neurectomy have not been widely applied. Traditional approaches to the vidian canal necessitate larger incisions, including transseptal, transpalatal and transantral methods. These approaches are often not reliable and at the risk of injury to the abutting neurovascular structures. Pioneers in endoscopic surgery are exploring alternatives to these traditional techniques in an attempt to minimize morbidity and the lack of irrelevant incisions. The main difficulties encountered during endoscopic approach are anatomic variations such as canal wall dehiscence, intra-sphenoid septa, pneumatization degree of pterygoid process and the relationship between vidian canal and middle turbinate. Those variations will have effect in determining the surgical success rate and the related complications. Therefore, a powerful tool, in the purpose of identifying the canal location and its surrounding anatomy, is very important to guide the surgeon in preoperative assessment and intraoperative approach. Computed tomography (CT) scanning is superior for the evaluation of the bony confines of the sinonasal tract and skull base. The most minimal recesses of the sinonasal region are easily assessed and it is possible to evaluate the position and configuration of the vidian canal. That valuable information provided by imaging studies enhances the surgical feasibility and offers an alternative for treating the rhinitis. This chapter describes the use of CT images in this capacity. Growing surgical experience and evolving technology will help to advance the feasibility of endoscopic vidian neurectomy and elucidate their indications by using preoperative images.

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Section: Discussionmentioning

confidence: 99%

Endoscopic Vidian Neurectomy: The Anatomy Consideration and Preoperative Images Analysis

Su¹,

Liu²,

Wang³

2012

Computed Tomography - Clinical Applications

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“…Therefore, PNN is expected to suppress nasal hypersecretion by blocking autonomic vidian nerve fibers, similar to vidian neurectomy (VN), as well as hypersensitivity by simultaneously blocking sensory nerve fibers. [6][7][8][9][10] However, the effects of PNN on the suppression of sensitivity in the nasal mucosa remain controversial. 11 Some previous reports have described the beneficial effects of PNN on rhinorrhea and sneezing, [6][7][8][9][10] although other reports have failed to observe an effect of PNN on sneezing.…”

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confidence: 99%

“…[6][7][8][9][10] However, the effects of PNN on the suppression of sensitivity in the nasal mucosa remain controversial. 11 Some previous reports have described the beneficial effects of PNN on rhinorrhea and sneezing, [6][7][8][9][10] although other reports have failed to observe an effect of PNN on sneezing. 11,12 The histological changes underlying the effects of PNN have not been elucidated because of the limitations of human studies and the lack of animal models.…”

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confidence: 99%

Denervation of nasal mucosa induced by posterior nasal neurectomy suppresses nasal secretion, not hypersensitivity, in an allergic rhinitis rat model

Nishijima

Kondo

Toma-Hirano

et al. 2016

Laboratory Investigation

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The posterior nasal nerve is the dominant source of the parasympathetic, sympathetic, and sensory fibers that innervate the nasal respiratory mucosa. Therefore, a posterior nasal neurectomy (PNN) is thought to induce denervation of the nasal mucosa and relieve the nasal symptoms of allergic rhinitis. However, the underlying mechanisms and therapeutic action of PNN remain unknown. To investigate the impact of PNN-induced denervation of the nasal mucosa on allergic rhinitis, we developed a rat model of PNN and examined the effects of PNN on allergic rhinitis in ovalbumin-sensitized rats. This rat model of PNN was characterized by the depletion of nerve fibers, choline acetyltransferase, and neuropeptides (eg, substance P, calcitonin gene-related peptide, vasoactive intestinal peptide, and neuropeptide Y) in the nasal respiratory mucosa. These animals exhibited nasal gland and goblet cell hypertrophy in the septal mucosa and atrophy of the submucosal gland in the lateral nasal wall, as well as reduced nasal secretion due to deficient acetylcholine synthesis. In an ovalbumin-sensitized model of allergic rhinitis, PNN also induced the depletion of nerve fibers, choline acetyltransferase, and neuropeptides in the nasal mucosa and suppressed nasal secretion. However, PNN did not affect mucosal thickening, eosinophil and mast cell infiltration, interleukin-4 and interferon-γ mRNA expression, and allergic symptoms (ie, sneezing and nasal scratching). These results suggest that the peripheral nerves and corresponding neuropeptides regulate nasal secretion, but not hypersensitivity, in allergic rhinitis, and that allergic rhinitis-related mucosal reactions occur in a highly denervated mucosa after PNN. Posterior nasal neurectomy may be a therapeutic option for the treatment of hyperrhinorrhea, but not allergic rhinitis hypersensitivity. Allergic rhinitis is among the most common diseases; affecting 10-30% of people in industrialized countries. [1][2][3] This condition presents with symptoms that reduce the quality of life such as rhinorrhea, sneezing, nasal obstruction, and nasal itching. 4 Medical allergic rhinitis treatment is approached in a stepwise manner and includes agents such as antihistamines and nasal topical steroids. 1,2,5 However, for patients with allergic rhinitis refractory to medication therapy; surgical interventions such as endoscopic posterior nasal neurectomy (PNN) have been attempted.Endoscopic PNN, which involves the intranasal severing of the posterior nasal nerve, is a common surgical treatment for allergic rhinitis in Asia. 2,6,7 The posterior nasal nerve, which is a peripheral branch of the vidian nerve, innervates the nasal cavity via the pterygopalatine ganglion, which comprises parasympathetic and sympathetic vidian nerve fibers and sensory nerve fibers from the trigeminal nerve. Therefore, PNN is expected to suppress nasal hypersecretion by blocking autonomic vidian nerve fibers, similar to vidian neurectomy (VN), as well as hypersensitivity by simultaneously blocking sensory nerve fibers. 6...

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“…The reduction of inflammatory cells may be explained not only by the cell damage at the focus point of HIFU, but also by inhibition of nerve activity (Baraniuk 1992;Bentley et al 1992), falloff of vessel density and decrease in vascular permeability. Ikeda et al (2008) reported the effect of resection of the posterior nasal nerve (PNN) on functional and morphologic changes in the inferior turbinate mucosa. Significant reductions in the densities of eosinophils, other inflammatory cells and submucosal glands were recognized, whereas no significant change was observed in the density of the vessels after PNN resection.…”

Section: Discussionmentioning

confidence: 99%

High-Intensity Focused Ultrasound Leads to Histopathologic Changes of the Inferior Turbinate Mucosa with Allergic Inflammation

Wei

Shi

Zhang

et al. 2014

Ultrasound in Medicine & Biology

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Effect of resection of the posterior nasal nerve on functional and morphological changes in the inferior turbinate mucosa

Cited by 51 publications

References 15 publications

Endoscopic Vidian Neurectomy: The Anatomy Consideration and Preoperative Images Analysis

Endoscopic Vidian Neurectomy: The Anatomy Consideration and Preoperative Images Analysis

Denervation of nasal mucosa induced by posterior nasal neurectomy suppresses nasal secretion, not hypersensitivity, in an allergic rhinitis rat model

High-Intensity Focused Ultrasound Leads to Histopathologic Changes of the Inferior Turbinate Mucosa with Allergic Inflammation

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