Efficacy of Vidian Neurectomy and Posterior Nasal Neurectomy in the Management of Nonallergic Rhinitis: A Systematic Review

Abstract

Background Nonallergic rhinitis (NAR) is characterized by rhinorrhea, nasal obstruction, and sneezing, in the absence of systemic sensitization to allergens. For cases refractory to medical therapy and conservative surgical interventions, more targeted procedures, such as endoscopic vidian neurectomy (EVN) and posterior nasal neurectomy (PNN), including surgical (SPNN) and cryoablative (CPNN) methods, may reduce symptoms of NAR. Objective The purpose of this study was to compare the efficacy, side effect profile, and complication rate between EVN and PNN for NAR. Methods A systematic review of primary articles that reported original patient data for either EVN or PNN was conducted using Embase, Medline, PubMed, and Cochrane databases since 2006, according to PRISMA guidelines. The primary outcome of the study was an improvement in NAR symptom severity. Secondary outcomes included the incidence of postoperative side effects or complications. Results In total, 58 articles met the search criteria with a total of 9 studies (including 2 RCTs) eligible for inclusion. There was a pooled sample of 229 NAR patients that underwent EVN (n = 65; 28.4%), SPNN (n = 50; 21.8%), or CPNN (n = 114; 49.8%). For all 3 techniques, there was a statistically significant improvement in nasal symptoms, particularly rhinorrhea, nasal congestion, and obstruction along with quality of life. Heterogeneity in outcome reporting prevented meta-analysis and direct comparison of efficacy. The pooled incidence of postoperative complications for EVN (n = 65), SPNN (n = 50), and CPNN (n = 70) was 30.8% versus 0% versus 2.9% for dry eye, 16.9% versus 0% versus 1.4% for palatal/cheek numbness, and 0% versus 6% versus 4.3% for bleeding. Conclusion EVN, SPNN, and CPNN are similarly efficacious for patients with NAR refractory to medical management. SPNN and CPNN are associated with lower rates of complications (dry eye and palatal/cheek numbness) compared with EVN.

Efficacy of Cryoablation on Chronic Rhinitis Management: A Systematic Review and Meta-Analysis

“…Cryotherapy has been trialed in the management of chronic rhinitis since the last quarter of the 20th century, and Kompelli et al's 42 2018 qualitative systematic review chronicles how modalities in administering cryotherapy for PNN ablation have evolved over the decades. Indeed, Senanayake et al 43 found cyroablative techniques to be of similar efficacy in treating patients with chronic rhinitis when compared to vidian neurectomy, highlighting the potential for this treatment modality. The present systematic review marks the first attempt to gather and synthesize the findings of all published articles on the efficacy of using a recently available cryotherapy device in the management of chronic rhinitis for both 1- and 3-month time points.…”

Posterior nasal neurectomy for intractable rhinitis: A systematic review of the literature

“…A recent systematic review looked at PNN in the context of non-allergic rhinitis along with other treatments; cryoablative PNN and endoscopic vidian neurectomy. 34 In total, 50 of their patients included underwent PNN. They found epistaxis as a complication in 6% of PNN and no patients had dry eye or paraesthesia as a complication.…”

“…A recent systematic review looked at PNN in the context of non‐allergic rhinitis along with other treatments; cryoablative PNN and endoscopic vidian neurectomy 34 . In total, 50 of their patients included underwent PNN.…”

Cadaveric analysis of autonomic nerve fiber density in posterior nasal, posterolateral nasal, and anterior ethmoid nerves

“…Studies on surgical interventions for rhinitis have shown success with posterior nasal nerve (PNN) cryoablation, 3 radiofrequency, 4 or endoscopic posterior nasal neurectomy (EPNN) 2,3 . These interventions remove postganglionic parasympathetic nasal innervation, which helps avoid endoscopic vidian neurectomy (EVN)‐related complications like xerophthalmia and facial/palatal hypesthesia 3,5 …”