LXXXIX. the Surgery of the Great Superficial Petrosal Nerve: Its Possible Relation to Some of the Pathology of the Nasal and Paranasal Mucous Membranes

Abstract

The pioneer work of Cushing,' Frazier, Royle," Adson and his co-workers" on the cerebrospinal, sympathetic and parasympathetic nervous systems is well known. Langley,' Kuntz" and others have contributed to our knowledge of the finer anatomy and physiology of this problem. The postoperative results in scleroderma, Raynaud's, Buerger's and in Hirschsprung's disease, by section of a portion of the lumbar sympathetic has stimulated further investigation.Though the sympathetic, parasympathetic and cerebrospinal nervous systems are very closely related to the ear, nose and throat, this relationship (especially the anatomic) is extremely difficult to utilize surgically. The observations of the pathology have been bacteriologic rather than neurologic. By contrast the lumbar sympathetic plexus and ganglia are relatively simple, likewise the stellate ganglion in the field of the thoracic or general surgeon. It is evident the nearer one gets to the central nervous system, the more difficult becomes the surgical approach to the various plexuses, ganglia and nerve fibers related to the sympathetic and parasympathetic. A few bold pioneers have blazed the trail. A small number of them have been otolaryngologists. Sluder" probably did most to stimulate members of the specialty to realize the importance of the relationship of nervous disturbances. Fenton and Larsell' have attempted to place the embryology and histology of some of the nerves related to the sphenopalatine ganglion on a sound scientific basis. Ruskin" has shown the relationship of neurogenic disturbances to clinical nasal pathology. Abroad Muller," in his excellent text, has added new light. Many years ago the researches of jonnesco'" stimulated great activity in the field of the sympathetics and their relation to clinical surgery;"

Endoscopic anatomy of the postganglionic pterygopalatine innervation of the posterolateral nasal mucosa

“…Knowledge of the pterygopalatine autonomic pathways was exploited as early as 1935 by Ziegelman8, who developed the transcranial greater superficial petrosal neurectomy1 in attempt to manage patients with vasomotor rhinitis. The transnasal vidian neurectomy was not described by Malcolmson9 until 1957, although it is generally attributed to Golding‐Wood, who described his series of 40 patients in 1961 1.…”

The petrosal nerves: Anatomy, pathology, and surgical considerations

“…Cusimano and Sekhar (1994) have reported the so-called pseudo-cerebrospinal fluid rhinorrhea syndrome following surgery of the skull base involving the GPN. This syndrome is characterized by nasal stuffiness and nasal hypersecretion with absent ipsilateral lacrimation (Ziegelman, 1934).…”