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. 2017:2017:1907862.
doi: 10.1155/2017/1907862. Epub 2017 Dec 12.

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

Daisuke Takahara  1 , Sachio Takeno  1 , Takao Hamamoto  1 , Takashi Ishino  1 , Katsuhiro Hirakawa  1
Affiliations

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

Daisuke Takahara et al. Int J Otolaryngol. 2017.

Abstract

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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Figures

Figure 1
Figure 1
The microdissectors, malleable cauterization microprobe, and microknife.
Figure 2
Figure 2
Intraoperative endoscopic view showing the branches of the posterior nasal nerve emerging from the SPF. (a) Resection of the anteroinferior branch toward the inferior turbinate. (b) Resection of the posterosuperior branch toward the middle meatus. (c) The SPA is well preserved after nerve resection (arrow). EC = ethmoidal crest.
Figure 3
Figure 3
Changes in each nasal symptom and the total nasal symptom score (TNSS) after surgery (n = 23). The data were examined with the Wilcoxon signed rank test. Symbols and error bars represent mean values with standard errors. Pre = pretreatment.
Figure 4
Figure 4
The improvement of each nasal symptom and the TNSS in the group of ≤2 branches versus the group of >2 after surgery. The data were examined with the Mann–Whitney U test. Bars and wings represent mean values with standard errors. NS = no significance.
See this image and copyright information in PMC

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