Long-term effectiveness, safety, and quality of life outcomes following endoscopic posterior nasal neurectomy with submucosal turbinectomy for the treatment of intractable severe chronic rhinitis

Sonoda, Serika; Murakami, Daisuke; Saito, Yuichi; Miyamoto, Yusuke; Higuchi, Ryota; Kikuchi, Yoshikazu; Sawatsubashi, Motohiro; Nakagawa, Takashi

doi:10.1016/j.anl.2020.12.009

Cited by 10 publications

(49 citation statements)

References 35 publications

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“…Five studies (12,15,(23)(24)26) examined PNN as a single intervention with no concomitant nasal surgery. Eight studies (9,13,(19)(20)(21)(22)(27)(28) examined PNN with concurrent turbinate and septal surgery and four (17)(18)21,25) examined PNN with concurrent turbinate reduction.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Kobayashi(21) retrospectively compared patients who underwent selective PNN to total PNN. The SPA was divided together with the posterior nasal nerve in four studies (15,25,26,28).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Five studies (12,17,(19)(20)22) cited a single post-operative review with no mention of timing, whereas Kanaya et al (12,22) did not specify their follow up at all. Ten studies(9,13,15-18,21-22,25,27) recruited patients with allergic rhinitis only and three studies (19,20,28) included both allergic and non-allergic patients. The allergy status was not recorded in 4 studies (12,(23)(24)26).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The allergy status was not recorded in 4 studies (12,(23)(24)26). Allergic rhinitis was defined by IgE or RAST testing in six studies (17,18,19,20,25,28), skin prick testing in one study (27), and diagnosis was confirmed by both in two studies (9,13). The remaining studies did not define how allergic rhinitis was diagnosed in the study populations.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The remaining studies did not define how allergic rhinitis was diagnosed in the study populations. Eleven studies (9,13,(15)(16)(18)(19)(22)(23)(24)(25)28) specified the treatments that had been used prior to PNN.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Endoscopic posterior nasal neurectomy for intractable rhinitis: a systematic review of the literature Running Title: Endoscopic PNN: a systematic review

Lee¹,

Chakravarty

Ellul³

2021

Preprint

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Objectives: Rhinitis affects up to 40% of the population worldwide and can significantly reduce quality of life. Some patients remain symptomatic despite maximal medical therapy. In refractory cases, posterior nasal neurectomy (PNN - the division of the intranasal nerve branches containing postganglionic parasympathetic fibres) is postulated to reduce symptom burden. The objectives of this paper were to review the literature to establish whether the procedure is effective and safe in the management of allergic and non-allergic rhinitis. Design: A systematic review of Pubmed, EMBASE and MEDLINE was undertaken. Studies were excluded if not available in English or undertaken in non-human subjects. Participants: Seventeen articles satisfied the inclusion criteria studying in total 2029 patients. Sample size ranged from 8-1056. Main Outcome Measures: Patient-reported objective and subjective outcomes and post-operative complications were reviewed Results: There were two randomised controlled trials, two case control studies, and the remaining thirteen were case series using both objective and subjective outcome measures. All but one study found improved patient reported outcomes following PNN. Complications were reported in 10 studies - haemorrhage was the most common complication and was observed in 28 patients (1.6% of subjects). Conclusions: Endoscopic posterior nasal neurectomy is safe and appears to be effective in the treatment of intractable rhinitis but the level of the available evidence was generally poor. Larger, well designed studies are needed to clarify its role in the management of difficult-to-treat rhinitis.

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Section: Study Characteristicsmentioning

confidence: 99%

“…Kobayashi(21) retrospectively compared patients who underwent selective PNN to total PNN. The SPA was divided together with the posterior nasal nerve in four studies (15,25,26,28).…”

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

See 3 more Smart Citations

Endoscopic posterior nasal neurectomy for intractable rhinitis: a systematic review of the literature Running Title: Endoscopic PNN: a systematic review

Lee¹,

Chakravarty

Ellul³

2021

Preprint

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The anatomy of the foramina and efferent nerve fibers from the pterygopalatine ganglion in posterolateral nasal wall

Ogi

Valentine

Suzuki

et al. 2022

Laryngoscope Investig Oto

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Background: The advance of endoscopic surgery has enabled selective section of the postganglionic nerve branches from pterygopalatine ganglion (PPG) as a modification of the vidian neurectomy. Recent microanatomic studies have suggested that the nasal mucosa is also innervated by multiple efferent rami associated with the sphenopalatine artery (SPA) in the procedure "posterior nasal neurectomy." This ana-

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

Lee

Chakravarty

Ellul

2022

Clinical Otolaryngology

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Background Rhinitis affects up to 40% of the population worldwide and can significantly reduce quality of life. Some patients remain symptomatic despite maximal medical therapy. In refractory cases, posterior nasal neurectomy (PNN—the endoscopic division of the intranasal nerve branches containing postganglionic parasympathetic fibres) is postulated to reduce symptom burden. Objectives of Review To establish whether PNN is effective and safe in the management of allergic and non‐allergic rhinitis. Type of Review Systematic review. Methods A comprehensive literature search was undertaken using PubMed, EMBASE, MEDLINE, and Cochrane. The inclusion criteria were: studies published in English, studies where PNN was performed either with or without additional procedures, and where measures of objective/subjective outcomes and/or complications were reported. Extracted data included study type, sample size, surgical technique, study population characteristics, follow‐up period, outcome measures, complications of surgery, and symptom outcomes. Results A total of 23 articles satisfied the inclusion criteria studying in total 2282 patients. Sample size ranged from 8 to 1056. There were 3 randomised controlled trials, 3 case‐control studies, and the remaining 17 were case series using both objective and subjective outcome measures. All but one study found improved patient‐reported outcomes following PNN. Complications were reported in 14 studies—epistaxis was the most common complication and was observed in 30 patients (1.5% of subjects). Conclusions PNN had a low rate of complications. Although most studies reported significant symptomatic improvement, their heterogeneity, level of evidence, study design, and/or quality was not sufficient to draw any firm conclusions on the effectiveness of the procedure. Larger, well‐designed studies are needed to clarify its role in the management of difficult‐to‐treat rhinitis.

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Long-term effectiveness, safety, and quality of life outcomes following endoscopic posterior nasal neurectomy with submucosal turbinectomy for the treatment of intractable severe chronic rhinitis

Cited by 10 publications

References 35 publications

Endoscopic posterior nasal neurectomy for intractable rhinitis: a systematic review of the literature Running Title: Endoscopic PNN: a systematic review

Endoscopic posterior nasal neurectomy for intractable rhinitis: a systematic review of the literature Running Title: Endoscopic PNN: a systematic review

The anatomy of the foramina and efferent nerve fibers from the pterygopalatine ganglion in posterolateral nasal wall

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

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