Vidian neurectomy: Neuroanatomical considerations and a report on a new surgical approach

Abstract

If conventional treatment fails, vidian neurectomy is a viable alternative for therapy of chronic rhinitis with recurrent polyposis of the nose and sinuses. From a neuroanatomical point of view beneficial and adverse effects of this surgical procedure are discussed. According to our own investigations and experiences, vidian neurectomy should be performed together with clearing out of the sinuses in every case. Beginning with this precondition a new surgical approach was developed: the vidian nerve is detected through a transethmoidal route in the pterygoid canal at the bottom of the sphenoid sinus and dissected using the operation microscope.

Long-Term Effectiveness and Safety of Endoscopic Vidian Neurectomy for the Treatment of Intractable Rhinitis

“…Previous reports described vidian neurectomy using the transantral (1, 8), transnasal (2, 7, 9, 10), and transpalatal approaches (11). However, correct identification and adequate sectioning of the vidian nerve were not performed.…”

Endoscopic Vidian Neurectomy

“…The risk to the maxillary nerve is small because it is almost 1 cm farther lateral in the pterygopalatine fossa. In the past, the vidian nerve was approached transantrally 1,15 , transnasally, 2,3,7,16 or via the palate. 17 However, in most, the nerve was not identified and sectioned accurately.…”

The effect of vidian neurectomy on nasal mucociliary clearance

“…The opportunity to examine MCT in subjects in whom the nerve supply has been surgically interrupted might provide insight into the overall influence of autonomic control on MCT in man. The vidian nerve which arises from the fusion of the greater superficial and deep petrosal nerves supplies the autonomic innervation of the nasal mucosa (Rose et al, 1979). The greater superficial petrosal nerve contains preganglionic secretomotor fibres for the lacrimal, nasal and palatine glands and vasodilator nerves for the nasal mucous membrane.…”