Selective Endoscopic Resection of the Distal Branches of the Posterior Nasal Nerve Combined with Submucosal Inferior Turbinate Conchotomy

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  • 粘膜下下鼻甲介骨切除と併用した選択的後鼻神経切断術のアレルギー性鼻炎への有用性に関する検討

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Background: Allergic rhinitis refractory to medical treatment requires surgical intervention. Although several surgical procedures have been proposed, their indications are still controversial. We developed modified selective endoscopic resection of the peripheral branches of the posterior nasal nerve (PNN) with submucosal inferior turbinate conchotomy, and studied the efficacy of this new surgical procedure. <br>Patients and Methods: Twenty-six consecutive patients with severe allergic rhinitis refractory to medical treatment were enrolled in this study. The PNN diverges into two main branches near the sphenopalatine foramen. Each main branch diverges into several peripheral branches that terminate in the nasal glands distributed in the inferior turbinate mucosa. After inferior turbinate conchotomy, all these branches were endoscopically identified, ablated with electrocautery, and resected. Results were evaluated using Practical Guidelines for the Management of Allergic Rhinitis in Japan (2009). <br>Results: Substantial improvements in the scores for sneezing, rhinorrhea, nasal obstruction, and interference with daily life were observed and maintained for one year in most patients (P<0.01). Although there were several minor temporal complications, no major bleeding was observed. <br>Conclusions: The present results indicated that this modified selective endoscopic resection of the peripheral branches of the PNN with submucosal inferior turbinate conchotomy is a relevant surgical intervention for the treatment of refractory allergic rhinitis.<br>

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