Endoscopic Endonasal Vidian Neurectomy

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  • 内視鏡下レーザー翼突管神経遮断術

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The effectiveness of vidian neurectomy in relieving the symptoms of vasomotor and allergic rhinitis is well established. Since the first description by Golding Wood, various surgical techniques have been reported, namely the transmaxillary, the transpalatal, the trans-septal, and the transnasal. Because they give patients some operative stress and have technical problems, however, they are applied to a very limited number of cases. In this article, a new technique of endonasal vidian neurectomy through a control hole is described. The advantages of this technique include : 1) There is no risk of bleeding from the sphenopalatine artery during the surgery because in this procedure the vidian nerve is approached through the control hole, not the sphenopalatine foramen ; 2) It is possible to operate even on children using the 4mm endoscope because the sphenopalatine foramen is approached from the middle meatus, which is larger than the superior meatus ; 3) There are only two proceduresmaking a short incision on the middle meatal mucosa and creating a small control hole on the vertical lamina of the palatine bone-necessary to reach the vidian nerve ; 4) The blood supply to the nasal mucosa can be preserved normally after surgery because there is no need to ligate the sphenopalatine artery to reach the vidian nerve.

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