VIDIAN &SELECTIVE VIDIAN NEURECTOMY//PNN скачать в хорошем качестве

VIDIAN &SELECTIVE VIDIAN NEURECTOMY//PNN

Selective Vidian neurectomy and posterior nasal neurectomy are surgical options for managing chronic rhinitis and severe nasal hyperreactivity when other treatments fail. These procedures target the nerves involved in nasal gland secretion to reduce symptoms like persistent nasal congestion and rhinorrhea. Let’s start with Selective Vidian Neurectomy. The Vidian nerve contributes to the parasympathetic innervation of nasal glands. By targeting this nerve, surgeons can reduce excessive nasal secretions. There are two primary techniques: The endoscopic transnasal approach is commonly performed under general anesthesia. Using an endoscope, the surgeon accesses the sphenoid sinus through the nasal passage. With precise dissection, the Vidian nerve is identified and sectioned at its entry point to the pterygopalatine fossa. This technique offers a direct path with minimal external scarring and is highly effective in experienced hands. However, it carries a risk of complications like dry eye syndrome due to potential damage to the lacrimal gland innervation. Alternatively, the microscopic submucosal approach involves accessing the Vidian nerve through a lateral incision in the nasal mucosa, using a microscope for enhanced visualization. This method allows for targeted dissection while preserving surrounding structures, making it suitable for patients where precision is paramount. Though it requires more time and specialized equipment, it can reduce some risks associated with the endoscopic method, like excessive crusting and sinusitis. Comparing the two, the endoscopic approach is less invasive with quicker recovery times, but the microscopic method may be better for avoiding complications in complex anatomical cases. The choice often depends on surgeon expertise and patient-specific anatomy. Now, let’s look at the Posterior Nasal Neurectomy. This procedure specifically targets the posterior branches of the nasal nerves, including parts of the sphenopalatine ganglion. It is usually performed endoscopically and involves cutting or cauterizing the nerves that innervate the nasal mucosa. This reduces symptoms like nasal discharge and congestion without affecting the Vidian nerve directly. It’s a suitable option for patients with localized symptoms and those looking to avoid the potential ocular side effects associated with Vidian neurectomy. Indications for both Vidian neurectomy and posterior nasal neurectomy include chronic rhinitis and vasomotor rhinitis that have not responded to medical therapy, such as corticosteroids or anticholinergic nasal sprays. Posterior nasal neurectomy may be particularly useful when symptoms are confined to the nasal cavity, while Vidian neurectomy is more comprehensive for patients with a broader set of symptoms. Comparing the procedures, Vidian neurectomy tends to offer more extensive relief but carries higher risks, including dry eyes due to its effect on the lacrimal pathway. Posterior nasal neurectomy, while less extensive, has fewer risks and is often preferred when the goal is to minimize side effects. Understanding the nuances of these techniques helps clinicians choose the best approach for their patients, balancing the desired outcomes with the risks involved.”