POSTERIOR NASAL NEURECTOMY WITH SURGERY скачать в хорошем качестве

POSTERIOR NASAL NEURECTOMY WITH SURGERY

Posterior Nasal Neurectomy (PNN) Dr. Sunil Kumar Sharma, MS ENT 1: Introduction • Posterior Nasal Neurectomy (PNN) is a minimally invasive surgical treatment for intractable allergic or vasomotor rhinitis. • Targets posterior nasal nerves (branches of the vidian nerve) to reduce parasympathetic nasal secretions. 2: Indications • Refractory allergic rhinitis not responding to maximal medical therapy • Non-allergic rhinitis (Vasomotor rhinitis) • Profuse watery rhinorrhea as the main symptom • Failure of other procedures like turbinate reduction 3:Contraindications • Active infection • Bleeding diathesis • Poor general health (not fit for GA) • Primary complaint is nasal obstruction (not secretions) 4: Anatomy of Posterior Nasal Nerve • The posterior nasal nerve arises from the pterygopalatine ganglion. • Enters nasal cavity through sphenopalatine foramen. • Supplies: • Nasal glands • Nasal mucosa of inferior and middle turbinate • Lateral nasal wall 5: Goals of Surgery • Reduce parasympathetic innervation • Decrease mucous hypersecretion • Reduce nasal congestion and sneezing • Preserve sympathetic fibers to avoid dryness 6: Surgical Approach (Endoscopic) 1. General anesthesia 2. Lateralization of middle turbinate 3. Identification of sphenopalatine foramen posterior to the posterior attachment of middle turbinate 4. Dissection of mucosa to expose posterior nasal nerve bundle 5. Sectioning or coagulation of nerve (typically 3–5 branches) #anatomy #biology #ent #ear #nosebleed #nose #science #otolaryngology #throathealth #tonsils