Novel Surgical Approach to Posterior Nasal Neurectomy without Identifying the Posterior Nasal Nerve

Introduction  Posterior nasal neurectomy (PNN), a procedure used to manage intractable allergic rhinitis, requires precise identification of the posterior nasal nerve and associated neurovascular bundles within the posterior nasal region, including the sphenoid artery. Mastery of reliable surgical techniques and considerable experience are imperative for successful execution.

Objectives  We describe a novel surgical strategy for posterior nasal neurectomy that circumvents the need to directly identify the posterior nasal nerve directly.

Methods  To clarify the effects of PNN, pre- and post-operative symptoms, including rhinorrhea, sneezing, and nasal obstruction, were evaluated in patients who underwent PNN using scores derived from the Practical Guidelines for Management of Allergic Rhinitis in Japan 2020. Additionally, preoperative and postoperative (>12 months) medication status and postoperative PNN complications were meticulously documented.

Results  This retrospective study included 80 patients who underwent PNN between January 2016 and December 2021; 46 of the 80 patients agreed to participate in the survey questionnaire, and the responses of these 46 patients were used for the analysis. Postoperatively, all patients were followed up in the outpatient clinic for >12 months (mean, 18 months). Among the 46 patients, the scores for all allergic symptoms showed significant improvement at 12 months postoperatively compared with the preoperative scores. The proportion of patients who received daily anti-allergic medications decreased from 93.5% (43/46) preoperatively to 15.2% (7/46) postoperatively. No severe complications occurred in any patient.

Conclusions  This innovative surgical approach demonstrated efficacy in ameliorating the symptoms associated with allergic rhinitis without concomitantly escalating procedural risks.

Keywords
allergic rhinitis; nasal obstruction; sneezing; rhinorrhea; endoscopic posterior nasal neurectomy