Vidian nerve cutting surgery

The article was consulted with Specialist Doctor I Tran Minh Tuan - Doctor of Ear, Nose and Throat - Head and Neck Surgery - Department of General Surgery - Vinmec Nha Trang International General Hospital.

Vidian neurectomy is indicated for patients with severe vasomotor rhinitis, severe rhinorrhea, who have been treated medically with drugs but have not improved. So, after the surgery to remove the vidian nerve, are there any complications?

The Vidian nerve is made up of the great petrous nerve that separates from the knee ganglia, and then joins the deep stone nerve from the carotid plexus. The Vidian nerve exits about 5 to 6 cm posterior to the palatine sphenoid ganglion.
Vidian neurectomy is endoscopic nasal surgery to cut the Vidian nerve.

Indications for Vidian nerve surgery for the following cases:
Patients with vasomotor rhinitis have been treated with medical therapy but do not respond, symptoms do not improve. Vasomotor rhinitis is a disease with symptoms similar to allergic rhinitis but the cause is unknown. The patient had lacrimation, severe nasal discharge and progressed to chronic. Vidian nerve surgery is contraindicated in the following cases:
Patient has chronic maxillary sinusitis. Children do not have permanent teeth yet.

Vidian nerve cutting surgery includes the following steps:
Step 1: The patient lies supine on the operating table. The doctor administers general anesthesia or local anesthesia. Step 2: The doctor puts a wick in the nose with a vasoconstrictor. Step 3: The position of the sphenoid foramen was determined to be located behind and above the medial caudal roller, about 1.2cm outside and above the posterior nasal opening. Use a blunt probe to probe the palatal foramen. Step 4: At the palatal sphenoid artery, the doctor will inject submucosal anesthesia. Inject into the large palatal foramen 2 ml of 1% xylocaine solution with 1:100,000 epinephrine to block the bilateral palatal sphenoid nerve prior to the exposure of the Vidian nerve. Step 5: The doctor uses a crescent knife to make an incision of the mucosa in a horizontal direction and about 5 - 10mm from the lower border of the sphenoid foramen, avoiding injury to the branches of the palatal sphenoid artery. Step 6: The doctor uses a graduated trowel to separate the mucosal flap close to the bone, then expand the mucosal flap upwards to reveal the palatal foramen. Use a curette to widen the palatal foramen posteriorly and downward if the foramen is small, thereby exposing the Vidian neural tube. Step 7: Immediately behind the female butterfly ganglion is the Vidian nerve, pull the ganglion anteriorly and use the hook to expose the Vidian nerve. Use surgical scissors to cut the Vidian nerve. Step 8: Cover the mucosal flap and insert gelfoam, merocel.

After 24 hours of Vidian nerve cutting surgery, the patient was withdrawn merocel, used painkillers, anti-inflammatory and antibiotics, physiological saline to wash the nose.
Patient may experience bleeding due to damaged palatine veins or arteries. The doctor can then manage the bleeding with wicking or electrocoagulation.
People with vasomotor rhinitis, severe rhinorrhea who have taken medicine but have not gone away can be indicated for surgical treatment of Vidian nerve cutting.
Otolaryngology - Vinmec International General Hospital specializes in examination and treatment of ENT diseases: Rhinitis, allergic rhinitis, vasomotor rhinitis, tonsillitis, sore throat, tinnitus, inflammation non-allergic nose, throat cancer; tumors of the head, face and neck, congenital malformations of the ear, nose and throat area by common surgical methods.
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