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The Effect of Posterior Neurectomy as A Method of Surgical Parasympathectomy of the Nasal Mucosa for Management of Refractory Rhinitis

Objectives: According to the World Health Organization (WHO) definition, idiopathic rhinitis is a case of allergic rhinitis (AR) that occurs for more than 4 days per week and lasts for more than 4 consecutive weeks. The ramus specifically innervating the nasal mucosa called the posterior nasal nerve. Selective resection of this ramus dennervate nasal cavity from its parasympathetic supply and provides the same advantages of vidian neurectomy, without having its complications. Methods: This prospective study includes 30 adult patients diagnosed AR with failed medical treatment. The fibroneurovascular bundle including the Sphenopalatine Nerve emerging from the sphenopalatine foramen and the crista ethmoidalis is the landmark where the fibrovascular bundle is seen emerging from the foramen behind it. The nerve is carefully dissected from the artery by sickle knife and both ends are cauterized. All patients were evaluated in terms of rhinorrhea, sneezing and quality of life with Japanese Rhino-conjunctivitis Quality of Life Questionnaire (JRQLQ) classification prior to treatment and at 1, 3 and 6 months during the follow-up period. Results: Throughout the 6 months follow-up period, a significant difference in the degree of rhinorrhea and quality of life could be identified before and after posterior neurectomy. While sneezing improvement was minimal, before and after neurectomy. Posterior neurectomy was well tolerated by the patients, with no serious complications. Conclusion: posterior neurectomy seems to be a safe and efficient therapy for improvement of allergic rhinitis symptoms.