electronic-Perak Medical Journal. August 2019; Volume 1, Special Issue 2
Journal homepage: http://gids.mohe.gov.my/index.php/pmj
49 CONFERENCE PROCEEDINGS
This abstract was submitted to Perak Research Conference 2019 20 August 2019
VIDIAN NEURECTOMY – TECHNIQUE FESEABILITY AND OUTCOMES
Harvinder Singh, Pospanathan Pravina
Otorhinolaryngology Department, Raja Permaisuri Bainun Hospital, Ministry of Health MALAYSIA
ABSTRACT
INTRODUCTION AND OBJECTIVES
Vidian Neurectomy is a surgical technique which aims to disrupt the autonomic supply with reduction in nasal symptoms and is usually offered as a last resort to non-allergic rhinitis patients with persistent and disabling symptoms refractory to maximal medical therapy.
Symptoms significantly affects patient’s quality of life, fatigue, headache, cognitive impairment and sleep disturbance. This case series describes five cases of non-allergic rhinitis patients who have undergone Vidian Neurectomy procedure.
CASE PRESENTATION Case 1
A 46-year-old Malay female under ENT follow up for vasomotor rhinitis. Patient initially was started on Budesonide nasal spray with anti-histamines, but after follow up for three months, noted patient’s symptoms were not improving and unable to control rhinitis, sneezing, nasal blocks and post nasal drips, despite on medical treatment. Endoscopic examination, bilateral medial meatus clear, small septal spur on right nasal cavity, with bilateral moderate inferior turbinate hypertrophy. Patient was then subjected for Vidian Neurectomy. Evaluation of SNOT-20 score pre 81 and post-op 15 for this patient showed a vast improvement in symptoms.Post op three months, Schirmer’s test performed by the ophthalmology team, patient had mild to moderate dry eyes bilaterally and palatal numbness.
Case 2
A 53-year-old Indian female known case of hypertension and long standing vasomotor rhinitis. Patient have been using nasal spray and anti-histamines for the longest time since 1998. In year 1999 she underwent trimming of Inferior turbinate and antral washout for VMR.
Despite being on maximum medical therapy patient’s rhinitis, nasal block and sneezing was persistent over the years. Endoscopic examination showed bilateral inferior turbinate hypertrophy with nasal congestion. In year 2016 patient agreed for Vidian Neurectomy.
Pre (68) and post (8) SNOT-20 score show tremendous difference. Patient was then subjected for Schirmer’s test after 3 months’ post op, noted mild to moderate dry eyes bilaterally and was given GUTT (Artificial tears). She also complaint of palatal numbness which resolved after.
Case 3
A 40-year-old Indian male, no comorbids. Presented to ENT clinic with nasal block, rhinitis and sneezing. Patient was then started with Nasal spray and anti-histamines, but patient still complaint of persistent symptoms and not
improving despite being on medical therapy. Endoscopic examination, right deviated nasal septum and inferior turbinate hypertrophy, with nasal mucosa congested with mucus. Patient then underwent Vidian Neurectomy, Pre (72) and post-op (3) SNOT-20 score. Three months’ post-surgery, schirmer’s test, patient had mild dry eyes.
Case 4
A 38-year-old Malay female, no comorbid. Presented with nasal block with sleepless nights and rhinitis uncontrollable despite on nasal spray and anti-histamines. Patient is also a mouth breather. Initially, suspected for Obstructive sleep apnoea, but AHI was low, and was able to rule out OSA. Endoscopic examination, mild deviated nasal septum, bilateral inferior turbinate hypertrophy, and no polyps.
Sleepless nights due to nasal block and rhinitis, patient was subjected for Vidian Neurectomy as a last resort for the uncontrollable symptoms. Pre (53) and Post-op (8) SNOT-20 score as showed in Table 1 showed so much improvement in symptom wise Post surgery.
Three months’ post-surgery schirmer’s test, no eye dryness, but patient had mild palatal numbness.
Case 5
A 31-year-old Malay male, no comorbid. Under Ent clinic for Vasomotor rhinitis (non-allergic rhinitis), on nasal spray and anti- histamines. Patients main complaint was uncontrollable sneezing when exposed to dust and cold weather and even air-conditioned room. Despite giving maximal medical treatment patient still had persistent symptoms and was keen for Vidian Neurectomy and Septoplasty. Endoscopic examination, deviated nasal septum, with congested nasal mucosa and hypertrophied inferior turbinates. Pre (27) and post-op (1) SNOT-20 as shown in Table 1. Patient also had left cheek numbness post op. Three-month post-operative schirmer’s test patient had mild eye dryness.
CONCLUSION
Endoscopic Vidian Neurectomy does have a significant and important role in the surgical management of refractory rhinitis. Endoscopic visualization of the vidian nerve and better comprehension of the anatomy has enabled us to precisely locate and transect the Vidian nerve. All of our patients had showed vast improvement in their rhinology, sleep and psychological symptoms.
electronic-Perak Medical Journal. August 2019; Volume 1, Special Issue 2
Journal homepage: http://gids.mohe.gov.my/index.php/pmj
50 CONFERENCE PROCEEDINGS
This abstract was submitted to Perak Research Conference 2019 20 August 2019
