For whom asking about posterior nasal neurectomy for management of sever refractory nasal

allergy or vasomotor rhinitis. I share this attached video for a case operated by our team in
minia university hospital. I prefer to name this surgery as selective surgical para-
sympathectomy. As presented in video; we cut and/or cauterize the two main branches of the
sphenoethemoidal postganglionic ramus of the pterygopalatine ganglion which gives a
parasympathetic supply to the posterolateral part of nasal mucosa; superior branch correctly
named sphenopalatine branch which wrongly known as superior branch of posterior lateral
nasal nerve (SPLN) and inferior branch correctly named posterior lateral nasal nerve which
wrongly known as inferior branch of posterior lateral nasal nerve (IPLN)

Excellent demonestration
What is the effect of this procedure on the allergic nasal symptoms .... does all symptoms
improve ??
and for how long ??

We have now about 9 months follow up for about 20 cases with marvellous results . It is about
90% for all allegic symptoms such PND, anterior rhino rhea, pruritus and sneezing. We are
working on a new research about using this tec‫ة‬hnique for managing intractable sever nasal
allergy depending on the concept of doing selective parasympathetctomy for the posterolateral
part of nasal mucosa, mucus glands

excellent job Dr mostafa .... but I believe that like most nasal surgeries .... the follow up period
should be at least 2 years .... so that you can call the effect ... perminant

Great job
Great surgeon and anaesthiologist
But iwant to ask some questions
I- for allergic and non allergic rhinitis or not
2.duration and type of treatment allergic rhinitis that can i do this surgery after
3.is it good for nasal obstruction
And you do turbinoplasty with it or not
4is it a must to dissect the nerve or can i cauterize it
5.what is your opinion about this device

Herin are the answers for your questions:

1. This technique is suitable for both allergic and vasomotor rhinitis as it depends upon doing
surgical parasympathectomy for nasal mucosa which can be done also medically as in Botox
injection turbinal and septal rather than working upon the pathophysiology of the disease
2. We call it refractory if failed responding to medications or recures shortly after stopping
medications which continued for 3 months (antihistamine , local steroids, montelukast and short
course of systemic steroids )
3. Our prefered technique in all cases is combined surgical nasal parasympathectomy with
bilateral partial inferior turbinectomy not turbinoplasty or submucous diathermy as here we are
not in the situation of preserving mucosa we need to resect good part of medial surface turbinal
mucosa that has the maximum concentration of mucosal receptors
4. We prefer to dissecte the superior branch from the SPA but in difficult cases we cautrize it
with artery directly
5. Lastly, I have no idea about this device and its mechanism of action

Good job but what about post operative nasal dryness?

It is near impossible to get nasal dryness with this technique thus it called selective
parasympathetctomy of nasal mucosa as compared with vidian neurectomy which represents
near total parasympathectomy not only for nasal mucosa but also for lacrimal apparatus

Vidian neurectomy was designed for management of "vasomotor rhinitis" which is cancelled
now due to reasons, the most important is the suspiciousness of existance of this category of
diease or at least it is difficult to have a sure diagnosis of it. In our dept. 30 years ago one of our
respectable Prof. tried to extend the indication of vidian neurectomy to management of allergi
rhinitis and I made my MS thesis on this topic as well as Dr. Mah Abd Aziz, but actually in my
follow up of the few cases done " transpalatal", the effects in allergic rhinitis was not
satisfactory.

To improve your outcome results in the surgical parasympathectomy for management of

refractory nasal allergy, you have to realize an important fact:
It is not only one postganglionic never that should be cutted and cautrized it is multiple
postganglionic neveres. It is our 4 steps procedure