Case

Female, 41 years old, came to the ENT Rhinology clinic on 28-9-2016 with
facial pain (VAS=6) for 2 years, watery eyes, nasal congestion felt present
(VAS=4) for 2 years, complaints of feeling of flowing in the throat (VAS=4) 1
year and sleep disturbances (epworth sleepiness scale = 10) 1 year. Runny
nose, itching in the nose or sneezing is not felt, there is no sniffing disorder or
coughing.

Physical examination found that there was edema of the right and left nasal
turbinates, post nasal drip on the right and left nose, there was a deviated
septum in the medial 1/3 of the left nose that was in contact with the left nasal
turbinate. Allergy test showed that there was no allergy in the patient. The
patient had previously received nasal spray and nasal wash for 3 months and
the complaints only decreased slightly. The patient was diagnosed with
nonallergic rhinitis with sleep disordered breathing and deviated septum. The
patient was then planned for posterior nasal nerve neurectomy, mini
functional endoscopic sinus surgery and septoplasty on 13-10-15.

The patient underwent an unsinectomy and middle meatus anthrostomy, then

an elliptical incision of 1.5 cm superior to the inferior turbinate was made to
the horizontal lamella basalis of the middle turbinate, then the mucoperiosteal
flap was opened to reveal the ethmoidal crest and sphenopalatine foramen,
posterosuperior nasal nerve dissection was performed and then cauterization
was performed. There is no reinnervation of the posterosuperior nasal nerve.
In the left nasal cavity there is an additional posterior nasal nerve which is
thought to be an inferoposterior nasal nerve. This nerve is anteroinferior to the
sphenopalatine foramen.

The patient was then performed septoplasty with a killian incision, the left side
of the mucoperichondrium was removed and an inferior and superior tunnel
was made and continued to the osseocartilage margin. Cartilage was
performed 0.5 from the mucoperichondrium incision, the contralateral
mucoperichondrium flap was removed to form an inferior and superior tunnel,
followed by posterior and inferior chondrotomies, the nasal crest of the
palatine bone was chiseled, the perpendicular lamina of the ethmoid bone and
the deviated cartilage was removed. The incision wound was stitched and
netcell tampons were placed on both noses to prevent nasal hematomas.

The patient was hospitalized for 2 days, before going home the tampon was
removed and evaluated, the right and left nasal cavities were spacious,
inferior turbinate edematous, medial turbinate edema, visible clotting in the
middle meatus, the maxillary sinus ostium was open and the mucoperiosteal
flap was good, the suture wound on the septum was good, not there is a
perforation. The patient was given antibiotics and analgesics and was advised
to wash the nose.

The patient was then followed up 2 weeks postoperatively, there were still
complaints of facial pain (VAS-4), watery eyes, no nasal congestion, runny
nose, feeling of running behind the throat, decreased sleep disturbances
(epworth sleepiness scale 6) On nasoendoscopic examination, both were
found. nasal cavity field, inferior turbinate eutrophic, median turbinate
eutrophic, middle meatus field minimal clotting at middle meatus, maxillary
sinus ostium is open and mecoperiosteal flap is good, suture wound to
septum is good, there is no perforation. The patient is then given topical
steroids and nasal wash.

After 3 years of follow-up, the complaints of watery eyes were still present,
there was no pain, no nasal congestion, no facial pain, sleep disturbances
were greatly reduced (epworth sleepiness scale = 4). On nascendoscopic
examination, it was found that on nascendoscopic examination, the right and
left nasal cavities were found, inferior turbinate was eutrophic, media was
eutrophic, middle meatus was open, maxillary sinus ostium was open and the
septum was not deviated. The patient is then given topical steroids and nasal
wash.

The patient then went to the ophthalmology clinic for watery eyes and said the
obstruction of the right and left nasolacrimal ducts, the patient then underwent
an open dacryocystorinostomy on the left nasolacrimal duct in January 2016
and a dacryocystorinostomy with an endoscopic approach to the right
nasolacrimal duct in October 2016.

After a 1-year follow-up, there were no complaints of pain, no nasal

congestion, no facial pain, no sleep disturbances (epworth sleepiness scale =
4). On nascendoscopic examination, the right and left nasal cavities were airy,
inferior turbinate was eutrophic, slightly granulation and stent was seen on the
lacrimal duct with mucopurulent secretions in the right nasal cavity, eutrophic
median conchae, open middle meatus, open maxillary sinus ostium and no
deviated septum.

The patient was then given topical steroids and nasal washes.