JW: Endoscopic intrasphenoidal vidian neurectomy: how we do it

Lee, J.-C.,* Hsu, C.-H.,*† Kao, C.-H.* & Lin, Y.-S.*
*Department of Otolaryngology–Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, and Department of Otolaryngology–Head and Neck Surgery, Taichung Armed Forces

Extract:
The new procedure was performed with the patient under general anaesthesia. The preoperative setting was the same as that for endoscopic sinus surgery. A rigid nasal endoscope with a 4-mm diameter and 0, 30or 70 was connected to a Charge Coupled Device camera (Karl-Storz, Tuttlingen, Germany). A cotton pledge soaked with 2 mL of 4% cocaine and 1 : 1000 epinephrine was used for topical nasal preparation. The anterior wall of the sphenoid sinus and the superior turbinate and posterior tip of the middle turbinate were infiltrated with 1% xylocaine with 1 : 100 000 epinephrine. The 0 endoscope was then inserted into the nasal cavity, and the middle turbinate was lateralized using a Freer elevator (Aesculp, Tuttlingen, Germany). Using the same instrument, the sphenoid sinus was entered by perforation of the anterior wall of the sphenoid sinus. Next, the
sphenoid sinus was opened laterally and inferiorly using a Kerrison rongeur (Aesculp General Hospital, aichung, aiwan Tuttlingen, Germany). The sphenoidotomy was enlarged until the vidian canal could be seen clearly by 30 or 70 endoscope.
Subsequently, the paper thin wall of the vidian canal was perforated and the nerve was severed using a curved instrument or laser under direct vision (Figs 2 and 3). After the vidian nerve was severed, the nasal cavity and sphenoid sinus were inspected; oozing or bleeding was trace and usually stopped spontaneously. The same procedure was repeated on the other side.
At the end of the procedure, the superior meatus was packed for 48 h. All patients were discharged after pack removal.

Source: Clinical Otolaryngology, Volume 34, Issue 6 (p 568-571)