A vidian neurectomy is a surgical procedure that involves severing or disrupting the vidian nerve. This nerve, also known as the nerve of the pterygoid canal, plays a role in controlling various bodily secretions. Specifically, it influences the production of mucus in the nose and tears in the eyes. The surgery is typically undertaken to alleviate persistent and severe nasal symptoms that have not responded to other forms of treatment.
Medical Reasons for the Procedure
The primary reason for performing a vidian neurectomy is to manage chronic non-allergic rhinitis, commonly referred to as vasomotor rhinitis. This condition causes a persistent runny nose, nasal congestion, and often a sensation of mucus dripping down the back of the throat, known as post-nasal drip. These symptoms occur without an identifiable allergic trigger and do not improve with standard treatments such as nasal sprays, decongestants, or antihistamines.
A vidian neurectomy is considered a treatment option when less invasive medical therapies have proven ineffective and other causes for chronic nasal symptoms have been ruled out. This procedure is also considered in less common instances for treating gustatory lacrimation, a condition where individuals experience excessive tearing while eating, sometimes called “crocodile tear syndrome.”
The Surgical Technique
Modern vidian neurectomy procedures are performed using a minimally invasive endoscopic approach. This means the surgery is carried out entirely through the nostrils, eliminating the need for any external incisions on the face. The procedure typically takes place in an operating room under general anesthesia, ensuring patient comfort and immobility.
The surgeon begins by inserting a thin tube equipped with a camera, called an endoscope, into the nasal cavity. This allows for a magnified and illuminated view of the internal structures. The endoscope guides the surgeon through the nasal passages to the specific area where the vidian nerve is located, deep within its bony canal.
Once the vidian nerve is precisely identified within the pterygoid canal, the surgeon proceeds to sever or cauterize it. This disruption of the nerve’s function reduces the signals that lead to excessive mucus production in the nose. Specialized instruments are used, ensuring accuracy while minimizing impact on surrounding tissues.
Post-Operative Expectations and Complications
Following a vidian neurectomy, patients may experience some immediate discomfort and light bleeding from the nose for approximately 24 to 48 hours. Nasal packing may be placed inside the nostrils temporarily to help control bleeding and support healing. Most individuals are advised to take one to three days off from work for initial recovery.
The procedure generally has a high success rate for reducing or eliminating a chronic runny nose. Patients often notice a reduction in nasal secretions within one to two weeks after the surgery. Improvements in nasal symptoms can be long-lasting, with some studies indicating sustained relief for up to seven years.
A common side effect of vidian neurectomy is a decrease in tear production, which can lead to chronic dry eye. This occurs because the vidian nerve also supplies fibers to the lacrimal gland, which produces tears. This symptom is reported in 35% to 72% of cases and can persist for one to five months post-operatively, though it often resolves or significantly improves over time.
Other potential complications, though less common, include numbness in the cheek or palate, reported in about 6% of patients. Nasal crusting and dryness within the nasal cavity may also occur in around 3.7% of individuals. Bleeding, often from branches of the sphenopalatine artery, is a possibility and can be managed with nasal packing or cautery during or after the procedure.