We are often faced with patients with intractable watery rhinorhea – patients with no demonstrable allergy, a diagnosis of NAR and no response to ipratropium or capsaicine. For such patients, vidian neurectomy has been devised – an old technique that had been discredited because of its high complications and poor efficacy. However, the use of endoscopes has given new life to this old technique – and the endoscopic version of it, as described by Kamel and Wormald, is increasingly gaining popularity. These authors from Canada have carried out one of the few prospective (but uncontrolled) studies of endoscopic vidian neurectomy, as performed on 11 patients and 22 sides. All patients underwent an opthalmological consultation before and after the operation (to asses for xerophthalmia, one of the most feared complications of the technique) while the PROM used was SNOT 22 and SSQ. The technique used was the pterygomaxilary approach, the one most commonly used (and my personal favourite). None of the patients suffered a dry eye after surgery, while the mean follow- up was a year and a half. SNOT 22 decreased from a very high 44 to an almost normal 10 after surgery. Overall, this study, despite its limitations, provides some of the best evidence for the efficacy and safety of endoscopic vidian neurectomy. 

Endoscopic vidian neurectomy: a prospective case series.
Zhang H, Micomonaco DC, Dziegielewski PT, Sowerby LJ, Weis E, Wright ED.
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Christos Georgalas

Academic Medical Center, The Netherlands.

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