WHEN conservative management fails to produce effective results in patients with vasomotor rhinitis, vidian neurectomy can be very helpful. It is also indicated for patients with "crocodile tears" after tympanic neurectomy fails.1
A satisfactory surgical approach for vidian neurectomy has been aided by the search for the sphenopalatine ganglion for the treatment of sphenopalatine neuralgia. Sewell2 has advocated the transantral approach to the sphenopalatine ganglion and others3-6 have used the same approach on the premise that vasomotor rhinitis is due to parasympathetic hyperactivity. Malcomson7 and Golding-Wood8 have performed petrosal neurectomy with successful results. This approach has not gained popularity because the greater superficial petrosal nerve has to be approached intracranially. Malcomson approached the vidian nerve by the transseptal route. He elevated the mucoperiosteum from the anterior wall and floor of the sphenoid sinus and reached a medial wall of the pterygoid plate where the nerve
Chandra R. Transpalatal Approach for Vidian Neurectomy. Arch Otolaryngol. 1969;89(3):542–545. doi:10.1001/archotol.1969.00770020544019
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