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Clinical assessment of diode laser-assisted endoscopic intrasphenoidal vidian neurectomy in the treatment of refractory rhinitis

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Abstract

For chronic rhinitis that is refractory to medical therapy, surgical intervention such as endoscopic vidian neurectomy (VN) can be used to control the intractable symptoms. Lasers can contribute to minimizing the invasiveness of ENT surgery. The aim of this retrospective study is to compare in patients who underwent diode laser-assisted versus traditional VN in terms of operative time, surgical field, quality of life, and postoperative complications. All patients had refractory rhinitis with a poor treatment response to a 6-month trial of corticosteroid nasal sprays and underwent endoscopic VN between November 2006 and September 2015. They were non-randomly allocated into either a cold instrument group or a diode laser-assisted group. Vidian nerve was excised with a 940-nm continuous wave diode laser through a 600-μm silica optical fiber, utilizing a contact mode with the power set at 5 W. A visual analog scale (VAS) was used to grade the severity of the rhinitis symptoms for quality of life assessment before the surgery and 6 months after. Of the 118 patients enrolled in the study, 75 patients underwent cold instrument VN and 43 patients underwent diode laser-assisted VN. Patients in the laser-assisted group had a significantly lower surgical field score and a lower postoperative bleeding rate than those in the cold instrument group. Changes in the VAS were significant in preoperative and postoperative nasal symptoms in each group. The application of diode lasers for vidian nerve transection showed a better surgical field and a lower incidence of postoperative hemorrhage. Recent advancements in laser application and endoscopic technique has made VN safer and more effective. We recommend this surgical approach as a reliable and effective treatment for patients with refractory rhinitis.

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References

  1. Bernstein JA (2010) Allergic and mixed rhinitis: epidemiology and natural history. Allergy Asthma Proc 31:365–369

    Article  PubMed  Google Scholar 

  2. Wu AW, Ting JY (2014) Indications for surgery in refractory rhinitis. Curr Allergy Asthma Rep 14:414

    Article  PubMed  Google Scholar 

  3. Marshak T, Yun WK, Hazout C, Sacks R, Harvey RJ (2016) A systematic review of the evidence base for vidian neurectomy in managing rhinitis. J Laryngol Otol 130(Suppl 4):S7–S28

    Article  PubMed  Google Scholar 

  4. Zhang H, Micomonaco DC, Dziegielewski PT, Sowerby LJ, Weis E, Wright ED (2015) Endoscopic vidian neurectomy: a prospective case series. Int Forum Allergy Rhinol 5:423–430

    Article  PubMed  Google Scholar 

  5. Ma Y, Tan G, Zhao Z, Li W, Huang L, Liu G (2014) Therapeutic effectiveness of endoscopic vidian neurectomy for the treatment of vasomotor rhinitis. Acta Otolaryngol 134:260–267

    Article  PubMed  Google Scholar 

  6. Tan G, Ma Y, Li H, Li W, Wang J (2012) Long-term results of bilateral endoscopic vidian neurectomy in the management of moderate to severe persistent allergic rhinitis. Arch Otolaryngol Head Neck Surg 138:492–497

    Article  PubMed  Google Scholar 

  7. Lee JC, Lin YS (2012) Endoscopic vidian neurectomy: update on techniques and evidence. Curr Opin Otolaryngol Head Neck Surg 20:66–72

    Article  PubMed  Google Scholar 

  8. Su WF, Liu SC, Chiu FS, Lee CH (2011) Antegrade transsphenoidal vidian neurectomy: short-term surgical outcome analysis. Am J Rhinol Allergy 25:e217–e220

    Article  PubMed  Google Scholar 

  9. Golding-Wood PH (1961) Observations on petrosal and vidian neurectomy in chronic vasomotor rhinitis. J Laryngol Otol 75:232–247

    Article  CAS  PubMed  Google Scholar 

  10. Minnis NL, Morrison AW (1971) Trans-septal approach for vidian neurectomy. J Laryngol Otol 85:255–260

    Article  CAS  PubMed  Google Scholar 

  11. Golding-Wood PH (1973) Vidian neurectomy: its results and complications. Laryngoscope 83:1673–1683

    Article  CAS  PubMed  Google Scholar 

  12. Fernandes CM (1988) The management of intractable vasomotor rhinorrhoea by transnasal vidian neurectomy. S Afr Med J 74:280–282

    CAS  PubMed  Google Scholar 

  13. Kamel R, Zaher S (1991) Endoscopic transnasal vidian neurectomy. Laryngoscope 101:316–319

    CAS  PubMed  Google Scholar 

  14. El-Guindy A (1994) Endoscopic transseptal vidian neurectomy. Arch Otolaryngol Head Neck Surg 120:1347–1351

    Article  CAS  PubMed  Google Scholar 

  15. Robinson SR, Wormald PJ (2006) Endoscopic vidian neurectomy. Am J Rhinol 20:197–202

    PubMed  Google Scholar 

  16. Pandolfo I, Gaeta M, Blandino A, Longo M (1987) The radiology of the pterygoid canal: normal and pathologic findings. AJNR Am J Neuroradiol 8:479–483

    CAS  PubMed  Google Scholar 

  17. Mato D, Yokota H, Hirono S, Martino J, Saeki N (2015) The vidian canal: radiological features in Japanese population and clinical implications. Neurol Med Chir (Tokyo) 55:71–76

    Article  Google Scholar 

  18. Liu SC, Wang HW, Kao HL, Hsiao PC, Su WF (2013) Three-dimensional bone CT reconstruction anatomy of the vidian canal. Rhinology 51:306–314

    CAS  PubMed  Google Scholar 

  19. Lee JC, Lai WS, Ju DT, Chu YH, Yang JM (2015) Diode laser assisted minimal invasive sphenoidotomy for endoscopic transphenoidal pituitary surgery: our technique and results. Lasers Surg Med 47:239–242

    Article  PubMed  Google Scholar 

  20. Newman J, Anand V (2002) Applications of the diode laser in otolaryngology. Ear Nose Throat J 81:850–851

    PubMed  Google Scholar 

  21. Sroka R, Janda P, Killian T, Vaz F, Betz CS, Leunig A (2007) Comparison of long term results after Ho:YAG and diode laser treatment of hyperplastic inferior nasal turbinates. Lasers Surg Med 39:324–331

    Article  PubMed  Google Scholar 

  22. Lee JC, Hsu CH, Kao CH, Lin YS (2009) Endoscopic intrasphenoidal vidian neurectomy: how we do it. Clin Otolaryngol 34:568–571

    Article  PubMed  Google Scholar 

  23. Lee JC, Kao CH, Hsu CH, Lin YS (2011) Endoscopic transsphenoidal vidian neurectomy. Eur Arch Otorhinolaryngol 268:851–856

    Article  PubMed  Google Scholar 

  24. Gerlinger I, Lujber L, Jarai T, Pytel J (2003) KTP-532 laser-assisted endoscopic nasal sinus surgery. Clin Otolaryngol Allied Sci 28:67–71

    Article  CAS  PubMed  Google Scholar 

  25. Boezaart AP, van der Merwe J, Coetzee A (1995) Comparison of sodium nitroprusside- and esmolol-induced controlled hypotension for functional endoscopic sinus surgery. Can J Anaesth 42:373–376

    Article  CAS  PubMed  Google Scholar 

  26. Liberman J, Stewart W, Seines O, Gordon B (1994) Rater agreement for the Rey-Osterrieth Complex Figure Test. J Clin Psychol 50:615–624

    Article  CAS  PubMed  Google Scholar 

  27. Fernandes CM (1994) Bilateral transnasal vidian neurectomy in the management of chronic rhinitis. J Laryngol Otol 108:569–573

    Article  CAS  PubMed  Google Scholar 

  28. Jang TY, Kim YH, Shin SH (2010) Long-term effectiveness and safety of endoscopic vidian neurectomy for the treatment of intractable rhinitis. Clin Exp Otorhinolaryngol 3:212–216

    Article  PubMed  PubMed Central  Google Scholar 

  29. Su WF, Liu SC, Hsu WC, Chen YC (2014) Randomized, double-blind, controlled study to evaluate the effect of vidian nerve cauterization on lacrimation. Am J Rhinol Allergy 28:255–259

    Article  PubMed  Google Scholar 

  30. Beer F, Korpert W, Passow H, Steidler A, Meinl A, Buchmair AG, Moritz A (2012) Reduction of collateral thermal impact of diode laser irradiation on soft tissue due to modified application parameters. Lasers Med Sci 27:917–921

    Article  CAS  PubMed  Google Scholar 

  31. Judy MM, Matthews JL, Aronoff BL, Hults DF (1993) Soft tissue studies with 805 nm diode laser radiation: thermal effects with contact tips and comparison with effects of 1064 nm Nd:YAG laser radiation. Lasers Surg Med 13:528–536

    Article  CAS  PubMed  Google Scholar 

  32. AlGhamdi KM, Kumar A, Moussa NA (2012) Low-level laser therapy: a useful technique for enhancing the proliferation of various cultured cells. Lasers Med Sci 27:237–249

    Article  PubMed  Google Scholar 

  33. Borzabadi-Farahani A (2016) Effect of low-level laser irradiation on proliferation of human dental mesenchymal stem cells; a systemic review. J Photochem Photobiol B 162:577–582

    Article  CAS  PubMed  Google Scholar 

  34. Ciprandi G, Mora F, Cassano M, Gallina AM, Mora R (2009) Visual analog scale (VAS) and nasal obstruction in persistent allergic rhinitis. Otolaryngol Head Neck Surg 141:527–529

    Article  PubMed  Google Scholar 

  35. Bousquet J, Hellings PW, Agache I, Bedbrook A, Bachert C, Bergmann KC, Bewick M, Bindslev-Jensen C, Bosnic-Anticevitch S, Bucca C et al (2016) ARIA 2016: care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle. Clin Transl Allergy 6:47

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Otolaryngology–Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, 325, Cheng-Kung Road, Sec. 2, Neihu District, Taipei, 114, Taiwan

    Wen-Sen Lai, Sheng-Yao Cheng, Yuan-Yung Lin, Hung-Che Lin, Li-Hsiang Cheng & Jih-Chin Lee

  2. Department of Otolaryngology–Head and Neck Surgery, Taichung Armed Forces General Hospital, Taichung, Taiwan

    Wen-Sen Lai

  3. Department of Biological Science and Technology, Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan

    Wen-Sen Lai, Li-Hsiang Cheng, Jinn-Moon Yang & Jih-Chin Lee

  4. School of Nursing, National Defense Medical Center, Taipei, Taiwan

    Pei-Lin Yang

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  1. Wen-Sen Lai
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Correspondence to Jih-Chin Lee.

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The study protocol was reviewed and approved by the Institutional Review Board at our institution (1-105-05-029).

Conflicts of interest

The authors declare that they have no conflicts of interest.

Financial disclosure

This work was supported in part by grants from the Research Fund of Tri-Service General Hospital (TSGH-C106-028), Taipei, Taiwan, and the Research Fund of Taichung Armed Forces General Hospital (106-A22), Taichung, Taiwan.

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Lai, WS., Cheng, SY., Lin, YY. et al. Clinical assessment of diode laser-assisted endoscopic intrasphenoidal vidian neurectomy in the treatment of refractory rhinitis. Lasers Med Sci 32, 2097–2104 (2017). https://doi.org/10.1007/s10103-017-2330-7

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  • DOI: https://doi.org/10.1007/s10103-017-2330-7

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