Hu Weini, Zuo Qiang, Wu Dawei, Song Yu
Peking University Third Hospital, Department of Otorhinolaryngology Head and Neck Surgery, Beijing, China.
Peking University Third Hospital, Department of Otorhinolaryngology Head and Neck Surgery, Beijing, China; Yan'an Traditionnal Chinese Medicine Hospital, Department of Otorhinolaryngology Head and Neck Surgery, Yan'an, China.
Braz J Otorhinolaryngol. 2025 May 27;91(5):101653. doi: 10.1016/j.bjorl.2025.101653.
This study aims to analyze how to perform a more minimally invasive and precise excision of posterior nasal neurectomy to reduce surgical time, minimize surgical trauma, and evaluate the clinical efficacy of this procedure in the treatment of moderate to severe persistent allergic rhinitis.
This study included a total of 110 patients, randomly divided into an experimental group and a control group based on whether preoperative CT three-dimensional positioning was used and whether middle turbinate mucosal graftcoverage was applied during surgery. In the experimental group, preoperative CT measurements were used to locate the sphenopalatine foramen, and intraoperatively, the accuracy of the positioning method was verified. Middle turbinate mucosal graftcoverage was applied to shorten the postoperative recovery time. Both groups were evaluated using Visual Analog Scales (VAS) and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) to compare the differences in symptoms between baseline and six months after operation. Regular endoscopic examinations were conducted to observe the status of mucosal epithelialization at the surgical site.
Preoperative CT measurements provided accurate intraoperative localization of the sphenopalatine foramen, allowing for a smaller surgical wound size. The average distance from the sphenopalatine foramen to the posteroinferior end of the uncinate process was 20.25 ± 2.69 mm, and from the sphenopalatine foramen to the upper edge of the inferior turbinate, it was 11.05 ± 1.71 mm. There was no statistically significant difference in preoperative symptom scores between the two groups (p > 0.05). At six months after operation, there were significant differences in VAS scores compared to baseline in both the experimental and control groups (p < 0.05). The average time for mucosal graftsurvival in the experimental group was 3.5 ± 1.0 weeks, while in the control group, the average time for exposed bone surface epithelialization was 9.0 ± 1.5 weeks.
Preoperative CT measurements for locating the sphenopalatine foramen and the use of middle turbinate mucosal grafts in the posterior nasal neurectomy are safe and effective. This new procedure reduces surgical wound size, shorten surgical time, accelerate postoperative wound recovery, and could possibly reduce complications of bleeding after surgery.
Level 3.
本研究旨在分析如何更微创、精准地进行后鼻孔神经切除术，以缩短手术时间，减少手术创伤，并评估该手术治疗中重度持续性变应性鼻炎的临床疗效。
本研究共纳入110例患者，根据术前是否使用CT三维定位及术中是否应用中鼻甲黏膜覆盖分为试验组和对照组。试验组采用术前CT测量定位蝶腭孔，术中验证定位方法的准确性，并应用中鼻甲黏膜覆盖以缩短术后恢复时间。两组均采用视觉模拟量表（VAS）和鼻结膜炎生活质量问卷（RQLQ）进行评估，比较基线及术后6个月症状的差异。定期进行鼻内镜检查，观察手术部位黏膜上皮化情况。
术前CT测量为蝶腭孔提供了准确的术中定位，使手术切口更小。蝶腭孔至钩突后下端的平均距离为20.25±2.69mm，至下鼻甲上缘的平均距离为11.05±1.71mm。两组术前症状评分差异无统计学意义（p>0.05）。术后6个月，试验组和对照组的VAS评分与基线相比均有显著差异（p<0.05）。试验组黏膜移植存活的平均时间为3.5±1.0周，而对照组骨面暴露上皮化的平均时间为9.0±1.5周。
术前CT测量定位蝶腭孔并在鼻后神经切除术中应用中鼻甲黏膜移植安全有效。这种新方法减小了手术切口大小，缩短了手术时间，加速了术后伤口恢复，并可能减少术后出血并发症。
3级。
