Efficacy of Additional (Selective) Vidian Neurectomy in Treating Chronic Rhinosinusitis with Nasal Polyp: A Systematic Review and Meta-Analysis.

INTRODUCTION: Recently, several reports have been published about the improvement of rhinitis symptoms through posterior nerve ablation. Therefore, we assess the effect of additional (selective) vidian neurectomy in patients with chronic rhinosinusitis with nasal polyp (CRSwNP) compared to conventional endoscopic sinus surgery. METHODS: We analyzed studies comparing the change of endoscopic findings and patient reporting scores (quality of life and nasal symptoms) related to CRSwNP from baseline (before treatment) to posttreatment between the treatment group (endoscopic sinus surgery plus [selective] vidian neurectomy) and the control group (endoscopic sinus surgery only). RESULTS: Additional (selective) vidian neurectomy significantly improved the Lund-Kennedy score and sinusitis-related life quality scores compared to the control group. In the subgroup analyses of these results according to neurectomy extent (conventional or selective vidian neurectomy), both types of vidian neurectomy changed the Lund-Kennedy score effectively. Conventional vidian neurectomy showed greater improvement of the patient-reported nasal symptom-related VAS than did selective vidian neurectomy, but there was no significant difference in the changes of sinusitis-related life quality scores between the two groups. Regarding the adverse effects of treatment, conventional vidian neurectomy led to significantly more frequent dry eyes than did selective vidian neurectomy. CONCLUSION: Selective vidian neurectomy, when performed in conjunction with endoscopic sinus surgery, provides additional benefits in enhancing endoscopic outcomes and alleviating symptoms in patients with CRSwNP. Vidian neurectomy can reduce nasal symptoms more effectively than selective vidian neurectomy, but there is no significant difference in sinus-related symptoms and there may be side effects.

Duke Scholars

Author David W Jang Rhinology and Skull Base Surgery