pterygoid neurectomy

The mechanism of the pterygotomy is to remove the parasympathetic nerves of the nose, so that the blood vessels of the nasal cavity and sinus are in a contracted state, and the secretion of nasal secretions and lacrimal glands is greatly reduced. After the removal of the pterygopalatine nerve, the lamina propria edema of the nasal mucosa epithelial cells is alleviated, the epithelium is restored to the pseudo-stratified state, the eosinophils disappear, and the mast cell degranulation is reduced. Therefore, the release of histamine, heparin and serotonin and other media are also reduced, postoperative allergy stimuli test can be negative. These results are the theoretical basis for the treatment of allergic rhinitis, vasomotor rhinitis and nasal polyps. Because the position of the wing tube is very deep, it is located outside the sphenoid sinus of the sphenoid pterygoid, and the inner side of the posterior wall of the maxillary sinus is equivalent to the posterior side of the lateral wall of the nasal cavity and parallel thereto. The outer hole of the wing tube is funnel-shaped. Therefore, it is necessary to perform a pterygotomy in the clinic. The operation is very complicated, and there are many methods, and each has its own advantages and disadvantages. Treatment of diseases: allergic rhinitis and nasal polyps Indication 1. Allergic rhinitis is not treated by medication. 2. Nasal polyps associated with allergic factors. Contraindications 1, with systemic diseases, can not tolerate surgery. 2, local infection, not suitable for surgery. Preoperative preparation Prepare for intranasal and maxillary sinus surgery. 1. Trim the nose hair and use it regularly in allergic rhinitis. 2. If nasal polyps should be taken before surgery, understand the development and inflammation of the sinus. Surgical procedure There are three methods of nasal, nasal septum and maxillary sinus surgery. First, nasal surgery After nasal surgery, the operation can be placed under the direct vision of the endoscope. The endoscope uses a hopkins0° or 30° sight glass. 1. Fracture the distal end of the middle turbinate, or remove the back end of the middle turbinate to make the field exposed widely. 2. Between the upper turbinate and the posterior end of the middle turbinate, which is equivalent to the intersection of the outer wall of the nasopharynx and the posterior wall of the apex, with the blunt tip of the curved probe and the pterygoid hole, it can be seen that there is a large thickness from the sphenoid hole. The blood vessels are oozing out, which is the branch of the blood vessels that the pterygoid artery distributes to the nasal cavity. The probe is then fixed here as a marker. 3. Use a miniature sickle knife behind the pterygopalatine hole to avoid the perforated blood vessel to cut the periosteum of the lateral wall longitudinally. The incision is up to 1 cm. 4. Peel off to the front first, in order to further confirm the trailing edge of the sphenoid hole. The funnel-shaped wing tube opening is then separated laterally backwards under the periosteum. 5. Under the direct vision of the endoscope, the wing tube nerves and blood vessels at the opening of the wing tube are cut off and electrocoagulated. The bone wax is closed at the opening, and the gelatin sponge is attached to the incision, and generally there is no need to block. 6. Or see the upper wall of the nostril, cut the mucosa and peel back to find the wing nerve, cut off and electrocoagulate with a spherical electrode. Second, nasal septal surgery The submucosal resection of the nasal septum was performed first, then the periosteum was removed posteriorly under the periosteum, directly to the anterior wall of the sphenoid sinus, and then separated to the outside of the sinus, reaching the root of the pterygoid, ie, the posterior superior part of the posterior nares, about 1 cm from the bone margin. So that it is possible to go to the funnel-shaped depression of the nerve hole of the wing tube. The electrocoagulation needle is then used to penetrate the wing tube hole to destroy the wing tube nerve. The wing canal can sometimes be seen under good lighting. Third, maxillary sinus surgery This method firstly performs maxillary sinus surgery, then removes the posterior maxillary sinus bone wall, cuts the posterior periosteum, enters the pterygopalatine fossa, looks for the internal maxillary artery, and ligates it. Or use a silver clip to block blood flow to prevent accidental bleeding. A circular hole is found along the infraorbital nerve, and the outer hole of the wing tube is determined from the round hole inward and downward, the wing tube nerve is cut, and electrocoagulated in the wing tube. The cleft lip incision is then sutured. Later, nomura improved this method by turning up the mucosa of the posterior horn of the maxillary sinus and exposing the bone wall of the posterior horn of the maxillary sinus. The opening of the wing tube is located behind the maxillary sinus, at the intersection of the inner wall and at the rear of the inner side wall. Remove the bone near the inner corner of the posterior wall of the maxillary sinus and part of the inner wall, and insert the gap between the mucosa of the outer wall of the nasal cavity and the periosteum of the posterior horn of the maxillary sinus with a stripper, and look for the wing tube opening in front of the sphenoid body under the microscope. The electric knife cuts off the wing tube nerve and electrocoagulates. The nomura method does not require opening the pterygopalatine fossa. In short, both methods are more complicated.