Prevention of ultrasonic coagulator-mediated mucoperiosteal flap injury and defects by using a clip manipulation in the resection of the posterior nasal nerve.

We previously reported on the clinical effectiveness of functional inferior turbinosurgery utilizing modified vidian neurectomy, the resection of the posterior nasal nerve (PNN), combined with inferior turbinoplasty. In order to prevent re-innervation of the PNN after resection and to avoid postoperative massive hemorrhage--presumably resulting from insufficient fixation and unexpected exposure of the bony or cartilaginous fragments covered on the resected neurovascular bundle containing the sphenopalatine vessels and the PNN--we designed a surgical technique during which a vascular clip was used in order to provide traction of the mucoperiosteal flap. Then we compared it with the previous procedure (without the use of the clip). The injury and defects of the mucoperiosteal flap were evaluated by the degree of exposure to the bony or cartilaginous fragments and scored on a scale of 0 to 2 points. The defects of the mucoperiosteal flap were reduced by using a vascular clip. The average score of the defects was 0.97 +/- 0.73 (n = 64) in the conventional procedure without any manipulation and 0.27 +/- 0.45 (n = 60) in the procedure using a vascular clip. The difference observed between the two gropups was statistically significant (p < 0.001). These results demonstrated that this is a safe technique to prevent injury and defects of the mucoperiosteal flap in gaining access to expose the PNN. This should promote early wound healing, reduce the chance of recurrence and of postoperative massive hemorrhage.