Historical, pathophysiological, and therapeutic aspects of vidian neurectomy.

Vidian neurectomy yields dramatic relief of nasal hypersecretion in patients with allergic rhinitis. Clinical studies conducted on vidian neurectomized nasal mucosa have shown that nasal hypersecretion observed after challenging the nasal mucosa with antigen is caused by reflexively induced activation of the parasympathetic center secondary to stimulation of the sensory nerve terminals in the nasal mucosa by histamine. On the contrary, nasal mucosal swelling is caused mostly by the direct effects of chemical mediators on the nasal vasculature, although vascular reflex mediated by the noncholinergic parasympathetic nerve may be partially involved in the onset of nasal mucosal swelling after antigen challenge. Considering the long-term side effects of inhibition of lacrimation and possible partial recurrence of hyperreactive nasal symptoms observed after vidian neurectomy, less invasive endoscopic posterior nasal neurectomy is considered the treatment of choice for patients with allergic rhinitis who require surgical intervention.