LECTURE PROPOSAL

Title: Endoscopic Transnasal Vidian Neurectomy and Pterygopalatine Fossa Anatomy

Authors:

1. Assoc. Prof. Ercan Akbay, MD

Department of Otorhinolaryngology, Aksaray İnova Hospital, Aksaray, Turkey

2. Sümeyye Akbay

Anatomy Postgraduate Student

Format & Duration: Video Presentation

Abstract

Background & Objectives: Vasomotor rhinitis (VMR) is a non-allergic chronic rhinitis characterized by vascular dysfunction within the nasal cavity and autonomic nervous system imbalance. In cases of medically refractory and resistant VMR, Endoscopic Transnasal Vidian Neurectomy—an advanced autonomic denervation surgery—is performed to control hypersecretion and vasodilation. This video presentation aims to demonstrate the vidian neurectomy surgical procedure guided by anatomical landmarks, and to discuss the deep anatomical structures of the pterygopalatine fossa, vidian nerve, and paranasal region from a surgical perspective.

Surgical Technique & Methods: The procedure is performed endoscopically under general anesthesia. Following the identification of the lateral nasal wall landmarks, a mucoperiosteal flap is elevated to access the sphenopalatine foramen. Precise dissection is required to expose the medial boundary of the pterygopalatine fossa. Upon localization of the vidian canal (canalis pterygoideus), the vidian nerve—comprising fibers from the nervus petrosus major and nervus petrosus profundus—is identified. Selective neurectomy is performed at this level, followed by measures to ensure the stability of the surgical site and prevent neural regeneration. The procedure concludes with the repositioning of the mucosal flap and appropriate stabilization.

Conclusion & Significance: This video presentation provides a comprehensive, step-by-step demonstration of endoscopic transnasal vidian neurectomy. By highlighting the critical anatomical landmarks of the pterygopalatine fossa, this work aims to contribute to the surgical success and safety of autonomic denervation procedures. It serves as a practical anatomical guide for clinicians managing refractory vasomotor rhinitis.

Assoc. Prof. Ercan Akbay, MD

Aksaray İnova Hastanesi Kulak Burun Boğaz Kliniği, Aksaray, Turkey

+90 5543429131

[email protected]

Background and Academic Framework

For approximately 15 years, my clinical and academic focus has been dedicated to transoral surgery of the floor of the mouth. My work in this anatomical region initiated with the intraoral excision of the submandibular gland and has since expanded to the development and implementation of numerous advanced surgical techniques.

A significant number of these surgical techniques were originally developed by our team, published as original research articles in international peer-reviewed journals, and subsequently compiled into a textbook. In 2020, we published the comprehensive textbook titled "Transoral Surgery of the Floor of the Mouth," which holds the distinction of being the first textbook worldwide dedicated exclusively to this specialized field.

Based on these clinical advancements, we have extensively delivered conferences and instructional training courses at various national congresses and scientific meetings across Turkey. A comprehensive dossier detailing our international publications, courses, and academic achievements in this field is attached to this proposal for your review.

Proposed Lecture Details

The proposed session will encompass a comprehensive review of advanced techniques, including but not limited to:

1. Transoral Submandibular Gland Excision
2. Transoral Surgical Approach to Non-Glandular Masses of the Submandibular Region
3. Wharton's Duct Marsupialization
4. Duct Re-routing and Parasympathetic Ganglion Neurectomy in Patients with Sialorrhea (Drooling)
5. Transoral Lingual and Facial Artery Ligation for Post-Tonsillectomy Hemorrhage
6. Transoral Transposition of the Lingual Thyroid Gland to the Submandibular Region
7. Excision of Thyroglossal Duct Cysts via the Transoral Midline Approach
8. Excision of Thyroglossal Duct Cysts via the Transoral Submandibular Approach
9. Other Advanced Surgical Techniques Applicable via the Transoral Approach

Proposed Title: Current Issues in Transoral Surgery of the Floor of the Mouth

Format & Duration: 30-Minute Lecture / Conference Presentation / Instructional Course

Speaker: Assoc. Prof. Ercan Akbay, MD

Conclusion: Given the pioneering nature of these minimally invasive techniques and our extensive experience in teaching them, I am confident that this lecture will highly benefit the congress delegates and enrich the scientific program.