Clinical anatomical study of nasal autonomic nerve-obtaining target points for the treatment of allergic rhinitis by blocking nasal autonomic nerve with high intensity focused ultrasound under nasal endoscope

Abstract:

Objective：To provide anatomical references for the treatment of allergic rhinitis by blocking nasal autonomic nerve with high intensity focused ultrasound under nasal endoscope. Methods：Ten （20 sides） adult head specimens sawn in midline sagittal were choosen，posterosuperior medial nasal branch and posterosuperior lateral nasal branch of sphenopalatine nerve as well as posteroinfe－rior nasal nerve were anatomized under microscope to study and research their branches and ramification and to measure the distance from point of posterosuperior medial nasal branch started from nasal septum to superior border of choana and nasal bottom，the dis－tance from posterosuperior lateral nasal branch in medial surface of middle turbinate to midpoint of inferior border of middle turbinate and the distance from point of posteroinferior nasal nerve reaching at inferior turbinate to posterior border of inferior turbinate. Re－sults：（1）Posterosuperior medial nasal branch of sphenopalatine nerve disturbed on the nasal septum from backward and upward to forward and downward；the route approximated straight line and reverse-parabola line. The nerves in 10 sides disturbed on surface of nasal septum as a main never，all reaching the bottom of nasal septum from anterior-middle segment of nasal septum. The nerves in 8 sides disturbed on surface of nasal septum as two main never branches，the branch near nasal bottom（inferior branch） reaching the bottom of nasal septum from anterior-middle segment of nasal septum（two sides was destroyed when anatomized）. The distances were （9.04±1.51） mm（inferior branch） and （15.76±2.17） mm （superior branch） to superior border of choana，（18.95±2.69） mm（inferior branch） and （23.39±2.42） mm（superior branch） to nasal bottom. （2）Posterosuperior lateral nasal branch of sphe－no-palatine nerve distributed on medial surface of middle turbinate，and moved from posterior segment of superior border of middle turbinate，travelled slantingly and reached posterior segment of middle-lower part of middle turbinate，then travelled forward nearly parallel to Frankfurt horizontal plane or inferior border of mid－dle turbinate，terminated at anterior segment of anterior border or inferior border of middle turbinate and the distance between the nerve and midponit of middle turbinate was （5.70±1.82） mm. （3）Posteroinferior nasal nerve turned into the inferior turbinate from superior border of posterior segment of inferior turbinate；the distance between the nerve from superior border and inferior border of inferior turbinate was （7.28±1.36） mm. Conclusions：In treatment of allergic rhinitis with high intensity focused ultrasound under nasal endoscope，the points of posterosuperior medial nasal branch started from nasal septum，posterosuperior lateral nasal branch through the connection of the midpoint of posterior and anterior border of middle turbinate，posteroinferior nasal branch up to superior border of inferior turbinate，can be chosen as reference points to block the autonomic nerves.