The nerve of the pterygoid canal (Vidian nerve) is formed by the union of the greater superficial petrosal nerve (parasympathetic, from the facial nerve geniculate ganglion) and the deep petrosal nerve (sympathetic, from the internal carotid plexus) within the pterygoid canal of the sphenoid bone. It carries secretomotor parasympathetic fibres to the lacrimal gland, nasal, and palatal glands (via the pterygopalatine ganglion) and sympathetic fibres through the ganglion without synapsing.
Vidian neurectomy (section of the Vidian nerve) in the pterygoid canal was historically used for vasomotor rhinitis and hypersecretory sinusitis. The procedure reduces nasal secretion and lacrimation by denervating the pterygopalatine ganglion parasympathetic output. Modern endoscopic approaches allow transnasal Vidian neurectomy without open approaches. The Vidian canal is identified on CT and MRI as a canal running through the sphenoid body from the foramen lacerum to the pterygopalatine fossa, used as a landmark in endoscopic skull base surgery.
Endoscopic Vidian neurectomy through the transnasal sphenopalatine approach divides the nerve of the pterygoid canal at the posterior pterygoid canal opening in the sphenoid, denervating the pterygopalatine parasympathetic ganglion to reduce nasal secretion, congestion, and lacrimation in patients with refractory non-allergic rhinitis.
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