- On September 20, 2018
Over the summer, Dr. Vincent F. Honrubia, MD, FACS performed a bilateral intranasal cryotherapy procedure on a patient suffering from chronic rhinitis (the most common symptom of which is a chronic runny nose). This video gives you a unique internal look at this nasal procedure, which utilizes a Clarifix cooling device to freeze the Vidian nerve.
If you are suffering from chronic rhinitis or dealing with other sinus, allergy, ear, nose or throat symptoms, request an appointment with South Texas Sinus Institute today online or by calling 956-661-8200 or 855-99-SINUS.
Watch the video and read the full transcript below.
This is Dr. Vincent Honrubia from the South Texas Sinus Institute showing this video about freezing the Vidian nerve.
Here we are showing a view of the middle turbinate on the left side as well as the ethmoid bulla area preparing for the freeze gun, or cryotherapy instrument, to be inserted. It is very important that we have good visualization and medialization of the middle turbinate. That’s a small polyp that we removed sitting on the middle turbinate. Here’s the Freer medializing the middle turbinate to prepare for space and, very important, utilizing an instrument to crush the middle turbinate and make it more narrow, again enabling us to get more space laterally for placement of the cryotherapy instrument.
Here is a pledget being placed to control bleeding, again for better access and better visualization of the area lateral where the Vidian nerve comes over by the sphenopalatine artery where we are going to place the freeze gun. Again medializing the middle turbinate, and again the middle turbinate seems a little floppy and not wanting to really lateralize as much as I would like. Again using the Freer, I am crushing the air cells in the middle turbinate for placement of the freeze cryotherapy instrument, or Clarifix device.
That is the Clarifix balloon being placed in the location of the posterior nasopharynx, two-thirds in and one-third out, anterior to the middle turbinate. The balloon enters gently with little to no resistance, and once the balloon is placed in the correct location, again one-third anterior and two-thirds posterior, to the area where the middle turbinate originates inferiorly. It was then inflated with the liquid nitrogen and held in place with a timer for the one-minute period as described by the Clarifix Company as what they recommend in terms of time of freezing. Once the balloon is filled with liquid nitrogen, you can immediately see some smoke and freezing as well as icicle formation on the balloon and the surrounding tissues.
So it is quite impressive the lesion this thing leaves once is it inflated with liquid nitrogen. It also does medialize the middle turbinate a little bit when it inflates enabling a better circumferential lesion of the Vidian nerve complex posteriorly.
The patient is under general anesthesia at this point using intravenous anesthesia and an LMA floor airway control. Some injections were made of the middle turbinate prior to the beginning of the video to generally produce a little vasoconstriction as well as produce anesthesia postoperatively in the recovery area. The patient did exceptionally well postoperatively and required very little pain medication following this procedure.
Once the freeze device is deflated, it is then de-thawed for 30 to 45 seconds (I actually waited about a minute) and then wiggled loose to prevent any tissue from being torn when the device is removed. There is the Clarifix device being removed, and what we see left is a nice yellow cryo-lesion in the area of the sphenopalatine vessel as well as the Vidian nerve area. No bleeding and no tissue destruction at this time that can be seen with a little bit of lesion there on the middle turbinate.
We are going to go again with the cryo Clarifix device a second time and we are now going to do a second lesion a little more inferiorly and posteriorly. Again going one minute utilizing the Clarifix cryo device, we are making a second lesion in a similar area as the first lesion to better cover the entrance point of the Vidian nerve. We see again the smoke and icicle formation with again little or no bleeding and no trauma to the rest of the nose and a very nice view of the device being placed two-thirds posteriorly and one-third sitting anterior to the middle turbinate at the lower edge of the origination of that middle turbinate on the left side.
Again now defrosting for 30 to 45 seconds (I actually waited about a minute), and at that point we were able to clearly remove the balloon without tearing or pulling any tissue. Once again now once the balloon is removed we should get a good view of the lesion that was produced with the second cryo application. It slides out gently and again looking at the yellow lesions there in the posterior nasopharynx.