PNN Laser Ablation

Clinical case:Ablation of Posterior Nasal Nerves (PNN)
Laser used:Epic-S Diode Laser 940 nm
Accessory used:400 um bare fiber tip, non-initiated, clear tip, 100mm long
Surgery handpiece
Treatment parameters:5 Watt CW
Non-contact ablation with clear (white) tip
Authored by physician:Yosef Krespi, MD
Professor of Otolaryngology, Hofstra School of Medicine, New York

Patient symptoms:

Nasal congestion and obstruction with watery rhinorrhea (nasal drip). Possible symptoms include itchy nose, sneezing and runny nose. Nasal obstruction may aggravate sleeping conditions and snoring.

Diagnosis:

No history or findings of sinusitis. Relatively normal nasal septum. Enlarged inferior turbinates and swell bodies could be present.

Management:

Medical management includes allergy testing. Medical treatment includes nasal sprays steroids or anti-histamine with or without oral anti-histamines, steroids, montelukast (Singulair). When medical management fails or patient is unwilling to continue with it surgical solution is attempted.

Laser surgery, Pre-Op:

Anesthesia is achieved with local application of a mixture of lidocaine2% and neosynephrine followed by injection of epinephrine 1:100000 with 2% lidocaine.

CAUTION
The laser treatment parameters above are provided as a guide and are based on results published or reported by physicians with experience in this indication. Individual treatment should be based on clinical training, clinical observation of laser-tissue interaction, appropriate clinical endpoints and each physician’s own medical judgment.