Conditions We Treat – Empty Nose Syndrome
Empty Nose Syndrome was first described by Dr Eugene Kern, MD at the Mayo Clinic.
It refers to the fact that a patients CT scan looks empty or devoid of normal tissue following nasal surgery including turbinate excision.
Indeed the syndrome may follow sinus surgery, septal surgery, turbinate removal or laser/diathermy of the turbinates.
There is a group of entities that has previously been described as atrophic rhinitis but now more commonly called “Empty Nose Syndrome”.
The pathogenesis relates to the sensory nerve supply of the nasal cavity which includes components and branches of the following nerves; long sphenopalatine nerves, greater palatine nerves, nasociliary nerves, infraorbital and anterior and middle superior alveolar nerves.
These primarily originate from the Maxillary division of the Trigeminal nerve, cranial nerve 5 (V2).
This major cranial nerve exits the midbrain via Foramen Rotundum at the skull base and traverses through the bone to the pterygopalatine fossa where it splits into the components as noted above.
Following surgery the sensory nerves undergo a neuropathy that is described as a sympathetic dystrophy.
While you may perceive your nose is blocked it is the nerve conduction and impulses back to the brain suggesting blockage when in fact the impulses are a false representation, similar to phantom limb pain and phantom tooth pain which is well described in the literature.
What the patient may perceive as a bad result or surgical misadventure is, in fact, is an auto-dysregulation of the nasal nerves from well-performed surgery.
A/Professor Russell Vickers has published extensively on neuropathic facial pain (see publications).
The mechanism of action to treat Empty Nose Syndrome is to introduce stem cells into the region of the major and minor branches of the maxillary nerve.
This includes into the pterygopalatine fossa and specifically the nerve branches to the turbinates, septum, nasal mucosae and sinuses.
The treatment is done under local anaesthesia and in an outpatient setting.
The mechanism of action of stem cells is that they retain the capacity to regenerate the autonomic and sensory nerve cells that have been altered during the surgical procedure.
As described above the dysregulation is no different to “phantom limb pain” which is well described in medical science.
This change of action of sensory and autonomic nerves following a procedure is no different from patients who complain of a painful or dry eye following LASIK surgery for refraction.
A/Professor Vickers is a consultant surgeon but also has excellent understanding of the anatomy of the midface and nasal complex.
He regularly gives deep injections into the face for a variety of neuropathic disorders.