Posterior Nasal Nerve Neurectomy With Mucosal Flap Coverage of the Sphenopalatine Foramen for Treatment of Allergic Rhinitis: 12-Month Outcomes After Treatment in a Prospective Cohort Study

Abstract

Objectives

Posterior nasal nerve (PNN) neurectomy is an effective surgical option for refractory allergic rhinitis (AR), but delayed massive hemorrhage remains a concern. This study aimed to evaluate whether preserving a mucosal flap to cover the sphenopalatine foramen (SPF) affects postoperative efficacy and complications.

Methods

This prospective cohort study included 61 patients with moderate-to-severe AR who underwent PNN neurectomy. Patients were divided into two groups based on whether a mucosal flap was preserved to cover the SPF. Outcomes included mucosal epithelialization time, incidence of delayed bleeding, Visual Analog Scale (VAS), reflective Total Nasal Symptom Score (rTNSS), Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), nasal airway resistance (NAR), and inflammatory markers. Follow-up was conducted at 1, 3, 6, and 12 months postoperatively.

Results

No significant differences were found between groups in baseline characteristics. Both groups showed significant improvements in VAS, rTNSS, RQLQ, and NAR, with sustained benefits up to 12 months. The With Mucosal Flap Preservation group had a significantly shorter epithelialization time (P < .001) and lower incidence of delayed bleeding (P = .046). Mediation analysis indicated that epithelialization time mediated the relationship between the surgical method and delayed bleeding (P = .046), while the direct effect was not significant (P = .748).

Conclusion

This study shows that PNN neurectomy with mucosal flap preservation reduces the risk of delayed postoperative bleeding through the key mediating mechanism of accelerated mucosal epithelialization, while achieving comparable improvements in nasal symptom relief and quality of life compared to the procedure without mucosal flap preservation.