A novel and effective surgical procedure for posterior nasal neurectomy in patients with allergic rhinitis

OBJECTIVE: This study aims to analyze how to perform a more minimally invasive and precise excision of posterior nasal neurectomy to reduce surgical time, minimize surgical trauma, and evaluate the clinical efficacy of this procedure in the treatment of moderate to severe persistent allergic rhinitis. METHODS: This study included a total of 110 patients, randomly divided into an experimental group and a control group based on whether preoperative CT three-dimensional positioning was used and whether middle turbinate mucosal graftcoverage was applied during surgery. In the experimental group, preoperative CT measurements were used to locate the sphenopalatine foramen, and intraoperatively, the accuracy of the positioning method was verified. Middle turbinate mucosal graftcoverage was applied to shorten the postoperative recovery time. Both groups were evaluated using Visual Analog Scales (VAS) and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) to compare the differences in symptoms between baseline and six months after operation. Regular endoscopic examinations were conducted to observe the status of mucosal epithelialization at the surgical site. RESULTS: Preoperative CT measurements provided accurate intraoperative localization of the sphenopalatine foramen, allowing for a smaller surgical wound size. The average distance from the sphenopalatine foramen to the posteroinferior end of the uncinate process was 20.25 ± 2.69 mm, and from the sphenopalatine foramen to the upper edge of the inferior turbinate, it was 11.05 ± 1.71 mm. There was no statistically significant difference in preoperative symptom scores between the two groups (p > 0.05). At six months after operation, there were significant differences in VAS scores compared to baseline in both the experimental and control groups (p < 0.05). The average time for mucosal graftsurvival in the experimental group was 3.5 ± 1.0 weeks, while in the control group, the average time for exposed bone surface epithelialization was 9.0 ± 1.5 weeks. CONCLUSION: Preoperative CT measurements for locating the sphenopalatine foramen and the use of middle turbinate mucosal grafts in the posterior nasal neurectomy are safe and effective. This new procedure reduces surgical wound size, shorten surgical time, accelerate postoperative wound recovery, and could possibly reduce complications of bleeding after surgery. LEVEL OF EVIDENCE: Level 3.