Outcomes of Adjunctive Posterior Nasal Nerve Ablation With Medial Flap Inferior Turbinoplasty

Inferior turbinate reduction with septoplasty effectively relieves nasal obstruction, and ablation of the posterior nasal nerve (PNN) is effective for residual hypersensitivity-related symptoms but raises concerns regarding bleeding and symptom recurrence. This study aimed to evaluate the additional clinical benefits and safety of PNN ablation when combined with septoplasty and medial flap inferior turbinoplasty.

This retrospective, single-center cohort study included adult patients who underwent medial flap inferior turbinoplasty with septoplasty, with or without additional PNN ablation. Outcomes were assessed using Sinonasal Outcome Test-22 (SNOT-22) and Total Nasal Symptom Score (TNSS) preoperatively and at early postoperative follow-up. Symptom recurrence at five months was evaluated using a severity-based analysis of SNOT-22 rhinologic items.

A total of 65 patients were included (PNN RF ablation, n=41; non-PNN RF ablation, n=24). Both groups showed significant postoperative improvement in SNOT-22 and TNSS scores. Additional PNN ablation was independently associated with greater improvement in SNOT-22 scores (B=12.102, p=0.002). At five months, 79-90% of patients experienced no symptom recurrence, and only one patient experienced a severe recurrence. Postoperative mild epistaxis occurred in 4.88% of PNN ablation-treated patients, with no major adverse events.

Additional PNN ablation was associated with greater improvement in SNOT-22 nasal symptoms after structural nasal surgery, particularly in rhinorrhea-related symptoms. Targeting the terminal branches of the posterior nasal nerve while sparing the sphenopalatine artery was associated with effective symptom control, and no major postoperative bleeding events were observed.