Clinical Outcomes of a Modified Technique Combining Submucosal Turbinectomy and Extended Neural Targeting in Chronic Rhinitis Management

Background/aim: This study evaluated the outcomes of combining submucosal turbinectomy with extensive disruption of the pterygopalatine ganglionic efferent nerve fibers through a minimucosal incision in patients with intractable rhinitis, irrespective of their dependency on the posterior nasal nerve.

Patients and methods: We describe an endoscopic extended neurectomy procedure performed via a minimucosal pocket. The primary outcome measures included the Total Nasal Symptom Score (TNSS), Visual Analog Scale (VAS) score, and runny nose and nasal obstruction subdomains of the Sino-Nasal Outcome Test-22 (SNOT-22), which were assessed pre-procedure and at 3 and 6 months post-procedure. The secondary outcomes included the incidence of adverse events and medication dependency.

Results: Six patients with rhinitis [66.7% female, 66.7% allergic rhinitis, average age: 48.17 (26-69) years] received treatment and completed a 6-month evaluation, with a mean follow-up period of 16.5 (8-30) months. The modified technique significantly reduced VAS scores from 8.67±1.21 to 0.50±0.55 (p=0.035) and TNSS from 8.83±2.40 to 1.17±0.75 (p=0.031) at three months compared to baseline. These effects were sustained at six months (p=0.0335 and p=0.0355, respectively). The severity and frequency of rhinorrhea and nasal congestion showed marked improvement, as assessed by the TNSS and SNOT-22. None of the patients experienced severe post-procedural adverse events, and all ceased medication use at the last follow-up visit.

Conclusion: Transturbinectomy extended neurectomy based on surgical dissection is a feasible technique and could be considered as a potential alternative to standard treatments for patients with intractable rhinitis.