Complication rates
Bleeding was the most common complication of the procedure and affected 1.6% of patients. In the studies reporting higher rates, all patients underwent turbinate reduction in addition to PNN. Sensory disturbance of the palate or lip was also observed as a complication, but this was noted to be usually transient. Ogi(25) was the only study that reported permanent numbness. Interestingly the authors reported similar rates of persistent numbness in the control group that underwent ESS without PNN. Their surgical procedure involved turbinate reduction using an incision anterior to the anterior pole of the inferior turbinate (at the level of the pyriform aperture) where terminal branches of the infraorbital nerve might be found on the anterior surface of the maxillary bone. Indeed Sonoda(28) also noted that it is likely to be the turbinate reduction or septoplasty component of the surgery that was likely responsible for dental or palatal numbness. Only 1 patient across all the studies reported persistent mild dryness of the eyes following the procedure but this did not require any treatment(28).