Objective To evaluate the clinical application of pedunculated boneperiosteum muscle flap extracted from the anterior and lateral walls of maxillary sinus in the treatment of primary atrophic rhinitis. Methods From Feb 2007 to Feb 2010, 40 patients with moderate to severe primary atrophic rhinitis received transplantation of pedunculated boneperiosteum muscle flap extracted from the anterior and lateral walls of maxillary sinus to narrow the nasal cavity. All the patients were followed up for two to five years postoperatively to observe the surgical effect. Results Successful operation was achieved in all 40 cases with a median operation time of 60 min and without severe surgical complications. All patients were followed postoperatively for 2 years, the obvious effective rate of the moderate group was 95.45% (21/22), and that of the severe group was 66.67% (12/18). 8 patients were followed up for more than 5 years, the total efficiency of 100% (40/40). The difference of obvious effective rate between the moderate and severe groups was significant. Conclusion Transplantation of pedunculated boneperiosteum muscle flap extracted from the anterior and lateral walls of maxillary sinus offers a simple and effective way for the treatment of moderate to severe primary atrophic rhinitis. Operation should be performed before it goes severe.