Background <p>Postoperative pain and sleep disturbance are common after endoscopic sinus surgery (ESS) and may delay postoperative recovery. Acupuncture has demonstrated analgesic and sleep-enhancing effects in perioperative care; however, the impact of cheek acupuncture—a minimally invasive facial microsystem technique—on postoperative recovery after ESS has not been evaluated in randomized controlled trials.</p> Methods <p>This single-center, prospective, randomized controlled pilot trial will enroll 90 adults undergoing ESS. Participants will be randomized 1:1 to receive cheek acupuncture or sham cheek acupuncture within 30 min before anesthesia induction. The primary outcome is the Quality of Recovery-15 (QoR-15) score at 24 h postoperatively. Secondary outcomes include the Insomnia Severity Index (ISI), Numerical Rating Scale (NRS) for pain, intraoperative hemodynamics, postoperative care unit (PACU) stay duration, postoperative nausea and vomiting (PONV), and inflammatory biomarkers (serum interleukin-6 [IL-6] and C-reactive protein [CRP]).</p> Discussion <p>This trial will assess the feasibility, safety, and preliminary efficacy of cheek acupuncture in improving postoperative recovery after ESS. Results will inform the design of a future multicenter randomized trial.</p> Trial registration <p>Chinese Clinical Trial Registry (ChiCTR2500110625). Registered on 16 October 2025.</p>