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Lee KB, Ventosa-Molina J, Fröhlich J. Computational analysis of nasal airflow and its alteration by a nasal dilator. Comput Biol Med 2024; 178:108634. [PMID: 38917531 DOI: 10.1016/j.compbiomed.2024.108634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 04/30/2024] [Accepted: 05/18/2024] [Indexed: 06/27/2024]
Abstract
Nasal airflow obstruction correlates with several ailments, such as higher patency, increased friction at the mucosal wall or the so-called Little's area, improper air conditioning, and snoring. Nasal dilators are frequently employed, mainly due to their ease of access and use, combined with their non-permanent and non-surgical nature. Their overall efficacy, however, has not been clearly demonstrated so far, with some studies reporting conflicting outcomes, mainly because being based on subjective evaluations. This study employs Computational Fluid Dynamics simulations to analyze the flow inside a real nose, performs an objective assessment of a nasal dilator's effect in terms of airflow and air conditioning, reporting flow paths, friction levels, heat and water fluxes and detailed temperature and humidity distributions. Coincidentally, the studied nose presents a septal deviation, with one nostril being wider than the other. The tubes of the dilator used in both nostrils are identical, as with any standard commercial dilator. Consequently, the dilator widens one nostril, as intended, but results in an obstruction in the other. This allows simultaneously addressing two situations, the nominal function of the dilator, as well as an off-design case. Results indicate a 24 % increase in nasal patency in the design situation. The effect, however, is limited, as quantified by appropriate measures, such as the flow-generated friction at the nose surfaces and the temperature fluxes. Hence, the effect of such a dilator in nominal conditions is perhaps not as large as might be hoped. In the off-design situation, nasal resistance increases by 62 %, an undesirable effect, illustrating the consequences of using an inappropriate dilator.
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Affiliation(s)
- Kyun Bum Lee
- Chair for Fluid Dynamics, Technische Universität Dresden, Dresden, Germany.
| | - Jordi Ventosa-Molina
- Chair for Fluid Dynamics, Technische Universität Dresden, Dresden, Germany; Heat Engines Department, Universitat Politècnica de Catalunya, Terrassa, Spain.
| | - Jochen Fröhlich
- Chair for Fluid Dynamics, Technische Universität Dresden, Dresden, Germany.
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Ma R, Hu Z, Tian L, Zheng G, Wang Y, Chen X, Lou M, Gong M, Wang B, Yang F, Dong J, Zhang Y. Numerical and experimental analysis of pollen inhalation exposure in nasal airways following various middle turbinectomy. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 907:168156. [PMID: 37898207 DOI: 10.1016/j.scitotenv.2023.168156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Middle turbinectomy (MT) has always been controversial. MT significantly alters the anatomy and redistributes the inhaled air. The current study is designed to quantify the effect of MT with varying resection volumes on airflow and associated pollen inhalation exposure characteristics in the nasal airways. METHODS Six realistic models following bilateral comprehensive Functional Endoscopic Sinus Surgery (FESS) deriving from CT images were constructed and their corresponding post-MT models with four types of MT procedures were virtually conducted. Inhalation exposure to pollen particles was simulated by the Computational Fluid-Particle Dynamics (CFPD) approach and validated through in vitro experiments. RESULTS Following the excision of the middle turbinate, a significant escalation in airflow was observed within the upper-middle region of the nasal cavities. Pollen deposition was observed to be more prominent in the nasal septum, laryngopharynx, and maxillary sinus, varying with the types of MT procedures. Notably, particles with diameters smaller than 50 μm exhibited two distinct "high peaks" and three "small peaks" within the nasal airways. CONCLUSION MT resulted in increased airflow volume within the upper-middle region of the nasal cavities. Following MT, notable shifts in pollen particle deposition hot spots were observed, transitioning from the nasal vestibule, nasal septum, and middle meatus to the nasal septum and laryngopharynx. These findings are anticipated to contribute valuable perspectives on pollen inhalation exposure risk assessments following diverse MT surgical interventions.
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Affiliation(s)
- Ruiping Ma
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710000, China
| | - Zhenzhen Hu
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710000, China
| | - Lin Tian
- School of Engineering - Mechanical and Automotive, RMIT University, Bundoora, VIC, Australia
| | - Guoxi Zheng
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710000, China
| | - Yusheng Wang
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710000, China
| | - Xiaole Chen
- School of Energy and Mechanical Engineering, Nanjing Normal University, Nanjing, Jiangsu 210046, China
| | - Miao Lou
- Department of Otolaryngology Head and Neck Surgery, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi 710021, China
| | - Minjie Gong
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710000, China
| | - Botao Wang
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710000, China
| | - Feilun Yang
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710000, China
| | - Jingliang Dong
- Institute for Sustainable Industries & Liveable Cities, Victoria University, PO Box 14428, Melbourne, VIC 8001, Australia; First Year College, Victoria University, Footscray Park Campus, Footscray, VIC 3011, Australia.
| | - Ya Zhang
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710000, China.
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Ormiskangas J, Valtonen O, Harju T, Rautiainen M, Kivekäs I. Computational fluid dynamics calculations in inferior turbinate surgery: a cohort study. Eur Arch Otorhinolaryngol 2023; 280:4923-4931. [PMID: 37341759 PMCID: PMC10562334 DOI: 10.1007/s00405-023-08058-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/08/2023] [Indexed: 06/22/2023]
Abstract
PURPOSE To investigate how the results of nasal computational fluid dynamics (CFD) simulations change due to inferior turbinate surgery and how the results correlate with patient specific subjective assessment and volumetric results in the nasal cavities. METHODS The steady inspiratory airflow of 25 patients was studied pre- and postoperatively with heat transfer from the mucous membrane by performing CFD calculations to patient-specific nasal cone beam computed tomography images. These results were then compared to the severity of the patients' nasal obstruction Visual Analogue Scale (VAS) and Glasgow Health Status Inventory assessments, and acoustic rhinometry measurements. RESULTS Total wall shear forces decreased statistically significantly (p < 0.01) in the operated parts of the inferior turbinates. Patients' subjective nasal obstruction VAS assessment changes between the pre- and postoperative conditions correlated statistically significantly (p = 0.04) with the wall shear force results. CONCLUSION Inferior turbinate surgery lead to decreased total wall shear force values postoperatively. Changes in subjective nasal obstruction VAS results against total wall shear force changes between the pre- and postoperative conditions were statistically significant. CFD data have a potential to be used for the evaluation of nasal airflow.
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Affiliation(s)
- Jaakko Ormiskangas
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
- Faculty of Engineering and Natural Sciences, Automation Technology and Mechanical Engineering Unit, Tampere University, Tampere, Finland.
| | - Olli Valtonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Otorhinolaryngology - Head and Neck Surgery, Tampere University Hospital, Tampere, Finland
| | - Teemu Harju
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Otorhinolaryngology - Head and Neck Surgery, Tampere University Hospital, Tampere, Finland
| | - Markus Rautiainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Otorhinolaryngology - Head and Neck Surgery, Tampere University Hospital, Tampere, Finland
| | - Ilkka Kivekäs
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Otorhinolaryngology - Head and Neck Surgery, Tampere University Hospital, Tampere, Finland
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Hu Z, Dong J, Lou M, Zhang J, Ma R, Wang Y, Gong M, Wang B, Tong Z, Ren H, Zheng G, Zhang Y. Effect of different degrees of adenoid hypertrophy on pediatric upper airway aerodynamics: a computational fluid dynamics study. Biomech Model Mechanobiol 2023; 22:1163-1175. [PMID: 37256522 DOI: 10.1007/s10237-023-01707-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 02/22/2023] [Indexed: 06/01/2023]
Abstract
To improve the diagnostic accuracy of adenoid hypertrophy (AH) in children and prevent further complications in time, it is important to study and quantify the effects of different degrees of AH on pediatric upper airway (UA) aerodynamics. In this study, based on computed tomography (CT) scans of a child with AH, UA models with different degrees of obstruction (adenoidal-nasopharyngeal (AN) ratio of 0.9, 0.8, 0.7, and 0.6) and no obstruction (AN ratio of 0.5) were constructed through virtual surgery to quantitatively analyze the aerodynamic characteristics of UA with different degrees of obstruction in terms of the peak velocity, pressure drop (△P), and maximum wall shear stress (WSS). We found that two obvious whirlpools are formed in the anterior upper part of the pediatric nasal cavity and in the oropharynx, which is caused by the sudden increase in the nasal cross-section area, resulting in local flow separation and counterflow. In addition, when the AN ratio was ≥ 0.7, the airflow velocity peaked at the protruding area in the nasopharynx, with an increase 1.1-2.7 times greater than that in the nasal valve area; the △P in the nasopharynx was significantly increased, with an increase 1.1-6.8 times greater than that in the nasal cavity; and the maximum WSS of the posterior wall of the nasopharynx was 1.1-4.4 times larger than that of the nasal cavity. The results showed that the size of the adenoid plays an important role in the patency of the pediatric UA.
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Affiliation(s)
- Zhenzhen Hu
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Jingliang Dong
- Institute for Sustainable Industries & Liveable Cities, Victoria University, PO Box 14428, Melbourne, VIC, 8001, Australia
- First Year College, Victoria University, Footscray Park Campus, Footscray, VIC, 3011, Australia
- School of Engineering, RMIT University, Bundoora, VIC, 3083, Australia
| | - Miao Lou
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Jingbin Zhang
- Department of Imaging, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Ruiping Ma
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Yusheng Wang
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Minjie Gong
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Botao Wang
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Zhenbo Tong
- School of Energy and Environment, Southeast University, Nanjing, China
| | - Hongxian Ren
- School of Energy and Environment, Southeast University, Nanjing, China
| | - Guoxi Zheng
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwu Road, Xi'an, 710004, Shaanxi, China.
| | - Ya Zhang
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwu Road, Xi'an, 710004, Shaanxi, China.
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Agarwal M, Lobo R, Srinivasan A. Postoperative Imaging Appearances of the Paranasal Sinuses. Semin Roentgenol 2023; 58:248-260. [PMID: 37507167 DOI: 10.1053/j.ro.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/13/2023] [Accepted: 03/19/2023] [Indexed: 07/30/2023]
Affiliation(s)
- Mohit Agarwal
- Department of Radiology, Froedtert and Medical College of Wisconsin, Milwaukee, WI.
| | - Remy Lobo
- Department of Radiology, Division of Neuroradiology, Michigan Medicine, Ann Arbor, MI
| | - Ashok Srinivasan
- Department of Radiology, Division of Neuroradiology, Michigan Medicine, Ann Arbor, MI
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Jin X, Lu Y, Ren X, Guo S, Jin D, Liu B, Bai X, Liu J. Exploring the influence of nasal vestibule structure on nasal obstruction using CFD and Machine Learning method. Med Eng Phys 2023; 117:103988. [PMID: 37331745 DOI: 10.1016/j.medengphy.2023.103988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 04/12/2023] [Accepted: 05/03/2023] [Indexed: 06/20/2023]
Abstract
Motivated by clinical findings about the nasal vestibule, this study analyzes the aerodynamic characteristics of the nasal vestibule and attempt to determine anatomical features which have a large influence on airflow through a combination of Computational Fluid Dynamics (CFD) and machine learning method. Firstly, the aerodynamic characteristics of the nasal vestibule are detailedly analyzed using the CFD method. Based on CFD simulation results, we divide the nasal vestibule into two types with distinctly different airflow patterns, which is consistent with clinical findings. Secondly, we explore the relationship between anatomical features and aerodynamic characteristics by developing a novel machine learning model which could predict airflow patterns based on several anatomical features. Feature mining is performed to determine the anatomical feature which has the greatest impact on respiratory function. The method is developed and validated on 41 unilateral nasal vestibules from 26 patients with nasal obstruction. The correctness of the CFD analysis and the developed model is verified by comparing them with clinical findings.
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Affiliation(s)
- Xing Jin
- Department of Otorhinolaryngology, Head and Neck Surgery, People's Hospital, Peking University, Beijing, 100044, China
| | - Yi Lu
- Image Processing Center, Beihang University, Beijing 102206, China
| | - Xiang Ren
- School of Astronautics, Beihang University, Beijing 100191, China
| | - Sheng Guo
- Image Processing Center, Beihang University, Beijing 102206, China
| | - Darui Jin
- Image Processing Center, Beihang University, Beijing 102206, China; ShenYuan Honors College, Beihang University, Beijing 100191, China
| | - Bo Liu
- Image Processing Center, Beihang University, Beijing 102206, China.
| | - Xiangzhi Bai
- Image Processing Center, Beihang University, Beijing 102206, China; State Key Laboratory of Virtual Reality Technology and Systems, Beihang University, Beijing 100191, China; Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing 100083, China.
| | - Junxiu Liu
- Jotolaryngology department, Third Hospital, Peking University, Beijing, 100191, China.
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Numerical and Experimental Analysis of Drug Inhalation in Realistic Human Upper Airway Model. Pharmaceuticals (Basel) 2023; 16:ph16030406. [PMID: 36986505 PMCID: PMC10054804 DOI: 10.3390/ph16030406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/14/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023] Open
Abstract
The demand for a more efficient and targeted method for intranasal drug delivery has led to sophisticated device design, delivery methods, and aerosol properties. Due to the complex nasal geometry and measurement limitations, numerical modeling is an appropriate approach to simulate the airflow, aerosol dispersion, and deposition for the initial assessment of novel methodologies for better drug delivery. In this study, a CT-based, 3D-printed model of a realistic nasal airway was reconstructed, and airflow pressure, velocity, turbulent kinetic energy (TKE), and aerosol deposition patterns were simultaneously investigated. Different inhalation flowrates (5, 10, 15, 30, and 45 L/min) and aerosol sizes (1, 1.5, 2.5, 3, 6, 15, and 30 µm) were simulated using laminar and SST viscous models, with the results compared and verified by experimental data. The results revealed that from the vestibule to the nasopharynx, the pressure drop was negligible for flow rates of 5, 10, and 15 L/min, while for flow rates of 30 and 40 L/min, a considerable pressure drop was observed by approximately 14 and 10%, respectively. However, from the nasopharynx and trachea, this reduction was approximately 70%. The aerosol deposition fraction alongside the nasal cavities and upper airway showed a significant difference in pattern, dependent on particle size. More than 90% of the initiated particles were deposited in the anterior region, while just under 20% of the injected ultrafine particles were deposited in this area. The turbulent and laminar models showed slightly different values for the deposition fraction and efficiency of drug delivery for ultrafine particles (about 5%); however, the deposition pattern for ultrafine particles was very different.
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Plášek M, Masárová M, Bojko M, Komínek P, Matoušek P, Formánek M. Computational Fluid Dynamics Could Enable Individualized Surgical Treatment of Nasal Obstruction (A Preliminary Study). Diagnostics (Basel) 2022; 12:diagnostics12112642. [PMID: 36359486 PMCID: PMC9689633 DOI: 10.3390/diagnostics12112642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 12/04/2022] Open
Abstract
Passage of nasal airflow during breathing is crucial in achieving accurate diagnosis and optimal therapy for patients with nasal disorders. Computational fluid dynamics (CFD) is the dominant method for simulating and studying airflow. The present study aimed to create a CFD nasal airflow model to determine the major routes of airflow through the nasal cavity and thus help with individualization of surgical treatment of nasal disorders. The three-dimensional nasal cavity model was based on computed tomography scans of the nasal cavity of an adult patient without nasal breathing problems. The model showed the main routes of airflow in the inferior meatus and inferior part of the common meatus, but also surprisingly in the middle meatus and in the middle part of the common nasal meatus. It indicates that the lower meatus and the lower part of the common meatus should not be the only consideration in case of surgery for nasal obstruction in our patient. CFD surgical planning could enable individualized precise surgical treatment of nasal disorders. It could be beneficial mainly in challenging cases such as patients with persistent nasal obstruction after surgery, patients with empty nose syndrome, and patients with a significant discrepancy between the clinical findings and subjective complaints.
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Affiliation(s)
- Marek Plášek
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. Listopadu 1790, 70852 Ostrava, Czech Republic
| | - Michaela Masárová
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. Listopadu 1790, 70852 Ostrava, Czech Republic
- Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic
| | - Marián Bojko
- Faculty of Mechanical Engineering, Technical University of Ostrava, 17. Listopadu 2172/15, 70800 Ostrava, Czech Republic
| | - Pavel Komínek
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. Listopadu 1790, 70852 Ostrava, Czech Republic
- Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic
| | - Petr Matoušek
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. Listopadu 1790, 70852 Ostrava, Czech Republic
- Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic
| | - Martin Formánek
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. Listopadu 1790, 70852 Ostrava, Czech Republic
- Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic
- Correspondence:
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Huang A, Chen W, Wu C, Lee T, Huang C, Kuo H. Characterization of nasal aerodynamics and air conditioning ability using CFD and its application to improve the empty nose syndrome (ENS) submucosal floor implant surgery – Part I methodology. J Taiwan Inst Chem Eng 2022. [DOI: 10.1016/j.jtice.2022.104481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ormiskangas J, Valtonen O, Harju T, Rautiainen M, Kivekäs I. Computational fluid dynamics assessed changes of nasal airflow after inferior turbinate surgery. Respir Physiol Neurobiol 2022; 302:103917. [PMID: 35500884 DOI: 10.1016/j.resp.2022.103917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 04/01/2022] [Accepted: 04/26/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To demonstrate how Computational Fluid Dynamics (CFD) simulations can reveal important airflow changes in the nasal cavities due to surgical interventions. MATERIAL AND METHODS The steady inspiratory airflow of eight patients was studied pre- and postoperatively with heat transfer from the mucous membrane by performing CFD calculations to patient specific cone beam computed tomography (CBCT) images. Eight patients with the largest distance from pre- and postoperative mean changes in inferior turbinate volumetry and Visual Analogue Scale (VAS) results were selected. RESULTS Calculated CFD heat transfer results from the anterior parts of the inferior turbinates, where surgical interventions were performed, decreased significantly. The heat transfer results were in line with VAS changes. CONCLUSION Surgical interventions reduced heat transfer in the operated parts of the inferior turbinates and were in line with VAS changes. CFD is an option in assessing patient well-being as a function of airflow parameters from mucous membrane with larger data sets. The limitations of the study were the small sample size and the preliminary nature of the study.
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Affiliation(s)
- Jaakko Ormiskangas
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Faculty of Engineering and Natural Sciences, Automation Technology and Mechanical Engineering Unit, Tampere University, Tampere, Finland.
| | - Olli Valtonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Otorhinolaryngology - Head and Neck Surgery, Tampere University Hospital, Tampere, Finland
| | - Teemu Harju
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Otorhinolaryngology - Head and Neck Surgery, Tampere University Hospital, Tampere, Finland
| | - Markus Rautiainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Otorhinolaryngology - Head and Neck Surgery, Tampere University Hospital, Tampere, Finland
| | - Ilkka Kivekäs
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Otorhinolaryngology - Head and Neck Surgery, Tampere University Hospital, Tampere, Finland
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Tang DM, Roxbury CR. Management of the middle turbinate during and after sinus surgery. Curr Opin Otolaryngol Head Neck Surg 2022; 30:40-45. [PMID: 34889849 DOI: 10.1097/moo.0000000000000777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Treatment of the middle turbinate (MT) during and after endoscopic sinus surgery (ESS) has been controversial. Historically, there has been concern that resection of the MT may result in smell loss and frontal sinus stenosis. However, these concerns must be balanced by knowledge that a residual diseased MT may result in surgical failure. This review discusses the current evidence on treatment of the MT during and after ESS. RECENT FINDINGS Several review articles have shown the safety of performing MT resection. Studies have not shown increase rates of frontal sinus stenosis, olfactory loss, or empty nose syndrome. However, the benefit of MT resection is highly debated. There have also been many recent advances and technological developments to assist in management of the postoperative MT. SUMMARY The literature supports the safety of performing MT resection, however, the benefit of resection over preservation is controversial. New technologies and techniques exist that may aid in preventing postoperative MT lateralization.
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Affiliation(s)
- Dennis M Tang
- Division of Otolaryngology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Christopher R Roxbury
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA
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Tomoum MO, ElSheikh MN, ElBasty H, Hagras MAE, El-Naggar A. Anterior part middle turbinoplasty in endoscopic sinus surgery: a randomized controlled study. Eur Arch Otorhinolaryngol 2021; 279:2465-2471. [PMID: 34453573 DOI: 10.1007/s00405-021-07053-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Resection of middle turbinate in the setting of endoscopic sinus surgery is a controversial procedure. Our aim is to assess the impact of the anterior part middle turbinoplasty on the outcome of endoscopic sinus surgery, incidence of synechia between the middle turbinate and the lateral nasal wall, intra- and post-operative accessibility to the paranasal sinuses. METHODS Single blinded randomized controlled study of 120 patients with chronic rhinosinusitis without polyps, they were allocated into two groups, we performed anterior part middle turbinoplasty in the group one "60 patients", and we preserved the middle turbinate in the group two "60 patients". We assessed the patients pre-operatively by Sino-nasal outcome Test (SNOT-22), intra-operatively by Likert scale score for the sinuses accessibility. At least 6 months post-operatively, we assessed the patients by SNOT-22, and Likert scale score for sinus accessibility. RESULTS During and after surgery, the Likert scale score in the group one showed statistically significant better sinuses accessibility than in the group two. We noticed synechia between the MT and the lateral nasal wall in 9.2% and 18.2% of the operated sides in group one and group two, respectively. SNOT-22 and its smell item improved significantly in both groups with no statistically significant differences between them. No major complications were reported. CONCLUSION Anterior part middle turbinoplasty is a safe and effective technique during endoscopic sinus surgery to improve the intra- and post-operative sinus accessibility, and decrease the incidence of post-operative synechia, with no adverse effect on olfaction or bleeding.
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Affiliation(s)
- Mohamed O Tomoum
- Department of otorhinolaryngology, Faculty of Medicine, University of Tanta, Tanta, Egypt.
| | | | - Hazem ElBasty
- Department of otorhinolaryngology, Faculty of Medicine, University of Tanta, Tanta, Egypt
| | | | - Ahmed El-Naggar
- Department of otorhinolaryngology, Faculty of Medicine, University of Tanta, Tanta, Egypt
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Inthavong K, Shang Y, Del Gaudio JM, Wise SK, Edwards TS, Bradshaw K, Wong E, Smith M, Singh N. Inhalation and deposition of spherical and pollen particles after middle turbinate resection in a human nasal cavity. Respir Physiol Neurobiol 2021; 294:103769. [PMID: 34352383 DOI: 10.1016/j.resp.2021.103769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/22/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022]
Abstract
Middle turbinate resection significantly alters the anatomy and redistributes the inhaled air. The superior half of the main nasal cavity is opened up, increasing accessibility to the region. This is expected to increase inhalation dosimetry to the region during exposure to airborne particles. This study investigated the influence of middle turbinate resection on the deposition of inhaled pollutants that cover spherical and non-spherical particles (e.g. pollen). A computational model of the nasal cavity from CT scans, and its corresponding post-operative model with virtual surgery performed was created. Two constant flow rates of 5 L/min, and 15 L/min were simulated under a laminar flow field. Inhaled particles including pollen (non-spherical), and a spherical particle with reference density of 1000 kg/m3 were introduced in the surrounding atmosphere. The effect of surgery was most prominent in the less patent cavity side, since the change in anatomy was proportionally greater relative to the original airway space. The left cavity produced an increase in particle deposition at a flow rate of 15 L/min. The main particle deposition mechanisms were inertial impaction, and to a lesser degree gravitational sedimentation. The results are expected to provide insight into inhalation efficiency of different aerosol types, and the likelihood of deposition in different nasal cavity surfaces.
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Affiliation(s)
- Kiao Inthavong
- Mechanical & Automotive Engineering, School of Engineering, RMIT University, Bundoora, Victoria 3083, Australia.
| | - Yidan Shang
- Mechanical & Automotive Engineering, School of Engineering, RMIT University, Bundoora, Victoria 3083, Australia
| | - John M Del Gaudio
- Department of Otolaryngology-Head and Neck Surgery Emory University, Atlanta, GA, USA
| | - Sarah K Wise
- Department of Otolaryngology-Head and Neck Surgery Emory University, Atlanta, GA, USA
| | - Thomas S Edwards
- Department of Otolaryngology-Head and Neck Surgery Emory University, Atlanta, GA, USA
| | - Kimberley Bradshaw
- Faculty of Medicine & Health, The University of Sydney, NSW 2006, Australia
| | - Eugene Wong
- Faculty of Medicine & Health, The University of Sydney, NSW 2006, Australia
| | - Murray Smith
- Faculty of Medicine & Health, The University of Sydney, NSW 2006, Australia
| | - Narinder Singh
- Faculty of Medicine & Health, The University of Sydney, NSW 2006, Australia; Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Westmead, NSW 2145, Australia
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Lim ZF, Rajendran P, Musa MY, Lee CF. Nasal airflow of patient with septal deviation and allergy rhinitis. Vis Comput Ind Biomed Art 2021; 4:14. [PMID: 34014417 PMCID: PMC8137764 DOI: 10.1186/s42492-021-00080-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/27/2021] [Indexed: 12/30/2022] Open
Abstract
A numerical simulation of a patient’s nasal airflow was developed via computational fluid dynamics. Accordingly, computerized tomography scans of a patient with septal deviation and allergic rhinitis were obtained. The three-dimensional (3D) nasal model was designed using InVesalius 3.0, which was then imported to (computer aided 3D interactive application) CATIA V5 for modification, and finally to analysis system (ANSYS) flow oriented logistics upgrade for enterprise networks (FLUENT) to obtain the numerical solution. The velocity contours of the cross-sectional area were analyzed on four main surfaces: the vestibule, nasal valve, middle turbinate, and nasopharynx. The pressure and velocity characteristics were assessed at both laminar and turbulent mass flow rates for both the standardized and the patient’s model nasal cavity. The developed model of the patient is approximately half the size of the standardized model; hence, its velocity was approximately two times more than that of the standardized model.
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Affiliation(s)
- Zi Fen Lim
- School of Aerospace Engineering, Universiti Sains Malaysia, 11800, Pulau Pinang, Malaysia
| | - Parvathy Rajendran
- School of Aerospace Engineering, Universiti Sains Malaysia, 11800, Pulau Pinang, Malaysia. .,Faculty of Engineering & Computing, First City University College, 47800, Selangor, Malaysia.
| | - Muhamad Yusri Musa
- Advanced Medical and Dental Institute, Universiti Sains Malaysia, 11800, Pulau Pinang, Malaysia
| | - Chih Fang Lee
- School of Aerospace Engineering, Universiti Sains Malaysia, 11800, Pulau Pinang, Malaysia
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15
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Three-dimensional modeling and automatic analysis of the human nasal cavity and paranasal sinuses using the computational fluid dynamics method. Eur Arch Otorhinolaryngol 2020; 278:1443-1453. [PMID: 33068172 PMCID: PMC8057972 DOI: 10.1007/s00405-020-06428-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/07/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE The goal of this study was to develop a complete workflow allowing for conducting computational fluid dynamics (CFD) simulation of airflow through the upper airways based on computed tomography (CT) and cone-beam computed tomography (CBCT) studies of individual adult patients. METHODS This study is based on CT images of 16 patients. Image processing and model generation of the human nasal cavity and paranasal sinuses were performed using open-source and freeware software. 3-D Slicer was used primarily for segmentation and new surface model generation. Further processing was done using Autodesk® Meshmixer TM. The governing equations are discretized by means of the finite volume method. Subsequently, the corresponding algebraic equation systems were solved by OpenFOAM software. RESULTS We described the protocol for the preparation of a 3-D model of the nasal cavity and paranasal sinuses and highlighted several problems that the future researcher may encounter. The CFD results were presented based on examples of 3-D models of the patient 1 (norm) and patient 2 (pathological changes). CONCLUSION The short training time for new user without a prior experience in image segmentation and 3-D mesh editing is an important advantage of this type of research. Both CBCT and CT are useful for model building. However, CBCT may have limitations. The Q criterion in CFD illustrates the considerable complication of the nasal flow and allows for direct evaluation and quantitative comparison of various flows and can be used for the assessment of nasal airflow.
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16
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Schertzer JS, Levy JM, Wise SK, Magliocca KR, DelGaudio JM. Is Respiratory Epithelial Adenomatoid Hamartoma Related to Central Compartment Atopic Disease? Am J Rhinol Allergy 2020; 34:610-617. [PMID: 32208747 DOI: 10.1177/1945892420914212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Respiratory epithelial adenomatoid hamartoma (REAH) is a benign lesion of the sinonasal tract that may mimic more concerning pathology. Clinical factors associated with REAH have not been well characterized. OBJECTIVE To report our findings on patients with this pathologic diagnosis. METHODS A retrospective chart review of patients with REAH between September 2006 and November 2019 was conducted. Data collected included clinical allergic rhinitis and asthma history, additional sinonasal diagnoses, prior sinus surgery, and the location of the REAH within the sinonasal cavity. RESULTS Twenty-six patients were identified (53.8% male, mean age 62 years [range, 29-93]). Bilateral REAH occurred in 50%. REAH was located at the superior nasal septum in 84.6% cases, with the remainder identified in sinus contents submitted for pathology, making definitive site uncertain. Concurrent sinonasal inflammatory disorders were identified in 18 patients (69.2%), including chronic rhinosinusitis with nasal polyps-not otherwise specified (6), chronic rhinosinusitis without nasal polyps (4), aspirin-exacerbated respiratory disease (2), allergic fungal rhinosinusitis (1), central compartment atopic disease (5), and IgG4-related sclerosing disease (1). Eight patients had isolated REAH. Adequate allergy records were available for 19 patients, of which 18 of 19 (94.7%) had clinical allergic rhinitis. CONCLUSIONS REAH is a benign sinonasal lesion commonly located within the central compartment of the nasal cavity, a site of significant allergen exposure. Affected patients have a high incidence of allergy along with chronic inflammatory conditions. The coexistence of REAH within inflammatory nasal mucosa in a consistent anatomic location, suggests REAH may have a similar etiology to central compartment atopic disease, with resultant respiratory glandular ingrowth within long-standing reactive changes of mucosa derived from ethmoid embryologic origin.
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Affiliation(s)
- Joseph S Schertzer
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia
| | - Joshua M Levy
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia
| | - Sarah K Wise
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia
| | - Kelly R Magliocca
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia
| | - John M DelGaudio
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia
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17
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DelGaudio JM, Levy JM, Wise SK. Central compartment involvement in aspirin-exacerbated respiratory disease: the role of allergy and previous sinus surgery. Int Forum Allergy Rhinol 2019; 9:1017-1022. [PMID: 31246375 PMCID: PMC6748623 DOI: 10.1002/alr.22367] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/15/2019] [Accepted: 05/27/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Evidence for a relationship between allergy and chronic rhinosinusitus with nasal polyps (CRSwNP) is equivocal. Central compartment (CC) atopic disease is a nasal inflammatory condition related to inhalant allergy. CC involvement is common in aspirin-exacerbated respiratory disease (AERD), a subset of CRSwNP, and we hypothesize it is related to allergic status. METHODS This study was a retrospective analysis of a single-institution database for the January 2016 to February 2019 time period. Data regarding endoscopic CC findings, clinical allergy history, and results of allergy testing were collected. Statistical analysis was performed, with significance set at p < 0.05. RESULTS Seventy-two AERD patients met the inclusion criteria. Fifty-nine patients had CC involvement (53 bilateral, 6 unilateral). For patients with documented allergy status, 100% of patients with endoscopic CC disease had clinical allergic rhinitis (AR), and 45 of 48 (93.8%) had positive allergy testing. Thirteen patients had no CC involvement (4 with clinical AR; 3 of 7 with positive allergy testing). CC endoscopic findings in AERD were significantly associated with clinical allergy (p < 0.0001, phi = 0.771). Overall, patients with CC involvement averaged 3.8 surgeries vs 3.2 for those without CC involvement (p = not statistically significant). However, patients with septal involvement averaged 4.2 surgeries vs 2.0 for those without septal involvement (p = 0.004). As the number of sinus surgeries increases, middle turbinate (MT) resection (r = 0.300, p = 0.022) and septal involvement (r = 0.372, p = 0.004) significantly increase. All patients with MT resection had septal disease, whereas none without CC disease had MT resection. CONCLUSION Most AERD patients exhibit AR, and this correlates with CC disease. As the number of surgeries increases, MT resection may predispose to polyposis of the septum.
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Affiliation(s)
- John M DelGaudio
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, GA
| | - Joshua M Levy
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, GA
| | - Sarah K Wise
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, GA
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18
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Zhang Y, Shang Y, Inthavong K, Tong Z, Sun B, Zhu K, Yu A, Zheng G. Computational investigation of dust mite allergens in a realistic human nasal cavity. Inhal Toxicol 2019; 31:224-235. [PMID: 31431101 DOI: 10.1080/08958378.2019.1647315] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Aim: Inhaled allergens from house dust mite (HDM) are a major source of allergic disease such as allergic rhinitis and asthma. It has been a challenge to properly evaluate health risks caused by HDM related allergens including mite bodies, eggs and fecal pellets. This paper presents a numerical study on particle deposition of dust mite allergens in a human nasal cavity. Materials and methods: A realistic nasal cavity model was reconstructed from CT scans and a Computational Fluid Dynamics analysis of steady airflow was simulated. The discrete phase model was used to trace particle trajectories of three dust mite related particles. Results: The flow and particle model were validated by comparing with nasal resistance measurement and previous literature respectively. Aerodynamic characteristics and deposition of dust mite allergens in the nasal cavity were analyzed under different breathing conditions including rest and exercising conditions. Conclusions: The numerical results revealed the roles of different nasal cavity regions in filtering various types of dust mite allergens with consideration of breathing conditions.
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Affiliation(s)
- Ya Zhang
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University , Xi'an , China
| | - Yidan Shang
- College of Air Transportation, Shanghai University of Engineering Science , Shanghai , China.,School of Engineering, RMIT University , Bundoora , Australia
| | - Kiao Inthavong
- School of Engineering, RMIT University , Bundoora , Australia
| | - Zhenbo Tong
- Key Laboratory of Energy Thermal Conversion and Control of Ministry of Education, School of Energy and Environment, Southeast University , Nanjing , China
| | - Bin Sun
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University , Xi'an , China
| | - Kang Zhu
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University , Xi'an , China
| | - Aibing Yu
- Laboratory for Simulation and Modelling of Particulate Systems, Department of Chemical Engineering, Monash University , Clayton , Australia
| | - Guoxi Zheng
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University , Xi'an , China
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19
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Kumar H, Jain R. Review: The role of computational simulation in understanding the postoperative sinonasal environment. Clin Biomech (Bristol, Avon) 2019; 68:212-220. [PMID: 31325767 DOI: 10.1016/j.clinbiomech.2018.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 01/12/2018] [Accepted: 01/17/2018] [Indexed: 02/07/2023]
Abstract
Nasal surgery improves symptoms in a majority of patients for whom medical treatment has failed. In rhinosinusitis patients, endoscopic sinus surgery aims to alleviate obstruction and re-establish mucociliary clearance. Surgery alters the structure-function relationship within the nasal passage, which is difficult to assess clinically. Computational modelling has been used to investigate this relationship by simulating air flow and environmental variables inside realistic three-dimensional models of the human nasal airway but many questions remain unanswered and need further investigation. The application of computational models to improve pre-surgical planning and post-surgical treatment may not be currently possible due to the absence of knowledge correlating the model-predicted parameters to physiological variables. Links between these parameters to patient outcomes are yet to be established. This article reviews the recent application of computational modelling to understand the nasal structure-function relationship following surgery in patients with sinusitis and nasal obstruction.
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Affiliation(s)
- Haribalan Kumar
- Auckland Bioengineering Institute, The University of Auckland, New Zealand.
| | - Ravi Jain
- Department of surgery, The University of Auckland, New Zealand
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20
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Kumar H, Jain R. Review: The role of computational simulation in understanding the postoperative sinonasal environment. Clin Biomech (Bristol, Avon) 2019; 66:2-10. [PMID: 30195934 DOI: 10.1016/j.clinbiomech.2018.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 01/29/2018] [Accepted: 02/01/2018] [Indexed: 02/07/2023]
Abstract
Nasal surgery improves symptoms in a majority of patients for whom medical treatment has failed. In rhinosinusitis patients, endoscopic sinus surgery aims to alleviate obstruction and re-establish mucociliary clearance. Surgery alters the structure-function relationship within the nasal passage, which is difficult to assess clinically. Computational modelling has been used to investigate this relationship by simulating air flow and environmental variables inside realistic three-dimensional models of the human nasal airway but many questions remain unanswered and need further investigation. The application of computational models to improve pre-surgical planning and post-surgical treatment may not be currently possible due to the absence of knowledge correlating the model-predicted parameters to physiological variables. Links between these parameters to patient outcomes are yet to be established. This article reviews the recent application of computational modelling to understand the nasal structure-function relationship following surgery in patients with sinusitis and nasal obstruction.
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Affiliation(s)
- Haribalan Kumar
- Auckland Bioengineering Institute, The University of Auckland, New Zealand.
| | - Ravi Jain
- Department of surgery, The University of Auckland, New Zealand
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21
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Frank-Ito DO, Kimbell JS, Borojeni AAT, Garcia GJM, Rhee JS. A hierarchical stepwise approach to evaluate nasal patency after virtual surgery for nasal airway obstruction. Clin Biomech (Bristol, Avon) 2019; 61:172-180. [PMID: 30594764 PMCID: PMC6813815 DOI: 10.1016/j.clinbiomech.2018.12.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/05/2018] [Accepted: 12/18/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite advances in medicine and expenditures associated in treatment of nasal airway obstruction, 25-50% of patients undergoing nasal surgeries complain of persistent obstructive symptoms. Our objective is to develop a "stepwise virtual surgery" method that optimizes surgical outcomes for treatment of nasal airway obstruction. METHODS Pre-surgery radiographic images of two subjects with nasal airway obstruction were imported into Mimics imaging software package for three-dimension reconstruction of the airway. A hierarchical stepwise approach was used to create seven virtual surgery nasal models comprising individual (inferior turbinectomy or septoplasty) procedures and combined inferior turbinectomy and septoplasty procedures via digital modifications of each subject's pre-surgery nasal model. To evaluate the effects of these procedures on nasal patency, computational fluid dynamics modeling was used to perform steady-state laminar inspiratory airflow and heat transfer simulations in every model, at resting breathing. Airflow-related variables were calculated for virtual surgery models and compared with dataset containing results of healthy subjects with no symptoms of nasal obstruction. FINDINGS For Subject 1, nasal models with virtual septoplasty only and virtual septoplasty plus inferior turbinectomy on less obstructed side were within the healthy reference thresholds on both sides of the nasal cavity and across all three computed variables. For Subject 2, virtual septoplasty plus inferior turbinectomy on less obstructed side model produced the best result. INTERPRETATION The hierarchical stepwise approach implemented in this preliminary report demonstrates computational fluid dynamics modeling ability to evaluate the efficiency of different surgical procedures for nasal obstruction in restoring nasal patency to normative level.
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Affiliation(s)
- Dennis O. Frank-Ito
- Division of Head and Neck Surgery & Communication Sciences, Durham, NC, U.S.A,Computational Biology & Bioinformatics Program, Duke University, Durham, NC, U.S.A,Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, U.S.A
| | - Julia S. Kimbell
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, U.S.A
| | - Azadeh A. T. Borojeni
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, U.S.A,Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, U.S.A
| | - Guilherme J. M. Garcia
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, U.S.A,Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, U.S.A
| | - John S. Rhee
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, U.S.A
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22
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Alam S, Li C, Bradburn KH, Zhao K, Lee TS. Impact of Middle Turbinectomy on Airflow to the Olfactory Cleft: A Computational Fluid Dynamics Study. Am J Rhinol Allergy 2018; 33:263-268. [PMID: 30543120 DOI: 10.1177/1945892418816841] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The impact of middle turbinate resection (MTR) on olfaction remains a point of debate in the current literature. Few studies have objectively evaluated olfactory cleft airflow following MTR; thus, the mechanism by which MTR may impact olfaction is poorly understood. It is not known whether the postsurgical changes in airway volume, flow, and resistance increase odorant transport or disrupt the patterns of normal airflow. Computational fluid dynamics can be used to study the nasal airway and predict responses to surgical intervention. OBJECTIVE To evaluate the functional impact of MTR on nasal airflow, resistance, and olfaction. METHODS Five maxillofacial computed tomography scans of patients without signs of significant sinusitis or nasal polyposis were used. Control models for each patient were compared to their corresponding model after virtual total MTR. For each model, nasal airway volume, nasal resistance, and air flow rate were determined. Odorant transport of 3 different odorants in the nasal cavity was simulated based on the computed steady airflow field. RESULTS Total airflow significantly increased following bilateral MTR in all patient models ( P < .05). Consistent with our airflow results, we found a decrease in nasal resistance following MTR. MTR significantly increased area averaged flux to the olfactory cleft when compared to controls for phenylethyl alcohol (high-sorptive odorant). Results for carvone (medium sorptive) were similarly elevated. MTR impact on limonene, a low flux odorant, was equivocal. CONCLUSION MTR increases nasal airflow while decreasing the nasal resistance. Overall, olfactory flux increased for high sorptive (phenylethyl alcohol) and medium sorpitve (l-carvone) odorants. However, the significant variation observed in one of our models suggests that the effects of MTR on the nasal airflow and the resultant olfaction can vary between individuals based on individual anatomic differences.
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Affiliation(s)
- Suhyla Alam
- 1 Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Chengyu Li
- 2 Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, Ohio.,3 Department of Mechanical Engineering, Villanova University, Villanova, Pennsylvania
| | | | - Kai Zhao
- 2 Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, Ohio.,5 Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio
| | - Thomas S Lee
- 1 Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
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23
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Asaumi R, Miwa Y, Kawai T, Sato I. Analysis of the development of human foetal nasal turbinates using CBCT imaging. Surg Radiol Anat 2018; 41:209-219. [PMID: 30523384 DOI: 10.1007/s00276-018-2145-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/26/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE The morphological structure of the nasal cavity (NC) is important for endoscopic surgical treatment. The location of nasal turbinates, including the superior turbinate (ST), middle turbinate (MT) and inferior turbinate (IT), are well presented during the formation of the human NC in cone beam CT (CBCT) images. There is a complex relationship between the nasal sinuses, the maxillary sinus (MS), ethmoidal sinus and sphenoid sinus, during formation of the NC structure at the morphological level. There is a need to clearly define the relationships of these nasal elements at the ossification level, during development. METHODS We investigated the three-dimensional construction of human foetal NC elements, including ST, MT, IT and vomer, using CBCT images from 16 weeks gestation (E16) to E31 (25 foetuses) and compared it to histochemical observations (E25). RESULTS At the stage of ossification, the studied elements are elongated in the posterior region near the sphenoidal bone, showing that the locations of the ST, MT, and IT are important during formation of the NC. CBCT analysis revealed that the horizontal and vertical directions of nasal turbinates affect the formation of the human NC. CONCLUSION The location and elongated development of the MT is one of the most important elements for NC formation. The relationship between the nasal sinus and nasal turbine at the level of ossification may provide useful information in clinical treatment of children.
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Affiliation(s)
- Rieko Asaumi
- Department of Oral and Maxillofacial Radiology, School of Life Dentistry at Tokyo, The Nippon Dental University, 1-9-20 Fujimi, Chiyoda-ku, Tokyo, 102-8159, Japan
| | - Yoko Miwa
- Department of Anatomy, School of Life Dentistry at Tokyo, The Nippon Dental University, 1-9-20 Fujimi, Chiyoda-ku, Tokyo, 102-8159, Japan
| | - Taisuke Kawai
- Department of Oral and Maxillofacial Radiology, School of Life Dentistry at Tokyo, The Nippon Dental University, 1-9-20 Fujimi, Chiyoda-ku, Tokyo, 102-8159, Japan
| | - Iwao Sato
- Department of Anatomy, School of Life Dentistry at Tokyo, The Nippon Dental University, 1-9-20 Fujimi, Chiyoda-ku, Tokyo, 102-8159, Japan.
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24
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Sanmiguel-Rojas E, Burgos MA, Esteban-Ortega F. Nasal surgery handled by CFD tools. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2018; 34:e3126. [PMID: 29968373 DOI: 10.1002/cnm.3126] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/14/2018] [Accepted: 06/24/2018] [Indexed: 06/08/2023]
Abstract
Annually, hundreds of thousands of surgical interventions to correct nasal airway obstruction are performed throughout the world. Recent studies have noted that a significant number of patients have persistent symptoms of nasal obstruction postoperatively. In the present work, we introduce a new methodology that raises the success rate of nasal cavity surgery. In this procedure, the surgeon performs virtual surgery on a 3D nasal model of a patient prior to the real surgery. The main goal of the methodology is to guide the surgeon throughout the virtual operation using mathematical estimators based on CFD results. The virtual surgery intervention ends as soon as the estimators fall into a region of a Cartesian coordinate system with a high success probability. This region is defined according to a statistical analysis of estimators corresponding to sets of healthy and diseased cavities. As examples of this application, this study includes 2 surgical operations performed with this innovative methodology on patients with severe nasal obstruction. The patients underwent nasal surgery according to the final nasal geometry revealed by CFD-guided virtual surgery. Currently, both subjects show high degrees of satisfaction.
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Affiliation(s)
- Enrique Sanmiguel-Rojas
- Escuela de Ingenierías Industriales, Andalucía Tech, Universidad of Málaga, 29071, Málaga, Spain
| | - Manuel Antonio Burgos
- Departamento de Ingenieŕıa Térmica y de Fluidos, Universidad Politécnica de Cartagena, Cartagena, Spain
| | - Francisco Esteban-Ortega
- Departamento de Otorrinolaringología, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain
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25
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Burgos MA, Sanmiguel-Rojas E, Singh N, Esteban-Ortega F. DigBody ®: A new 3D modeling tool for nasal virtual surgery. Comput Biol Med 2018; 98:118-125. [PMID: 29787939 DOI: 10.1016/j.compbiomed.2018.05.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/06/2018] [Accepted: 05/15/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND PURPOSE Recent studies have demonstrated that a significant number of surgical procedures for nasal airway obstruction (NAO) have a high rate of surgical failure. In part, this problem is due to the lack of reliable objective clinical parameters to aid surgeons during preoperative planning. Modeling tools that allow virtual surgery to be performed do exist, but all require direct manipulation of computed tomography (CT) or magnetic resonance imaging (MRI) data. Specialists in Rhinology have criticized these tools for their complex user interface, and have requested more intuitive, user-friendly and powerful software to make virtual surgery more accessible and realistic. In this paper we present a new virtual surgery software tool, DigBody®. METHODS This new surgery module is integrated into the computational fluid dynamics (CFD) program MeComLand®, which was developed exclusively to analyze nasal airflow. DigBody® works directly with a 3D nasal model that mimics real surgery. Furthermore, this surgery module permits direct assessment of the operated cavity following virtual surgery by CFD simulation. RESULTS The effectiveness of DigBody® has been demonstrated by real surgery on two patients based on prior virtual operation results. Both subjects experienced excellent surgical outcomes with no residual nasal obstruction. CONCLUSIONS This tool has great potential to aid surgeons in modeling potential surgical maneuvers, minimizing complications, and being confident that patients will receive optimal postoperative outcomes, validated by personalized CFD testing.
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Affiliation(s)
- M A Burgos
- Departamento de Ingeniería Térmica y de Fluidos, Universidad Politécnica de Cartagena, Cartagena, Spain
| | - E Sanmiguel-Rojas
- Escuela de Ingenierías Industriales, Universidad de Málaga, Campus de Teatinos, 29071, Málaga, Spain.
| | - Narinder Singh
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia; University of Sydney, Sydney, Australia
| | - F Esteban-Ortega
- Servicio de Otorrinolaringología, Hospital Universitario Virgen del Rocío, Departamento de Cirugía, Universidad de Sevilla, Sevilla, Spain
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