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Macellari M, Schillaci A, Tanzini U, Trimarchi M, Quadrio M. An adjoint-based approach for the surgical correction of nasal septal deviations. Comput Biol Med 2024; 176:108566. [PMID: 38744016 DOI: 10.1016/j.compbiomed.2024.108566] [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: 12/18/2023] [Revised: 04/04/2024] [Accepted: 05/05/2024] [Indexed: 05/16/2024]
Abstract
Deviations of the septal wall are widespread anatomic anomalies of the human nose; they vary significantly in shape and location, and often cause the obstruction of the nasal airways. When severe, septal deviations need to be surgically corrected by ear-nose-throat (ENT) specialists. Septoplasty, however, has a low success rate, owing to the lack of suitable standardized clinical tools for assessing type and severity of obstructions, and for surgery planning. Moreover, the restoration of a perfectly straight septal wall is often impossible and possibly unnecessary. This paper introduces a procedure, based on advanced patient-specific Computational Fluid Dynamics (CFD) simulations, to support ENT surgeons in septoplasty planning. The method hinges upon the theory of adjoint-based optimization, and minimizes a cost function that indirectly accounts for viscous losses. A sensitivity map is computed on the mucosal wall to provide the surgeon with a simple quantification of how much tissue removal at each location would contribute to easing the obstruction. The optimization procedure is applied to three representative nasal anatomies, reconstructed from CT scans of patients affected by complex septal deviations. The computed sensitivity consistently identifies all the anomalies correctly. Virtual surgery, i.e. morphing of the anatomies according to the computed sensitivity, confirms that the characteristics of the nasal airflow improve significantly after small anatomy changes derived from adjoint-based optimization.
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Affiliation(s)
- Marcello Macellari
- Department of Aerospace Science and Technologies, Politecnico di Milano, Campus Bovisa, Milano 20156, Italy
| | - Andrea Schillaci
- Department of Aerospace Science and Technologies, Politecnico di Milano, Campus Bovisa, Milano 20156, Italy
| | - Umberto Tanzini
- Division of Head and Neck, Otorhinolaryngology unit, IRCCS San Raffaele Scientific Institute, Milano, Italy; School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
| | - Matteo Trimarchi
- Department of Otolaryngology - Head and Neck Surgery, Ente Ospedaliero Cantonale, Ospedale Regionale di Lugano - Universita' della Svizzera Italiana, Lugano, Switzerland
| | - Maurizio Quadrio
- Department of Aerospace Science and Technologies, Politecnico di Milano, Campus Bovisa, Milano 20156, Italy.
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Segalerba E, Dini Ciacci G, Quadrio M, Pralits JO. On the comparison between pre- and post-surgery nasal anatomies via computational fluid dynamics. Biomech Model Mechanobiol 2024; 23:305-314. [PMID: 37902893 PMCID: PMC10902155 DOI: 10.1007/s10237-023-01776-5] [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: 04/12/2023] [Accepted: 09/21/2023] [Indexed: 11/01/2023]
Abstract
Nasal breathing difficulties (NBD) are widespread and difficult to diagnose; the failure rate of their surgical corrections is high. Computational fluid dynamics (CFD) enables diagnosis of NBD and surgery planning, by comparing a pre-operative (pre-op) situation with the outcome of virtual surgery (post-op). An equivalent comparison is involved when considering distinct anatomies in the search for the functionally normal nose. Currently, this comparison is carried out in more than one way, under the implicit assumption that results are unchanged, which reflects our limited understanding of the driver of the respiratory function. The study describes how to set up a meaningful comparison. A pre-op anatomy, derived via segmentation from a CT scan, is compared with a post-op anatomy obtained via virtual surgery. State-of-the-art numerical simulations for a steady inspiration carry out the comparison under three types of global constraints, derived from the field of turbulent flow control: a constant pressure drop (CPG) between external ambient and throat, a constant flow rate (CFR) through the airways and a constant power input (CPI) from the lungs can be enforced. A significant difference in the quantities of interest is observed depending on the type of comparison. Global quantities (flow rate, pressure drop and nasal resistance) as well as local ones are affected. The type of flow forcing affects the outcome of the comparison between pre-op and post-op anatomies. Among the three available options, we argue that CPG is the least adequate. Arguments favouring either CFR or CPI are presented.
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Affiliation(s)
- Eric Segalerba
- Department of Civil, Chemical and Environmental Engineering, University of Genova, Via Montallegro, 1, 16145, Genoa, Italy
| | - Gabriele Dini Ciacci
- Department of Aerospace Sciences and Technologies, Politecnico di Milano, Campus Bovisa, 20156, Milano, Italy
| | - Maurizio Quadrio
- Department of Aerospace Sciences and Technologies, Politecnico di Milano, Campus Bovisa, 20156, Milano, Italy.
| | - Jan O Pralits
- Department of Civil, Chemical and Environmental Engineering, University of Genova, Via Montallegro, 1, 16145, Genoa, Italy.
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Pipolo C, Bulfamante AM, Schillaci A, Banchetti J, Castellani L, Saibene AM, Felisati G, Quadrio M. Through The Back Door: Expiratory Accumulation of SARS-Cov-2 in the Olfactory Mucosa as Mechanism for CNS Penetration. Int J Med Sci 2021; 18:2102-2108. [PMID: 33859516 PMCID: PMC8040411 DOI: 10.7150/ijms.56324] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/04/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction: SARS-CoV-2 is a respiratory virus supposed to enter the organism through aerosol or fomite transmission to the nose, eyes and oropharynx. It is responsible for various clinical symptoms, including hyposmia and other neurological ones. Current literature suggests the olfactory mucosa as a port of entry to the CNS, but how the virus reaches the olfactory groove is still unknown. Because the first neurological symptoms of invasion (hyposmia) do not correspond to first signs of infection, the hypothesis of direct contact through airborne droplets during primary infection and therefore during inspiration is not plausible. The aim of this study is to evaluate if a secondary spread to the olfactory groove in a retrograde manner during expiration could be more probable. Methods: Four three-dimensional virtual models were obtained from actual CT scans and used to simulate expiratory droplets. The volume mesh consists of 25 million of cells, the simulated condition is a steady expiration, driving a flow rate of 270 ml/s, for a duration of 0.6 seconds. The droplet diameter is of 5 µm. Results: The analysis of the simulations shows the virus to have a high probability to be deployed in the rhinopharynx, on the tail of medium and upper turbinates. The possibility for droplets to access the olfactory mucosa during the expiratory phase is lower than other nasal areas, but consistent. Discussion: The data obtained from these simulations demonstrates the virus can be deployed in the olfactory groove during expiration. Even if the total amount in a single act is scarce, it must be considered it is repeated tens of thousands of times a day, and the source of contamination continuously acts on a timescale of several days. The present results also imply CNS penetration of SARS-CoV-2 through olfactory mucosa might be considered a complication and, consequently, prevention strategies should be considered in diseased patients.
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Affiliation(s)
- Carlotta Pipolo
- Unit of Otolaryngology, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Antonio Mario Bulfamante
- Unit of Otolaryngology, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Andrea Schillaci
- Dept. of Aerospace Science and Technologies, Politecnico di Milano, Milan, Italy
| | - Jacopo Banchetti
- Dept. of Aerospace Science and Technologies, Politecnico di Milano, Milan, Italy
| | - Luca Castellani
- Unit of Otolaryngology, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Alberto Maria Saibene
- Unit of Otolaryngology, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Felisati
- Unit of Otolaryngology, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Maurizio Quadrio
- Dept. of Aerospace Science and Technologies, Politecnico di Milano, Milan, Italy
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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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Simulation of patient-specific bi-directional pulsating nasal aerosol dispersion and deposition with clockwise 45° and 90° nosepieces. Comput Biol Med 2020; 123:103816. [DOI: 10.1016/j.compbiomed.2020.103816] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/05/2020] [Accepted: 05/08/2020] [Indexed: 02/06/2023]
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Saibene AM, Felisati G, Pipolo C, Bulfamante AM, Quadrio M, Covello V. Partial Preservation of the Inferior Turbinate in Endoscopic Medial Maxillectomy: A Computational Fluid Dynamics Study. Am J Rhinol Allergy 2020; 34:409-416. [PMID: 31992048 DOI: 10.1177/1945892420902005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Endoscopic medial maxillectomy (EMM) is a workhorse for multiple sinonasal conditions. To reduce its burden on the sinonasal physiology, several modified EMM (M-EMM) have been proposed. Objective: In order to provide a theoretical basis for EMM and its modifications, this study introduces a computational fluid dynamics (CFD) model, based on a time-resolved direct numerical simulation, describing EMM and assessing the role of the M-EMM in preserving the overall fluid dynamics of the sinonasal cavities. Methods A normal sinonasal CT scan was converted into a geometrical model and used as a reference; 2 anatomies were then created by virtual surgery, mimicking EMM and M-EMM, with the latter sparing the anterior portion of inferior turbinate and medial maxillary sinus wall. The airflow was simulated in the models via the OpenFOAM CFD software and compared in terms of flow rate, mean and fluctuating velocity, vorticity, and turbulent structures. Results The analysis shows that EMM induces a massive flow rate increase in the operated side, which becomes less obvious in the M-EMM model. In contrast to M-EMM, EMM induces higher velocity fields that reach the maxillary sinus. Velocity and vorticity fluctuations are negligible in the baseline model, but become increasingly evident and widespread in the M-EMM and EMM models. Conclusions A significant disruption of the nasal fluid dynamics is observed in EMM, while M-EMM minimizes variations and reduces interference with nasal air conditioning. Our analysis provides insights into the pathophysiology of radical sinus surgery and provides a theoretical basis for the ability of M-EMM to reduce the temporary surgery-related changes on both healthy and operated sides.
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Affiliation(s)
- Alberto M Saibene
- Unit of Otolaryngology, ASST Santi Paolo e Carlo, Milan, Italy.,Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Felisati
- Unit of Otolaryngology, ASST Santi Paolo e Carlo, Milan, Italy.,Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Carlotta Pipolo
- Unit of Otolaryngology, ASST Santi Paolo e Carlo, Milan, Italy.,Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Antonio Mario Bulfamante
- Unit of Otolaryngology, ASST Santi Paolo e Carlo, Milan, Italy.,Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Maurizio Quadrio
- Department of Aerospace Sciences and Technologies, Politecnico di Milano, Milan, Italy
| | - Vanessa Covello
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Department of Aerospace Sciences and Technologies, Politecnico di Milano, Milan, Italy
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Calmet H, Inthavong K, Eguzkitza B, Lehmkuhl O, Houzeaux G, Vázquez M. Nasal sprayed particle deposition in a human nasal cavity under different inhalation conditions. PLoS One 2019; 14:e0221330. [PMID: 31490971 PMCID: PMC6730903 DOI: 10.1371/journal.pone.0221330] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 08/06/2019] [Indexed: 01/03/2023] Open
Abstract
Deposition of polydisperse particles representing nasal spray application in a human nasal cavity was performed under transient breathing profiles of sniffing, constant flow, and breath hold. The LES turbulence model was used to describe the fluid phase. Particles were introduced into the flow field with initial spray conditions, including spray cone angle, insertion angle, and initial velocity. Since nasal spray atomizer design determines the particle conditions, fifteen particle size distributions were used, each defined by a log-normal distribution with a different volume mean diameter (Dv50). Particle deposition in the anterior region was approximately 80% when Dv50 > 50μm, and this decreased to 45% as Dv50 decreased to 10μ m for constant and sniff breathing conditions. The decrease in anterior deposition was countered with increased deposition in the middle and posterior regions. The significance of increased deposition in the middle region for drug delivery shows there is potential for nasal delivered drugs to reach the highly vascularised mucosal walls in the main nasal passages. For multiple targeted deposition sites, an optimisation equation was introduced where deposition results of any two targeted sites could be combined and a weighting between 0 to 1 was applied to each targeted site, representing the relative importance of each deposition site.
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Affiliation(s)
- Hadrien Calmet
- Barcelona Supercomputing Center (BSC-CNS), Department of Computer Applications in Science and Engineering, Barcelona, Spain
- * E-mail:
| | - Kiao Inthavong
- School of Engineering (Mechanical & Automotive), RMIT University, Bundoora, Victoria, Australia
| | - Beatriz Eguzkitza
- Barcelona Supercomputing Center (BSC-CNS), Department of Computer Applications in Science and Engineering, Barcelona, Spain
| | - Oriol Lehmkuhl
- Barcelona Supercomputing Center (BSC-CNS), Department of Computer Applications in Science and Engineering, Barcelona, Spain
| | - Guillaume Houzeaux
- Barcelona Supercomputing Center (BSC-CNS), Department of Computer Applications in Science and Engineering, Barcelona, Spain
| | - Mariano Vázquez
- Barcelona Supercomputing Center (BSC-CNS), Department of Computer Applications in Science and Engineering, Barcelona, Spain
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Buijs EFM, Covello V, Pipolo C, Saibene AM, Felisati G, Quadrio M. Thermal water delivery in the nose: experimental results describing droplet deposition through computational fluid dynamics. ACTA ACUST UNITED AC 2019; 39:396-403. [PMID: 30745596 PMCID: PMC6966775 DOI: 10.14639/0392-100x-2250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 11/27/2018] [Indexed: 11/23/2022]
Abstract
Thermal water therapies have a role in treating various inflammatory disorders dating back to ancient Greece. Several studies have demonstrated beneficial effects of thermal water inhalations for upper respiratory disorders, such as improvement of mucociliary function and reduction of inflammatory cell infiltration. This experimental study describes the numerical investigation and clinical implications of thermal water droplet deposition in the nasal cavity of a single patient. To our knowledge, the numerical flow simulations described are the first investigations specifically designed for thermal water applications. To simulate nasal airflow, a patient-specific 3D computer model was created from a CT scan. The numerical approach is based on the Large Eddy Simulation (LES) technique and builds entirely upon open-source software. Deposition on mucosa was studied for two droplet sizes (5 and 10 μm diameter), corresponding to common thermal therapy applications (aerosol and vapour inhalation). The simulations consider steady inspiration at two different (low and moderate) breathing intensities. The results of this preliminary study show specific deposition patterns that favour droplet deposition in the middle meatus region to the inferior meatus, with particle size- and breathing intensity-related effects. These global data on particle deposition differ from findings related to the single-phase nasal airflow, which is more evenly distributed between the middle and inferior meatus. The potential clinical consequences of deposition data are discussed. The study furthermore provides evidence for the effectiveness of thermal aerosol and vapour inhalation therapies in reaching important areas of nasal mucosa with considerable clinical significance.
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Affiliation(s)
- E F M Buijs
- Unit of Otolaryngology, Department of Head and Neck Surgery, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Italy
| | - V Covello
- Department of Aerospace Sciences and Technologies, Politecnico di Milano, Italy
| | - C Pipolo
- Unit of Otolaryngology, Department of Head and Neck Surgery, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Italy
| | - A M Saibene
- Unit of Otolaryngology, Department of Head and Neck Surgery, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Italy
| | - G Felisati
- Unit of Otolaryngology, Department of Head and Neck Surgery, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Italy
| | - M Quadrio
- Department of Aerospace Sciences and Technologies, Politecnico di Milano, Italy
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