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Lepley TJ, Kim K, Ardizzone M, Kelly KM, Otto BA, Zhao K. 3D Printing as a Planning Tool to Optimize Sinonasal Irrigation. Ann Otol Rhinol Laryngol 2023; 132:1306-1313. [PMID: 36704822 PMCID: PMC10368789 DOI: 10.1177/00034894221149242] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Topical sinus irrigation plays a critical role in the management of sinonasal diseases. Yet, the penetration of irrigant to targeted sinuses may be highly variable and difficult to predict. Here, we investigate the use of 3D printing as a planning tool to optimize outcomes. METHODS Eight post-operative models were 3D printed with a FormLabs Form3 printer based on individual CT scans. Irrigations were performed and video recorded with a squeeze bottle attached via silicon water-tight seal, in 4 head positions: 45° to-the-side, 90° to-the-side, 45° forward and 45° to-the-side, and 90° forward, with irrigation fluid entering the upper (conventional) or lower (backfill) nostrils. RESULTS Significant individual variations were observed in sinus penetration as a function of head position. In general, the maxillary sinus was the easiest to irrigate in most head positions (P < .05), followed by frontal and ethmoid, with sphenoid being the most difficult. Both the 90°-to-the-side and the 90°-forward positions were significantly more effective than the others (P < .05), with 90°-forward better for frontal sinuses and 90°-to-the-side superior for all other sinuses. The backfill was significantly superior to conventional technique in head positions involving a side tilt (P < .05). CONCLUSION Variations in technique and position significantly impacted irrigation outcome. Backfill irrigation that pushes fluid against gravity to pool around the ostium, seems to provide overall better outcomes. This study demonstrates the advantage of 3D printing as a rapid planning tool to guide irrigation strategies.
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Affiliation(s)
- Thomas J. Lepley
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University, Columbus, OH, USA
| | - Kanghyun Kim
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University, Columbus, OH, USA
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
| | - Melissa Ardizzone
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University, Columbus, OH, USA
| | - Kathleen M. Kelly
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University, Columbus, OH, USA
| | - Bradley A. Otto
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University, Columbus, OH, USA
| | - Kai Zhao
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University, Columbus, OH, USA
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
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Salati H, Khamooshi M, Fletcher DF, Inthavong K. Computational investigation of nasal surface coverage from squeeze bottle and Neti Pot saline irrigation flow. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 227:107223. [PMID: 36370595 DOI: 10.1016/j.cmpb.2022.107223] [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: 09/07/2022] [Revised: 10/19/2022] [Accepted: 11/02/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND OBJECTIVE Nasal saline irrigation is a common therapy for inflammatory nasal and paranasal disease or for managing post nasal and sinus surgery recovery. Two common irrigation devices include the netipot and squeeze bottles, where anecdotally, these devices alleviate congestion, facial pain, and pressure. However, a quantitative evaluation of these devices' performance and the fluid dynamics responsible for the irrigation distribution through the nose is lacking. This study tracked the liquid surface coverage and wall shear stresses during nasal saline irrigation produced from a Neti Pot and squeeze bottle. METHODS This study used transient computational fluid dynamics (CFD) simulations to investigate the saline irrigation flow field in a subject-specific sinonasal model. The computational nasal cavity model was constructed from a high-resolution computed tomography scan (CT). The irrigation procedure applied a head position tilted at 90° forward using an 80 ml squeeze bottle and 120 ml Neti Pot. RESULTS The results from a single sinonasal model demonstrated that the Neti Pot irrigation was more effective in delivering saline solution to the nasal cavity on the contralateral side of irrigation due to typically larger volumes but at the expense of reduced flow and shearing rates, as the flow entered under gravitational forces. The squeeze bottle irrigation provided greater surface coverage on the side of irrigation. CONCLUSIONS The results from the single patient model, demonstrated the Neti Pot increased surface coverage in the paranasal sinuses. Reducing the jet diameter may aid the direct targeting of a specific region at the side of irrigation by preventing the impingement of the jet to the nasal passage surface and redirection of the flow. Evaluating this performance across a wider cohort of patients can strengthen the findings.
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Affiliation(s)
- Hana Salati
- Mechanical & Automotive Engineering, School of Engineering, RMIT University, Bundoora, VIC 3083, Australia
| | - Mehrdad Khamooshi
- Cardio-Respiratory Engineering and Technology Laboratory (CREATElab), Department of Mechanical and Aerospace Engineering, Monash University, VIC 3004, Australia
| | - David F Fletcher
- School of Chemical and Biomolecular Engineering, The University of Sydney, NSW 2006, Australia
| | - Kiao Inthavong
- Mechanical & Automotive Engineering, School of Engineering, RMIT University, Bundoora, VIC 3083, Australia.
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Wu D, Chang F, Hong J, Su B, Wei Y. A novel irrigation device with superior nasal irrigation efficiency to the classic rinse bottle. J Otolaryngol Head Neck Surg 2022; 51:19. [PMID: 35505412 PMCID: PMC9066877 DOI: 10.1186/s40463-022-00575-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 04/07/2022] [Indexed: 11/10/2022] Open
Abstract
Background The ability of saline irrigation to detach the mucous and the flow-limiting effect of the nasal valve has not been well explored. The objective of this study was to compare the removal efficiency of a novel irrigation device with an extended nozzle versus a classic rinse bottle. Methods Transparent casts of the unoperated sinonasal cavity were made by 3D printing. Yogurt was used to simulate mucous. The cast filled with 5 ml yogurt was fixed in six head positions and irrigated with 120 ml, 175 ml, and 240 ml dyed water through the novel device and the rinse bottle. The irrigation efficiency was the ratio of the weight of yogurt washed away divided by the total weight of yogurt. Results The irrigation stream of a long nozzle with a side opening was different from the irrigation stream of the outlet within the nasal vestibule. The novel devices presented with continuous water stream directly upwards to the anterior part of the olfactory cleft. Depending on different head positions, it was easy for the novel devices to achieve an irrigation efficiency of 100% when the cast was irrigated with 120 ml or 175 ml water. There was still a tiny amount of yogurt left in the olfactory cleft when the cast was irrigated with 240 ml water under each head position for the rinse bottle. The irrigation efficiency was volume-dependent, and the average irrigation efficiency of the rinse bottle at 240 ml only reached 69.1%. Conclusions The novel irrigation device presented with superior nasal irrigation efficiency to the classic rinse bottle. A continuous water stream directly upwards to the anterior part of the olfactory cleft combined with an extended nozzle overcoming the flow-limiting effect of the nasal valve promotes nasal irrigation efficiency. Graphical Abstract ![]()
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Affiliation(s)
- Dawei Wu
- Department of Otolaryngology-Head and Neck Surgery, Peking University Third Hospital, Beijing, People's Republic of China.
| | - Feifan Chang
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, People's Republic of China
| | - Junsheng Hong
- Department of Otolaryngology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Baihan Su
- Department of Otolaryngology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yongxiang Wei
- Department of Otorhinolaryngology-Head and Neck Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China
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Fokkens WJ, Landis BN, Hopkins C, Reitsma S, Sedaghat AR. Rhinology in review: from COVID-19 to biologicals. Rhinology 2021; 59:490-500. [PMID: 34812433 DOI: 10.4193/rhin21.424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We look back at the end of what soon will be seen as an historic year, from COVID-19 to real-world introduction of biologicals influencing the life of our patients. This review describes the important findings in Rhinology over the past year. A large body of evidence now demonstrates loss of sense of smell to be one of the most common symptoms of COVID-19 infection; a meta-analysis of 3563 patients found the mean prevalence of self-reported loss to be 47%. A number of studies have now shown long-term reduced loss of smell and parosmia. Given the high numbers of people affected by COVID-19, even with the best reported recovery rates, a significant number worldwide will be left with severe olfactory dysfunction. The most prevalent causes for olfactory dysfunction, besides COVID-19 and upper respiratory tract infections in general, are trauma and CRSwNP. For these CRSwNP patients a bright future seems to be starting with the development of treatment with biologics. This year the Nobel prize in Medicine 2021 was awarded jointly to David Julius and Ardem Patapoutian for their discoveries of receptors for temperature and touch which has greatly enhanced our understanding of nasal hyperreactivity and understanding of intranasal trigeminal function. Finally, a new definition of chronic rhinitis has been proposed in the last year and we have seen many papers emphasizing the importance of endotyping patients in chronic rhinitis and rhinosinusitis in order to optimise treatment effect.
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Affiliation(s)
- W J Fokkens
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands
| | - B N Landis
- Department of Otorhinolaryngology, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - C Hopkins
- Department of Otorhinolaryngology, Guy's Hospital, London, UK
| | - S Reitsma
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands
| | - A R Sedaghat
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Deruyver L, Rigaut C, Lambert P, Haut B, Goole J. The importance of pre-formulation studies and of 3D-printed nasal casts in the success of a pharmaceutical product intended for nose-to-brain delivery. Adv Drug Deliv Rev 2021; 175:113826. [PMID: 34119575 DOI: 10.1016/j.addr.2021.113826] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/19/2021] [Accepted: 06/07/2021] [Indexed: 02/08/2023]
Abstract
This review aims to cement three hot topics in drug delivery: (a) the pre-formulation of new products intended for nose-to-brain delivery; (b) the development of nasal casts for studying the efficacy of potential new nose-to-brain delivery systems at the early of their development (pre-formulation); (c) the use of 3D printing based on a wide variety of materials (transparent, biocompatible, flexible) providing an unprecedented fabrication tool towards personalized medicine by printing nasal cast on-demand based on CT scans of patients. This review intends to show the links between these three subjects. Indeed, the pathway selected to administrate the drug to the brain not only influence the formulation strategies to implement but also the design of the cast, to get the most convincing measures from it. Moreover, the design of the cast himself influences the choice of the 3D-printing technology, which, in its turn, bring more constraints to the nasal replica design. Consequently, the formulation of the drug, the cast preparation and its realisation should be thought of as a whole and not separately.
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Affiliation(s)
- Laura Deruyver
- Laboratoire de Pharmacie Galénique et de Biopharmacie, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Clément Rigaut
- TIPs (Transfers, Interfaces and Processes), Université libre de Bruxelles, Brussels, Belgium
| | - Pierre Lambert
- TIPs (Transfers, Interfaces and Processes), Université libre de Bruxelles, Brussels, Belgium
| | - Benoît Haut
- TIPs (Transfers, Interfaces and Processes), Université libre de Bruxelles, Brussels, Belgium
| | - Jonathan Goole
- Laboratoire de Pharmacie Galénique et de Biopharmacie, Université libre de Bruxelles (ULB), Brussels, Belgium.
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Martinez-Paredes JF, Karatayli-Ozgursoy S, Gonzalez V, Olomu O, Donaldson AM. Effect of Partial Uncinectomy After Balloon Sinuplasty on Maxillary Sinus Irrigant Penetration: A Cadaveric Study. OTO Open 2021; 5:2473974X21989583. [PMID: 33598598 PMCID: PMC7863165 DOI: 10.1177/2473974x21989583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/23/2020] [Indexed: 11/15/2022] Open
Abstract
Objective The uncinate process may play a role in the amount of irrigation penetrance. In this cadaver study, we aimed to investigate if the addition of partial uncinectomy provides better maxillary sinus irrigation penetrance than balloon sinuplasty (BSP) alone. Study Design Cadaveric study. Setting Simulation laboratory at the Mayo Clinic in Florida. Methods Five fresh-frozen human cadaveric heads (10 sides) were used to assess maxillary sinus irrigation penetration after 3 interventions performed sequentially: irrigation penetrance with no intervention, irrigation after BSP, and irrigation after BSP and partial removal of the uncinate. Penetrance was recorded with intrasinus endoscopy and scored by 4 blinded observers using a scale from 0 (no irrigation) to 5 (fully irrigated). The diameter of the maxillary ostium was measured before and after BSP. Internal consistency was evaluated with Cronbach’s alpha. Results Mean ostium size increased from 4.1 to 6.8 mm after BSP (P = .013). Cronbach’s alpha was 0.93. The median scores of irrigation penetration after no intervention, BSP, and BSP and partial uncinectomy were 2.5, 3, and 4, respectively. We found a significantly higher penetrance following partial uncinectomy plus BSP versus BSP alone (P = .008). Both interventions had a statistically significant difference in irrigation penetrance as compared with no intervention (P = .0001). Conclusion Maxillary sinus irrigation penetration increased from baseline after BSP. The addition of a partial uncinectomy to the balloon dilation of the maxillary sinus was associated with a statistically significant increase in irrigation penetrance scores as compared with BSP alone.
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Affiliation(s)
- Jhon F Martinez-Paredes
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Selmin Karatayli-Ozgursoy
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Valeria Gonzalez
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Osarenoma Olomu
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Angela M Donaldson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic in Florida, Jacksonville, Florida, USA
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