Dataset Information

Computational Fluid Dynamics to Evaluate the Effectiveness of Inferior Turbinate Reduction Techniques to Improve Nasal Airflow.

ABSTRACT: Inferior turbinate reduction (ITR) is a commonly performed procedure for the treatment of nasal obstruction. Which portion of the inferior turbinates should be surgically addressed to improve nasal airflow has yet to be determined.To use computational fluid dynamics (CFD) analysis to evaluate the airflow changes after reduction along different portions of the inferior turbinate.Computed tomographic scans of 5 patients were selected. Seven CFD models were created for each patient: 1 unaltered and 6 various ITRs, including 3 one-third ITRs (anterior, middle, and posterior one-third); 2 two-thirds ITRs (anterior and posterior two-thirds); and 1 full-length ITR model. Total airflow rate and nasal resistance was obtained through CFD analysis, and regression analysis was performed on the increased nasal volume, locations, and nasal resistance for all 5 patients.Total airflow rate and nasal resistance was obtained through CFD analysis, and regression analysis was performed on the increased nasal volume, locations, and nasal resistance for all 5 patients.Full ITR over the whole length was consistently most effective to improve nasal airflow and resistance for all 5 patients (2 men and 3 women), adjusted for the volume. Regression analysis showed a strong linear (R2?0.79) relationship between nasal volume changes and nasal airflow. However, the most effective location of partial turbinate reduction was not consistent among patients. Surprisingly, for some patients, posterior ITRs were more effective than anterior ITRs. The site of most effective partial ITR differed from 1 side to the other even in the same individual.The effectiveness of partial ITR and target location likely depends on individual patient anatomy. The fact that full ITRs were consistently most effective and the linear regression between flow and nasal volume changes may indicate that the entire length of the IT has a functional impact on nasal airflow and resistance.NA.

SUBMITTER: Lee TS

PROVIDER: S-EPMC5872907 | biostudies-other | 2018 Jul

REPOSITORIES: biostudies-other

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Computational Fluid Dynamics to Evaluate the Effectiveness of Inferior Turbinate Reduction Techniques to Improve Nasal Airflow.

Lee Thomas S TS Goyal Parul P Li Chengyu C Zhao Kai K

JAMA facial plastic surgery 20180701 4

<h4>Importance</h4>Inferior turbinate reduction (ITR) is a commonly performed procedure for the treatment of nasal obstruction. Which portion of the inferior turbinates should be surgically addressed to improve nasal airflow has yet to be determined.<h4>Objective</h4>To use computational fluid dynamics (CFD) analysis to evaluate the airflow changes after reduction along different portions of the inferior turbinate.<h4>Design, setting, and participants</h4>Computed tomographic scans of 5 patients ...[more]

PMID: 29372235

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Project description:BACKGROUND:Empty nose syndrome (ENS) remains highly controversial, with aggressive inferior turbinate reduction (ITR) or mucociliary dysfunction frequently implicated. However, the appropriate degree of ITR is highly debatable. METHODS:We applied individual computed tomography (CT)-based computational fluid dynamics (CFD) to 5 patients receiving relatively aggressive ITR but with no ENS symptoms, and compared them to 27 symptomatic ENS patients who all had histories of aggressive ITRs, and 42 healthy controls. Patients' surgical outcomes were confirmed with 22-item Sino-Nasal Outcome Test (SNOT-22) (ITR: 6.40 ± 4.56; ENS: 58.2 ± 15.9; healthy: 13.2 ± 14.9), Nasal Obstruction Symptom Evaluation (NOSE) scores (ITR: 4.00 ± 2.24; ENS: 69.4 ± 17.1; healthy: 11.9 ± 12.9), and Empty Nose Syndrome 6-Item Questionnaire (ENS6Q) (?11 for ENS). RESULTS:Both aggressive ITR without ENS symptoms and symptomatic ENS patients had significantly lower nasal resistance (ITR: 0.059 ± 0.020 Pa·s/mL; ENS: 0.052 ± 0.015 Pa·s/mL; healthy: 0.070 ± 0.021 Pa·s/mL) and higher cross-sectional areas surrounding the inferior turbinate (ITR: 0.94 ± 0.21 cm2 ; ENS: 1.19 ± 1.05 cm2 ; healthy: 0.42 ± 0.22 cm2 ) than healthy controls. The lack of significant differences among patient groups indicated similar degrees of surgeries between ITR with and without ENS symptom cohorts. However, symptomatic ENS patients have paradoxical significantly less airflow in the inferior meatus (ITR: 47.7% ± 23.6%; ENS: 25.8% ± 17.6%; healthy: 36.5 ± 15.9%; both p < 0.01), but higher airflow around the middle meatus (ITR: 49.7% ± 22.6%; ENS: 66.5% ± 18.3%; healthy: 49.9% ± 15.1%, p < 0.0001) than aggressive ITR without symptoms and controls. Aggressive ITR patients have increased inferior meatus airflow as expected (p < 0.05). This imbalanced airflow produced less inferior wall-shear-stress distribution among symptomatic ENS patients only (ITR: 42.45% ± 11.4%; ENS: 32.2% ± 12.6%; healthy: 49.7% ± 9.9%). ENS patients (n = 12) also had impaired nasal trigeminal function, as measured by menthol lateralization detection thresholds (ITR: 15.2 ± 1.2; ENS: 10.3 ± 3.9; healthy: 13.8 ± 3.09, both p < 0.0001). Surprisingly, aggressive ITR patients without ENS symptoms have better menthol lateralization detection thresholds (LDTs) than healthy controls. CONCLUSION:Although turbinate tissue loss is linked with ENS, the degree of ITR that might distinguish postoperative patient satisfaction in their nasal breathing vs development of ENS symptoms is unclear. Our results suggest that a combination of distorted nasal aerodynamics and loss of mucosal sensory function may potentially lead to ENS symptomology.

Dataset Information

Computational Fluid Dynamics to Evaluate the Effectiveness of Inferior Turbinate Reduction Techniques to Improve Nasal Airflow.

Publications

Computational Fluid Dynamics to Evaluate the Effectiveness of Inferior Turbinate Reduction Techniques to Improve Nasal Airflow.

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