Numerical Study of the Aerodynamic Effects of Septoplasty and Partial Lateral Turbinectomy

The Laryngoscope (Impact Factor: 2.14). 01/2008; 118(2):330 - 334. DOI: 10.1097/MLG.0b013e318159aa26
Source: PubMed


Objectives: To investigate, first, the effects of septal deviation and concha bullosa on nasal airflow, and second, the aerodynamic changes induced by septoplasty and partial lateral turbinectomy, using computational fluid dynamics (CFD).Methods: A three-dimensional model of a nasal cavity was generated using paranasal sinus computed tomography images of a cadaver with concha bullosa and septal deviation. Virtual septoplasty and partial lateral turbinectomy were performed on this model to generate a second model representing the postoperative anatomy. Aerodynamics of the nasal cavity in the presence of concha bullosa and septal deviation as well as postoperative changes due to the virtual surgery were analyzed by performing CFD simulations on both models. Inspiratory airflow with a constant flow rate of 500 mL/second was used throughout the analyses.Results: In the preoperative model, the airflow mostly pass through a narrow area close to the base of the nasal cavity. Following the virtual operation, a general drop in the maximum intranasal air speed is observed with a significant increase of the airflow through right middle meatus. While in the preoperative model the greatest reduction in pressure is found to be in the localization of anterior septal deviation on the right side and confined to a very short segment, for the postoperative model, it is observed to be in the nasal valve region in both nasal cavities. Following septoplasty and partial lateral turbinectomy, total nasal resistance is reduced significantly.Conclusions: CFD simulations promise to make great contributions to understand the airflow characteristics of healthy and pathologic noses. Before surgery, planning for any specific intervention using CFD techniques on the nasal cavity model of the patient may help foreseeing the aerodynamic effects of the operation and might increase the success rate of the surgical treatment.

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Available from: Ergin Tönük, Aug 01, 2014
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    • "The study of nasal function, which broadly includes airflow, respiratory heat exchange, filtering of environmental contaminants, and chemical sensing, is of significance in the fields of respiratory physiology (Schmidt- Nielsen et al., 1970; Collins et al., 1971; Schroter and Watkin, 1989; Pless et al., 2004; Lindemann et al., 2004, 2006), otolaryngology (Kim and Chung, 2004; Ozlugedik et al., 2008; Rhee et al., 2011; Zhao et al., 2014), inhalation toxicology (Morgan and Monticello, 1990; Morgan et al., 1991; Kimbell et al., 1993, 2001), and olfaction (Keyhani et al., 1997; Zhao et al., 2006; Craven et al., 2010; Lawson et al., 2012). However, due to the anatomical complexity of the nasal fossa, in vivo experiments of nasal function are problematic. "
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    ABSTRACT: This special issue of The Anatomical Record is the outcome of a symposium entitled “Inside the Vertebrate Nose: Evolution, Structure and Function.” The skeletal framework of the nasal cavity is a complicated structure that often houses sinuses and comprises an internal skeleton of bone or cartilage that can vary greatly in architecture among species. The nose serves multiple functions, including olfaction and respiratory air-conditioning, and its morphology is constrained by evolution, development, and conflicting demands on cranial space, such as enlarged orbits. The nasal cavity of vertebrates has received much more attention in the last decade due to the emergence of nondestructive methods that allow improved visualization of the internal anatomy of the skull, such as high-resolution x-ray computed tomography and magnetic resonance imaging. The 17 articles included here represent a broad range of investigators, from paleontologists to engineers, who approach the nose from different perspectives. Key topics include the evolution and development of the nose, its comparative anatomy and function, and airflow through the nasal cavity of individual species. In addition, this special issue includes review articles on anatomical reduction of the olfactory apparatus in both cetaceans and primates (the vomeronasal system), as well as the molecular biology of olfaction in vertebrates. Together these articles provide an expansive summary of our current understanding of vertebrate nasal anatomy and function. In this introduction, we provide background information and an overview of each of the three primary topics, and place each article within the context of previous research and the major challenges that lie ahead. Anat Rec, 297:1975–1984, 2014. © 2014 Wiley Periodicals, Inc.
    The Anatomical Record Advances in Integrative Anatomy and Evolutionary Biology 11/2014; 297(11). DOI:10.1002/ar.23021 · 1.54 Impact Factor
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    • "Ozlugedik et al.20 detected that the airflow crossing the middle meatus was highly increased after virtual dissection of the lateral portion of the concha bullosa. Using CFD, Gaball et al.21 found that a submucous cartilaginous and/or bony window after septoplasty can cause nasal obstruction. "
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    ABSTRACT: The computational fluid dynamics (CFD) are used to evaluate the physiological function of the nose. We evaluated the aerodynamics of the nasal cavity in a patient with septal perforation (SP), pre- and postvirtual repair. Three-dimensional nasal models were reconstructed, and then a wide range of the pressure drops and flow rates were analyzed. The airflow velocity is higher in the central region and is lower around the boundary of the SP. The air velocity in the SP increases as the pressure drop increases. Furthermore, at the anterior part of the SP, the shear stress is higher in the upper part. In addition, the repair of SP does not affect the total nasal airflow rate and the velocity contour patterns. The potential usage of the CFD technique as a predictive technique to explore the details and a preoperative assessment tool to help in clinical decision making in nasal surgery is emphasized.
    07/2014; 5(2). DOI:10.2500/ar.2014.5.0090
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    • "The postoperative outcome of patients could be simulated by visualizing nasal airflow before and after a virtual endoscopic procedure 32. Other research groups also confirmed the suitability of CFD for generating models that show both surgeons and patients the postoperative benefit of surgical procedures (rapid maxillary expansion 29, turbinate surgery of hypertrophic turbinate 19 41, septoplasty and partial lateral turbinectomy 30). "
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    ABSTRACT: This systematic review aims first to summarize the previous areas of application of computational fluid dynamics (CFD) and then to demonstrate that CFD is also a suitable instrument for generating three-dimensional images that depict drug effects on nasal mucosa. Special emphasis is placed on the three-dimensional visualization of the antiobstructive effect of nasal steroids and antihistamines in the treatment of allergic rhinitis. In the beginning, CFD technology was only used to demonstrate physiological and pathophysiological airflow conditions in the nose and to aid in preoperative planning and postoperative monitoring of surgical outcome in the field of rhinosurgery. The first studies using CFD examined nasal respiratory physiology, important functions of the nose, such as conditioning and warming of inspired air, and the influence of pathophysiological changes on nasal breathing. Also, postoperative outcome of surgical procedures could be "predicted" using the nasal airflow model. Later studies focused on the three-dimensional visualization of the effect of nasal sprays in healthy subjects and postoperative patients. A completely new approach, however, was the use of CFD in the area of allergic rhinitis and the treatment of its cardinal symptom of nasal obstruction. In two clinical trials, a suitable patient with a positive history of allergic rhinitis was enrolled during a symptom-free period after the pollen season. The patient developed typical allergic rhinitis symptoms after provocation with birch pollen. The 3-D visualization showed that the antiallergic treatment successfully counteracted the effects of nasal allergen provocation on nasal airflow. These observations were attributed to the antiobstructive effect of a nasal steroid (mometasone furoate) and a systemic antihistamine (levocetirizine), respectively. CFD therefore constitutes a non-invasive, precise, reliable and objective examination procedure for generating three-dimensional images that depict the effects of drugs used in the treatment of allergic rhinitis.
    Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 02/2013; 33(1):36-42. · 1.64 Impact Factor
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