Virtual septoplasty: a method to predict surgical outcomes for patients with nasal airway obstruction. Int J Comput Assist Radiol Surg 2020 Apr;15(4):725-735
Date
02/23/2020Pubmed ID
32078099Pubmed Central ID
PMC7148186DOI
10.1007/s11548-020-02124-zScopus ID
2-s2.0-85079604195 (requires institutional sign-in at Scopus site) 33 CitationsAbstract
PURPOSE: A deviated nasal septum is the most common etiology for nasal airway obstruction (NAO), and septoplasty is the most common surgical procedure performed by ear-nose-throat surgeons in adults. However, quantitative criteria are rarely adopted to select patients for surgery, which may explain why up to 50% of patients report persistent or recurrent symptoms of nasal obstruction postoperatively. This study reports a systematic virtual surgery method to identify patients who may benefit from septoplasty.
METHODS: One patient with symptoms of NAO due to a septal deviation was selected to illustrate the virtual surgery concept. Virtual septoplasty was implemented in three steps: (1) determining if septal geometry is abnormal preoperatively, (2) virtually correcting the deviation while preserving the anatomical shape of the septum, and (3) estimating the post-surgical improvement in airflow using computational fluid dynamics. Anatomical and functional changes predicted by the virtual surgery method were compared to a standard septoplasty performed independently from the computational analysis.
RESULTS: A benchmark healthy nasal septum geometry was obtained by averaging the septum dimensions of 47 healthy individuals. A comparison of the nasal septum geometry in the NAO patient with the benchmark geometry identified the precise locations where septal deviation and thickness exceeded the healthy range. Good agreement was found between the virtual surgery predictions and the actual surgical outcomes for both airspace minimal cross-sectional area (0.05 cm2 pre-surgery, 0.54 cm2 virtual surgery, 0.50 cm2 actual surgery) and nasal resistance (0.91 Pa.s/ml pre-surgery, 0.08 Pa.s/ml virtual surgery, 0.08 Pa.s/ml actual surgery).
CONCLUSIONS: Previous virtual surgery methods for NAO were based on manual edits and subjective criteria. The virtual septoplasty method proposed in this study is objective and has the potential to be fully automated. Future implementation of this method in virtual surgery planning software has the potential to improve septoplasty outcomes.
Author List
Moghaddam MG, Garcia GJM, Frank-Ito DO, Kimbell JS, Rhee JSAuthors
Guilherme Garcia PhD Assistant Professor in the Biomedical Engineering department at Medical College of WisconsinJohn S. Rhee MD Chair, Professor in the Otolaryngology department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Aged, 80 and over
Female
Humans
Male
Middle Aged
Nasal Obstruction
Nasal Septum
Prognosis
Rhinoplasty
Software
Tomography, X-Ray Computed
Treatment Outcome
Young Adult