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Predicting postsurgery nasal physiology with computational modeling: current challenges and limitations. Otolaryngol Head Neck Surg 2014 Nov;151(5):751-9



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2-s2.0-84908672297   26 Citations


INTRODUCTION: High failure rates for surgical treatment of nasal airway obstruction (NAO) indicate that better diagnostic tools are needed to improve surgical planning. This study evaluates whether computer models based on a surgeon's edits of presurgery scans can accurately predict results from computer models based on postoperative scans of the same patient using computational fluid dynamics.

STUDY DESIGN: Prospective study.

SETTING: Academic medical center.

METHODS: Three-dimensional nasal models were reconstructed from computed tomographic scans of 10 patients with NAO presurgery and 5 to 8 months postsurgery. To create transcribed-surgery models, the surgeon digitally modified the preoperative reconstruction in each patient to represent physical changes expected from surgery and healing. Steady-state, laminar, inspiratory airflow was simulated in each model under physiologic, pressure-driven conditions.

RESULTS: Transcribed-surgery and postsurgery model variables were statistically different from presurgery variables at α = 0.05. Unilateral nasal resistance and airflow were not statistically different between transcribed-surgery and postsurgery models, but bilateral resistance was significantly different. Cross-sectional average pressures in transcribed surgery trended with postsurgery. Transcribed-surgery prediction errors of postsurgery bilateral resistance were within 10% to 20% and 20% to 30% in 5 and 4 subjects, respectively. Prediction errors for unilateral resistance were <10%, 10% to 20%, and 20% to 30% in 1, 2, and 4 subjects, respectively.

CONCLUSIONS: Computational models with modifications mimicking actual surgery and healing have the potential to predict postoperative outcomes. However, software to effectively translate virtual surgery steps into computational models is lacking. The ability to account for healing factors and the current limited virtual surgery tools are challenges that need to be overcome for greater accuracy.

Author List

Frank-Ito DO, Kimbell JS, Laud P, Garcia GJ, Rhee JS


Guilherme Garcia PhD Assistant Professor in the Biomedical Engineering department at Medical College of Wisconsin
Purushottam W. Laud PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
John 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

Computer Simulation
Cross-Sectional Studies
Imaging, Three-Dimensional
Middle Aged
Nasal Obstruction
Prospective Studies
Recovery of Function
Young Adult
jenkins-FCD Prod-480 9a4deaf152b0b06dd18151814fff2e18f6c05280