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Identifying patients who may benefit from inferior turbinate reduction using computer simulations. Laryngoscope 2015 Dec;125(12):2635-41

Date

05/13/2015

Pubmed ID

25963247

Pubmed Central ID

PMC4641847

DOI

10.1002/lary.25367

Abstract

OBJECTIVES/HYPOTHESIS: (1) To determine objective criteria to predict which patients may benefit most from inferior turbinate reduction surgery. (2) To test whether the site of turbinate reduction, either along the nasal floor (bottom resection) or along the septal side (medial resection), impacts the extent to which nasal resistance is reduced.

STUDY DESIGN: Case series.

METHODS: Three-dimensional reconstructions of the nasal anatomy of five nasal airway obstruction patients were created based on presurgical computed tomography scans. Inferior turbinate reduction models were created for each patient using virtual surgery. Airflow, heat transfer, and humidity transport during inspiration were simulated using computational fluid dynamics (CFD).

RESULTS: Nasal resistance curves revealed little to no difference between bottom resection and medial resection models. In two patients, little change was observed in nasal resistance after virtual inferior turbinate reduction, which was attributed to the narrowest cross-sections being restricted to the anterior nose (i.e., anterior to the inferior turbinate). The three patients whose nasal resistances decreased substantially after virtual inferior turbinate reduction had a narrower airspace in the turbinate region and higher nasal resistance presurgery. Nasal air conditioning capacity was more affected by medial resections.

CONCLUSIONS: CFD simulations predicted no significant difference in the decrease in nasal resistance between virtual inferior turbinate reductions performed by bottom versus medial resection of the turbinate. However, bottom resections better preserved the calculated humidification efficiency. The simulations predicted that the greatest reduction in nasal resistance occurs in patients with the highest presurgical resistance in the turbinate region.

LEVEL OF EVIDENCE: 4.

Author List

Hariri BM, Rhee JS, Garcia GJ

Authors

Guilherme Garcia PhD Assistant Professor in the Biomedical Engineering 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

Adolescent
Adult
Computer Simulation
Female
Humans
Humidity
Hydrodynamics
Male
Models, Anatomic
Models, Theoretical
Nasal Obstruction
Nasal Surgical Procedures
Patient Selection
Respiration
Tomography, X-Ray Computed
Turbinates
Young Adult
jenkins-FCD Prod-467 7c8a156729bba74d775d9c546792cde315827259