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A hierarchical stepwise approach to evaluate nasal patency after virtual surgery for nasal airway obstruction. Clin Biomech (Bristol, Avon) 2019 01;61:172-180



Pubmed ID


Pubmed Central ID




Scopus ID

2-s2.0-85058820393   4 Citations


BACKGROUND: Despite advances in medicine and expenditures associated in treatment of nasal airway obstruction, 25-50% of patients undergoing nasal surgeries complain of persistent obstructive symptoms. Our objective is to develop a "stepwise virtual surgery" method that optimizes surgical outcomes for treatment of nasal airway obstruction.

METHODS: Pre-surgery radiographic images of two subjects with nasal airway obstruction were imported into Mimics imaging software package for three-dimension reconstruction of the airway. A hierarchical stepwise approach was used to create seven virtual surgery nasal models comprising individual (inferior turbinectomy or septoplasty) procedures and combined inferior turbinectomy and septoplasty procedures via digital modifications of each subject's pre-surgery nasal model. To evaluate the effects of these procedures on nasal patency, computational fluid dynamics modeling was used to perform steady-state laminar inspiratory airflow and heat transfer simulations in every model, at resting breathing. Airflow-related variables were calculated for virtual surgery models and compared with dataset containing results of healthy subjects with no symptoms of nasal obstruction.

FINDINGS: For Subject 1, nasal models with virtual septoplasty only and virtual septoplasty plus inferior turbinectomy on less obstructed side were within the healthy reference thresholds on both sides of the nasal cavity and across all three computed variables. For Subject 2, virtual septoplasty plus inferior turbinectomy on less obstructed side model produced the best result.

INTERPRETATION: The hierarchical stepwise approach implemented in this preliminary report demonstrates computational fluid dynamics modeling ability to evaluate the efficiency of different surgical procedures for nasal obstruction in restoring nasal patency to normative level.

Author List

Frank-Ito DO, Kimbell JS, Borojeni AAT, Garcia GJM, Rhee JS


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

Computer Simulation
Image Processing, Computer-Assisted
Imaging, Three-Dimensional
Middle Aged
Models, Anatomic
Nasal Obstruction
Nasal Septum
Surgery, Computer-Assisted
Treatment Outcome
Young Adult
jenkins-FCD Prod-482 91ad8a360b6da540234915ea01ff80e38bfdb40a