The effect of "Pyriform Turbinoplasty" on nasal airflow using a virtual model.
Simmen Daniel,Sommer Fabian,Briner Hans Rudolf,Jones Nick,Kröger Ralf,Hoffmann Thomas Karl,Lindemann Jörg
BACKGROUND:A new procedure, pyriform turbinoplasty, is described and nasal airflow is measured before and after this procedure in a virtual model. METHODOLOGY:Pyriform turbinoplasty is the submucosal reduction of the bone of the frontal process of the maxilla and the lacrimal bone. It opens part of the lateral margin of the nasal valve area with minimal damage to nasal mucosa. The resection of bone in this area can be extended by "nasal wall lateralization" when the lacrimal bone that joins the uncinate process behind the lacrimal duct as well as the base of the inferior turbinate and the edge of the maxilla at the rim of the pyriform aperture are removed. Nasal airflow was simulated using computational fluid dynamics and ANSYS Fluent solver. RESULTS:Analysis using fluid dynamics showed that these procedures help ventilation in the main airflow areas without substantially altering the normal pattern of airflow. CONCLUSIONS:The changes after performing a pyriform turbinoplasty seem to be an improvement when compared to the changes after inferior turbinate surgery that can misdirect the airflow largely through the inferior meatus.
An optimization method for surgical reduction of hypertrophied inferior turbinate.
Xiong Huahui,Cao Han,Huang Yaqi
Journal of biomechanics
Surgical reductions of the hypertrophied inferior turbinate (HIT) can improve nasal obstruction. However, there is currently a lack of personalized and objective methods to guide surgical operations, which results in the excessive or inadequate resection of HIT. In this study, we proposed an optimizing method based on homotopy deformation to determine the resected amount and shape of the tissue by matching the flow resistance in the two nasal passageways. The simulation results obtained using computational fluid dynamics showed that after such an optimization procedure, the most obstructed nasal side could have a similar air flux as the less obstructed side. A 35% and a 56% less tissue resection in the optimizing operation compared to that in the total turbinectomy could well balance the air flow between the two nasal cavities in the simulations for patients 1 and 2 with unilateral nasal obstruction respectively. Compared with the optimization operation, the total turbinectomy made a more aggressive resection of HIT, which could worsen the air conditioning capacity of the nose. A sensitivity test indicated that in the optimization operation, the most constricted region in the nasal cavity should be adequately enlarged. However, more tissue resection than is required for the optimization operation did not improve the flow in the obstructed side strikingly. Simulations of the optimization operation in both nasal cavities for a patient with bilateral nasal obstruction were also performed. The flow rate could reach the normal level and be well balanced in the two sides after such an optimization procedure.