ABSTRACT

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Otolaryngology-Head and Neck Surgery 147(2S) ORAL PRESENTATIONS changed mentors. Overall, 82% of participants endorsed continuing the program. Conclusion: Mentorship programs are an effective tool in facilitating resident development. Residents would prefer choosing their own mentor and value honesty and supportiveness. Topics relating to private practice and contract negotiations were the areas of greatest discomfort for residents and the least frequently discussed. This represents an area for improvement.

Objective To use computational fluid dynamics (CFD) technology to help providers understand 1) how septal perforations may alter nasal physiology and 2) how these alterations are influenced by perforation size and location. Study Design Computer simulation study Setting Facial Plastic and Reconstructive Surgery clinic Subjects and Methods With the aid of medical imaging and modeling software, septal perforations of 1 and 2 cm in anterior, posterior, and superior locations were virtually created in a nasal cavity digital model. CFD techniques were used to analyze airflow, nasal resistance, air conditioning, and wall shear stress. Results Bilateral nasal resistance was not significantly altered by a septal perforation. Airflow allocation changed, with more air flowing through the lower-resistance nasal cavity. This effect was greater for anterior and posterior perforations than for the superior location. At the perforation sites, there was less localized heat and moisture flux and wall shear stress in superior perforations compared to those in anterior or posterior locations. For anterior perforations, a larger size produced higher wall shear and velocity, while in posterior perforations a smaller size produced higher wall shear and velocity. Conclusions Septal perforations may alter nasal physiology. In the subject studied, airflow allocation to each side was changed as air was shunted through the perforation to the lower-resistance nasal cavity. Anterior and posterior perforations caused larger effects than those in a superior location. Increasing the size of anterior perforations and decreasing the size of posterior perforations enhanced alterations in wall shear and velocity at the perforation.

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Background Quantitative methods for comparing intranasal drug delivery efficiencies pre- and postoperatively have not been fully utilized. The objective of this study is to use computational fluid dynamics techniques to evaluate aqueous nasal spray penetration efficiencies before and after surgical correction of intranasal anatomic deformities. Methods Ten three-dimensional models of the nasal cavities were created from pre- and postoperative computed tomography scans in five subjects. Spray simulations were conducted using a particle size distribution ranging from 10–110μm, a spray speed of 3m/s, plume angle of 68°, and with steady state, resting inspiratory airflow present. Two different nozzle positions were compared. Statistical analysis was conducted using Student T-test for matched pairs. Results On the obstructed side, posterior particle deposition after surgery increased by 118% and was statistically significant (p-value=0.036), while anterior particle deposition decreased by 13% and was also statistically significant (p-value=0.020). The fraction of particles that by-passed the airways either pre- or post-operatively was less than 5%. Posterior particle deposition differences between obstructed and contralateral sides of the airways were 113% and 30% for pre- and post-surgery, respectively. Results showed that nozzle positions can influence spray delivery. Conclusions Simulations predicted that surgical correction of nasal anatomic deformities can improve spray penetration to areas where medications can have greater effect. Particle deposition patterns between both sides of the airways are more evenly distributed after surgery. These findings suggest that correcting anatomic deformities may improve intranasal medication delivery. For enhanced particle penetration, patients with nasal deformities may explore different nozzle positions.

Musculoskeletal disorders are common in patients suspected of having lumbosacral radiculopathy. The high prevalence among both patients with normal studies and those with radiculopathy and other disorders limits the usefulness of this information in predicting study outcome. In particular, it is common for patients to have two or more problems and the presence of a musculoskeletal disorder should not preclude such testing.

Introduction There are often multiple anatomic factors that contribute to nasal obstruction, creating difficulty in deciding which components to address for a successful outcome. The purpose of this pilot study is to demonstrate the effect of individual components of functional nasal airway surgery in a patient with multifactorial obstruction and discuss the potential benefit of computational fluid dynamics (CFD)-aided virtual surgery. Methods A 53 year old female underwent septoplasty, turbinate reduction, and nasal valve repair. Pre- and post-operative digital nasal models were created from CT images and nasal resistance was calculated using CFD techniques. The digital models were then manipulated to isolate the effects of the components of the surgery, creating a nasal valve repair alone model and a septoplasty/turbinate reduction alone model. Results Bilateral nasal resistance on the post-operative model was approximately 25% less than pre-operative values. Similarly, CFD analysis showed reductions in nasal resistance of the virtual models: 19% reduction with intranasal surgery alone and 6% reduction with nasal valve repair alone. Conclusions Most of the reduction in nasal resistance was accomplished with performance of septoplasty and inferior turbinate reduction. The contribution from nasal valve repair was less in comparison but not insignificant. This pilot study implies that CFD-aided virtual surgery may be useful as part of pre-operative planning in patients with multifactorial anatomic nasal airway obstruction.