Computational Fluid Dynamic Study of Nasal Respiratory Function Before and After Bimaxillary Orthognathic Surgery With Bone Trimming at the Inferior Edge of the Pyriform Aperture

Kita, Soma; Oshima, Mitsuko; Shimazaki, K.; Iwai, Toshinori; Omura, Susumu; Ono, Takashi

doi:10.1016/j.joms.2016.06.171

Cited by 19 publications

(20 citation statements)

References 24 publications

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“…Recently, a study using computed fluid dynamic analysis of nasal respiratory function reported that the postoperative pressure effort showed a decreasing tendency and the cross-sectional area showed an increasing tendency in each area of the nasal cavity, for class III patients with L1 and SSRO. 33 This theoretical result obtained by a dynamic calculation method was in accordance with previous studies on nasal function after maxillary impaction by L1. [13][14][15][16][17][18][19] Furthermore, they stated that reshaping of inferior edge of the piriform aperture was very useful to prevent worsening of nasal function after maxillary impaction.…”

Section: Discussionsupporting

confidence: 91%

“…[13][14][15][16][17][18][19] Furthermore, they stated that reshaping of inferior edge of the piriform aperture was very useful to prevent worsening of nasal function after maxillary impaction. 33 The outcome with this method may be more predictable than other rhino-surgery procedures, as postoperative hypertrophy or edema of the nasal membrane at the inferior choncha can be reduced when used.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of Nasal Function and Upper Airway Morphology After Bi-Maxillary Surgery Using Rhinomanometry and Computed Tomography

Tsutsui

Moroi

Yoshizawa

et al. 2021

Journal of Craniofacial Surgery

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This study was performed to evaluate changes in nasal airflow, nasal airway resistance, nasal cross-sectional area, pharyngeal horizontal area, nasopharyngeal and oropharyngeal volume following Le Fort I osteotomy (L1) impaction with sagittal split ramus osteotomy (SSRO) in classes II and III. Materials and Methods: The subjects consisted of 35 patients (6 males and 29 females, 70 sides) 17 of which were diagnosed as class II and 18 as class III who underwent L1 and SSRO. Nasal airflow and resistance were measured using the rhinomanometry system (GM NR-6 EXECUTIVE) before and at 1 and 6 months after surgery. Nasal, cross-sectional area, and volume were measured using a 3-dimensional computed tomography respectively, before and 1-year after surgery. Results: Although a significant decrease was found in nasal volume after surgery (P ¼ 0.0042), there was no difference between before and after surgery in the nasal airway resistance in class II.A significant decrease in nasal volume was found after surgery (P ¼ 0.0005) and there were no postoperative changes in both nasal airflow and resistance in class III. Conclusion:The study suggested that L1 impaction with SSRO did not worsen nasal function such as nasal airflow and nasal airway resistance, although nasal volume significantly decreased in both groups.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Evaluation of Nasal Function and Upper Airway Morphology After Bi-Maxillary Surgery Using Rhinomanometry and Computed Tomography

Tsutsui

Moroi

Yoshizawa

et al. 2021

Journal of Craniofacial Surgery

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“…To identify airway structures that may lead to OSA, previous studies have used both cephalometry and CT. Recently, CFD has become a highly precise and reliable method for numeric analysis of respiration flow and has emerged as the preferred tool for predicting OSA [ 14 , 16 , 21 , 22 ]. However, a CFD analysis requires large-scale calculations [ 15 ], and there are precision-related difficulties with comparing simulation results to measured physiological data.…”

Section: Discussionmentioning

confidence: 99%

A preoperative predictive study of advantages of airway changes after maxillomandibular advancement surgery using computational fluid dynamics analysis

et al. 2021

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The purpose of this study was to develop a simulation approach for predicting maxillomandibular advancement-induced airway changes using computational fluid dynamics. Eight patients with jaw deformities who underwent maxillomandibular advancement and genioglossus advancement surgery were included in this study. Computed tomography scans and rhinomanometric readings were performed both preoperatively and postoperatively. Computational fluid dynamics models were created, and airflow simulations were performed using computational fluid dynamics software; the preferable number of computational mesh points was at least 10 million cells. The results for the right and left nares, including simulation and postoperative measurements, were qualitatively consistent, and surgery reduced airflow pressure loss. Geometry prediction simulation results were qualitatively consistent with the postoperative stereolithography data and postoperative simulation results. Simulations were performed with either the right or left naris blocked, and the predicted values were similar to those found clinically. In addition, geometry prediction simulation results were qualitatively consistent with the postoperative stereolithography data and postoperative simulation results. These findings suggest that geometry prediction simulation facilitates the preoperative prediction of the postoperative structural outcome.

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“…In patient 3, ΔP Nose was increased, but ΔP All , which represents the ΔP in the entire upper airway, was lower in the POST model than that in the PRE model. Our previous study [ 29 ] found that the nasal cavity has a greater influence on the ΔP compared to the pharynx after surgery for mandibular prognathism (i.e., Class III skeletal relationship of the jaws). These findings are consistent with those of the present study, in which the ratio of ΔP Nose to ΔP All was higher ( Table 3 ) than that of ΔP Pharynx to ΔP All in maxillary prognathism (i.e., Class II skeletal relationship of the jaws).…”

Section: Discussionmentioning

confidence: 99%

“…The inlet boundary conditions were set at a flow rate of 2.000 × 10 −4 m 3 /s based on previous studies on the peak respiratory flow at rest [ 28 ] and simulation of upper airway flow [ 29 – 31 ]. The inflow velocity was calculated using the flow rate and area of the inlet.…”

Section: Methodsmentioning

confidence: 99%

Computational fluid dynamic analysis of the nasal respiratory function before and after postero-superior repositioning of the maxilla

et al. 2022

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Morphological changes in the upper airway and the resulting alteration in the nasal respiratory function after jawbone repositioning during orthognathic surgery have garnered attention recently. In particular, nasopharyngeal stenosis, because of the complex influence of both jaws, the effects of which have not yet been clarified owing to postero-superior repositioning of the maxilla, may significantly impact sleep and respiratory function, necessitating further functional evaluation. This study aimed to perform a functional evaluation of the effects of surgery involving maxillary repositioning, which may result in a larger airway resistance if the stenosis worsens the respiratory function, using CFD for treatment planning. A model was developed from CT images obtained preoperatively (PRE) and postoperatively (POST) in females (n = 3) who underwent maxillary postero-superior repositioning using Mimics and ICEM CFD. Simultaneously, a model of stenosis (STENOSIS) was developed by adjusting the severity of stenosis around the PNS to simulate greater repositioning than that in the POST. Inhalation at rest and atmospheric pressure were simulated in each model using Fluent, whereas pressure drop (ΔP) was evaluated using CFD Post. In this study, ΔP was proportional to airway resistance because the flow rate was constant. Therefore, the magnitude of ΔP was evaluated as the level of airway resistance. The ΔP in the airway was lower in the POST compared to the PRE, indicating that the analysis of the effects of repositioning on nasal ventilation showed that current surgery is appropriate with respect to functionality, as it does not compromise respiratory function. The rate of change in the cross-sectional area of the mass extending pharynx (α) was calculated as the ratio of each neighboring section. The closer the α-value is to 1, the smaller the ΔP, so ideally the airway should be constant. This study identified airway shapes that are favorable from the perspective of fluid dynamics.

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Computational Fluid Dynamic Study of Nasal Respiratory Function Before and After Bimaxillary Orthognathic Surgery With Bone Trimming at the Inferior Edge of the Pyriform Aperture

Cited by 19 publications

References 24 publications

Evaluation of Nasal Function and Upper Airway Morphology After Bi-Maxillary Surgery Using Rhinomanometry and Computed Tomography

Evaluation of Nasal Function and Upper Airway Morphology After Bi-Maxillary Surgery Using Rhinomanometry and Computed Tomography

A preoperative predictive study of advantages of airway changes after maxillomandibular advancement surgery using computational fluid dynamics analysis

Computational fluid dynamic analysis of the nasal respiratory function before and after postero-superior repositioning of the maxilla

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