Impact of Middle versus Inferior Total Turbinectomy on Nasal Aerodynamics

Abstract

Objectives This computational study aims to: (1) Use virtual surgery to theoretically investigate the maximum possible change in nasal aerodynamics after turbinate surgery; (2) Quantify the relative contributions of the middle and inferior turbinates to nasal resistance and air conditioning; (3) Quantify to what extent total turbinectomy impairs the nasal air conditioning capacity. Study Design Virtual surgery and computational fluid dynamics (CFD). Setting Academic tertiary medical center. Subjects and Methods Ten patients with inferior turbinate hypertrophy were studied. Three-dimensional models of their nasal anatomies were built based on pre-surgery computed tomography scans. Virtual surgery was applied to create models representing either total inferior turbinectomy (TIT) or total middle turbinectomy (TMT). Airflow, heat transfer, and humidity transport were simulated at a 15 L/min steady-state inhalation rate. The surface area stimulated by mucosal cooling was defined as the area where heat fluxes exceed 50 W/cm2. Results In both virtual total turbinectomy models, nasal resistance decreased and airflow increased. However, the surface area where heat fluxes exceed 50 W/cm2 either decreased (TIT) or did not change significantly (TMT), suggesting that total turbinectomy may reduce the stimulation of cold receptors by inspired air. Nasal heating and humidification efficiencies decreased significantly after both TIT and TMT. All changes were greater in the TIT models than in the TMT models. Conclusion TIT yields greater increases in nasal airflow, but also impairs the nasal air conditioning capacity to a greater extent than TMT. Radical resection of the turbinates may decrease the surface area stimulated by mucosal cooling.

Correlation of Nasal Mucosal Temperature With Subjective Nasal Patency in Healthy Individuals

“…Subjective nasal patency; nasal airflow sensation; nasal mucosal temperature; mucosal cooling; NOSE score; visual analog scale; nasal airway obstruction Recent computational studies demonstrated that it is possible to quantify inspiratory mucosal heat loss utilizing computational fluid dynamics (CFD) simulations in 3-dimensional patient-specific models of the nasal anatomy built from radiologic imaging. [15][16][17][18] These computational studies confirmed that subjective nasal patency correlates better with mucosal heat loss than with nasal resistance to airflow. 16,18 The CFD technique, however, has some disadvantages, including the high cost of medical imaging, radiation exposure when based Bailey et al…”

Estimates of nasal airflow at the nasal cycle mid-point improve the correlation between objective and subjective measures of nasal patency

“…Researchers have explored a myriad of topics, such as characterizing nasal airflow in healthy subjects (Zhao and Jiang, 2014), quantifying nasal filtration of airborne particles (Frank-Ito et al, 2015; Garcia et al, 2015b; Schroeter et al, 2011; Schroeter et al, 2015), heating and humidification of inspired air (Dayal et al, 2016; Goodarzi-Ardakani et al, 2016), the relationship between nasal function and nasal anatomy (Garcia et al, 2016; Patki and Frank-Ito, 2016), and airflow in the paranasal sinuses (Zhu et al, 2012; Zhu et al, 2014). In particular, there is much interest in identifying flow variables that correlate with symptoms of nasal airway obstruction (Garcia et al, 2016; Garcia et al, 2010; Hariri et al, 2015; Kim et al, 2014; Na et al, 2012).…”

“…This manuscript is part of a larger study investigating the correlation between subjective and objective measures of nasal airflow (Dayal et al, 2016; Frank-Ito et al, 2014; Garcia et al, 2016; Hariri et al, 2015; Kimbell et al, 2013; Patel et al, 2015; Rhee et al, 2014; Sullivan et al, 2014). The cohort consisted of 27 patients all undergoing surgery to treat chronic nasal airway obstruction (septoplasty, turbinectomy, and/or functional rhinoplasty).…”

Impact of endoscopic craniofacial resection on simulated nasal airflow and heat transport

“…For example, in the CFR models studied, only an anterior septal strut and inferior turbinates remained after surgery. Given that extensive intranasal surgery has been correlated with ineffective air conditioning, it is reasonable to assume that CFR patients would report symptoms of congestion, dryness, and crusting. However, the majority deny significant nasal complaints in the long‐term postoperative period .…”

“…Nasal humidification efficiency, previously described by Dayal et al, was defined as: where C nostril , C postseptum , and C mucosa are the water concentrations in air at the nostril, posterior septum, and nasal mucosa, respectively. This represents the overall transport of water from nasal mucosa during inspiration.…”