Sinus irrigations before and after surgery—Visualization through computational fluid dynamics simulations

Abstract

Objective Topical sinus irrigations play a critical role in the management of sinonasal disease, and the improvement in irrigant penetration into the sinuses postoperatively greatly contributes to the success of the endoscopic sinus surgery. Prior investigations on postoperative sinus irrigations have been mostly limited to cadaver studies, which are labor intensive, and do not capture the full dynamics of the flows. A pilot study was conducted to investigate the impact of surgery on sinus irrigation through Computational Fluid Dynamics (CFD) simulations. Study Design Retrospective computational study Methods Pre- and postoperative CT scans were obtained on a patient who underwent standard Endoscopic surgeries for all sinuses, including a Draf III frontal sinusotomy. CT based pre- and postoperative CFD models then simulated irrigations of 120 mL saline per nostril at 12mL/s (typical of Sinugator®) and 60mL/s (SinusRinse Bottle®), in two head positions: face parallel and at 45° angle to the ground. Results Overall, surgery most significantly improved frontal sinus irrigation, but surprisingly resulted in less maxillary and ethmoid sinuses penetration. This may due to the partial removal of septum during the Draf III, causing most fluid to exit pre-maturely across the resected septum. Higher flow rate slightly improved ethmoid sinus irrigation, but resulted in less contralateral maxillary sinus penetration. Conclusions CFD modeling of sinonasal irrigations is a novel technique for evaluating irrigant penetration of individual sinus cavities. It may prove useful in determining the optimal degree of surgery or the ideal irrigation strategy to allow for maximal and targeted sinus irrigant penetration.

Topical corticosteroid irrigations in chronic rhinosinusitis

“…The surgical state of anatomic remodeling of the sinus cavity is directly related to distribution of topical therapy within the cavity. Previous studies have shown improved penetration in sinuses that have been opened widely, compared with those that have been incompletely opened or have not undergone surgical intervention, particularly so for the frontal and sphenoid sinuses . Three cadaveric model studies and 1 computational dynamics study have shown improved penetration, force, and lavage of a widely open surgical cavity in the frontal, maxillary, and sphenoid sinuses .…”

“…Previous studies have shown improved penetration in sinuses that have been opened widely, compared with those that have been incompletely opened or have not undergone surgical intervention, particularly so for the frontal and sphenoid sinuses . Three cadaveric model studies and 1 computational dynamics study have shown improved penetration, force, and lavage of a widely open surgical cavity in the frontal, maxillary, and sphenoid sinuses . In a study by Harvey et al, all patients underwent a very similar complete sinus surgery with the only difference being surgical management of the frontal sinus.…”

Computational fluid dynamic modeling of nose‐to‐ceiling head positioning for sphenoid sinus irrigation

“…Based on previously published methods, postoperative CFD models were then created from the postoperative cadaveric CT scans. In brief, AMIRA® software (Visualization Sciences Group, Burlington, MA) was used to establish the interface between the nasal mucosa and air on the CT scans.…”

Diseases of the nasal cavity

“…In the absence of a clinical response, ESS is undertaken with an estimated 450, 000 cases performed annually in the United States alone (Meltzer et al, 2004). In addition to restoring mucociliary drainage pathways for the paranasal sinuses, ESS optimizes CRS disease control by optimizing sinonasal mucosal distribution of topical therapies (Harvey et al, 2008(Harvey et al, , 2010Abouali et al, 2012;Snidvongs et al, 2013;Thomas 3rd et al, 2013;Bahmanzadeh et al, 2015;Wofford et al, 2015;Barham et al, 2016;Zhao et al, 2016). Impaired olfaction is a frequent complaint among patients afflicted with CRS, with a reported incidence of up to 80% in these patients (Raviv and Kern, 2004;Rosenfeld et al, 2007;Jiang et al, 2008;Soler et al, 2008;Litvack et al, 2009b).…”