Partial Preservation of the Inferior Turbinate in Endoscopic Medial Maxillectomy: A Computational Fluid Dynamics Study
| Autor: | V. Covello, Carlotta Pipolo, Giovanni Felisati, Antonio Mario Bulfamante, Maurizio Quadrio, Alberto Maria Saibene |
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| Rok vydání: | 2020 |
| Předmět: |
Medial maxillectomy
medicine.medical_specialty Maxillary sinus Turbinates 03 medical and health sciences 0302 clinical medicine stomatognathic system Paranasal Sinuses otorhinolaryngologic diseases medicine Maxilla Immunology and Allergy Humans Computer Simulation 030223 otorhinolaryngology medicine.diagnostic_test business.industry Orthognathic Surgical Procedures Computational Biology Endoscopy General Medicine bacterial infections and mycoses Surgery stomatognathic diseases Endoscopic sinus surgery medicine.anatomical_structure Paranasal sinuses Otorhinolaryngology 030220 oncology & carcinogenesis Hydrodynamics Nasal airflow Nasal Cavity business |
| Zdroj: | American journal of rhinologyallergy. 34(3) |
| ISSN: | 1945-8932 |
| Popis: | BackgroundEndoscopic medial maxillectomy (EMM) is a workhorse for multiple sinonasal conditions. To reduce its burden on the sinonasal physiology, several modified EMM (M-EMM) have been proposed. Objective: In order to provide a theoretical basis for EMM and its modifications, this study introduces a computational fluid dynamics (CFD) model, based on a time-resolved direct numerical simulation, describing EMM and assessing the role of the M-EMM in preserving the overall fluid dynamics of the sinonasal cavities.MethodsA normal sinonasal CT scan was converted into a geometrical model and used as a reference; 2 anatomies were then created by virtual surgery, mimicking EMM and M-EMM, with the latter sparing the anterior portion of inferior turbinate and medial maxillary sinus wall. The airflow was simulated in the models via the OpenFOAM CFD software and compared in terms of flow rate, mean and fluctuating velocity, vorticity, and turbulent structures.ResultsThe analysis shows that EMM induces a massive flow rate increase in the operated side, which becomes less obvious in the M-EMM model. In contrast to M-EMM, EMM induces higher velocity fields that reach the maxillary sinus. Velocity and vorticity fluctuations are negligible in the baseline model, but become increasingly evident and widespread in the M-EMM and EMM models.ConclusionsA significant disruption of the nasal fluid dynamics is observed in EMM, while M-EMM minimizes variations and reduces interference with nasal air conditioning. Our analysis provides insights into the pathophysiology of radical sinus surgery and provides a theoretical basis for the ability of M-EMM to reduce the temporary surgery-related changes on both healthy and operated sides. |
| Databáze: | OpenAIRE |
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