Improvements in airflow characteristics and effect on the NOSE score after septoturbinoplasty: A computational fluid dynamics analysis

Septoturbinoplasty is a surgical procedure that can improve nasal congestion symptoms in patients with nasal septal deviation and inferior turbinate hypertrophy. However, it is unclear which physical domains of nasal airflow after septoturbinoplasty are related to symptomatic improvement. This work...

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Bibliographic Details
Published in:PloS one 2022-11, Vol.17 (11), p.e0277712-e0277712
Main Authors: Na, Yang, Kim, Youn-Ji, Kim, Hyo Yeol, Jung, Yong Gi
Format: Article
Language:English
Subjects:
Air conditioning
Air flow
Air temperature
Airway management
Biology and Life Sciences
Cartilage
Computational fluid dynamics
Computed tomography
Computer applications
Domains
Dynamic tests
Fluid dynamics
Heat
Heat flux
Heat transfer
Humans
Hydrodynamics
Hypertrophy
Mathematical models
Medical imaging
Medicine and Health Sciences
Nasal Obstruction - surgery
Nasal Septum - surgery
Nose
Numerical models
Patients
Physical Sciences
Relative humidity
Research and Analysis Methods
Social Sciences
Surgery
Surgical techniques
Symptom Assessment
Turbinates - surgery
Vestibules
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Summary:Septoturbinoplasty is a surgical procedure that can improve nasal congestion symptoms in patients with nasal septal deviation and inferior turbinate hypertrophy. However, it is unclear which physical domains of nasal airflow after septoturbinoplasty are related to symptomatic improvement. This work employs computational fluid dynamics modeling to identify the physical variables and domains associated with symptomatic improvement. Sixteen numerical models were generated using eight patients' pre- and postoperative computed tomography scans. Changes in unilateral nasal resistance, surface heat flux, relative humidity, and air temperature and their correlations with improvement in the Nasal Obstruction Symptom Evaluation (NOSE) score were analyzed. The NOSE score significantly improved after septoturbinoplasty, from 14.4 ± 3.6 to 4.0 ± 4.2 (p < 0.001). The surgery not only increased the airflow partition on the more obstructed side (MOS) from 31.6 ± 9.6 to 41.9 ± 4.7% (p = 0.043), but also reduced the unilateral nasal resistance in the MOS from 0.200 ± 0.095 to 0.066 ± 0.055 Pa/(mL·s) (p = 0.004). Improvement in the NOSE score correlated significantly with the reduction in unilateral nasal resistance in the preoperative MOS (r = 0.81). Also, improvement in the NOSE score correlated better with the increase in surface heat flux in the preoperative MOS region from the nasal valve to the choanae (r = 0.87) than in the vestibule area (r = 0.63). Therefore, unilateral nasal resistance and mucous cooling in the preoperative MOS can explain the perceived improvement in symptoms after septoturbinoplasty. Moreover, the physical domain between the nasal valve and the choanae might be more relevant to patient-reported patency than the vestibule area.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0277712