Impact of Middle versus Inferior Total Turbinectomy on Nasal Aerodynamics. (22nd July 2016)

• Record Type: Journal Article
• Authors: Dayal, Anupriya; Rhee, John S.; Garcia, Guilherme J. M.
• Is Part Of: Otolaryngology--head and neck surgery. Volume 155:Number 3(2016:Sep.)
• Page Start: 518
• Page End: 525
• Publication Date: 2016-07-22
• Subjects: middle turbinate resection -- inferior turbinate reduction -- nasal airway obstruction -- computational fluid dynamics simulations -- secondary atrophic rhinitis -- empty nose syndrome -- mucosal cooling -- nasal airflow sensation; Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0194599816644915
• Languages: English
• ISSNs: 0194-5998

Abstract

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, and (3) quantify to what extent total turbinectomy impairs the nasal air‐conditioning capacity. Study Design: Virtual surgery and computational fluid dynamics. 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 according to presurgery 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 steady‐state inhalation rate of 15 L/min. The surface area stimulated by mucosal cooling was defined as the area where heat fluxes exceed 50 W/m 2 . Results: In both virtual total turbinectomy models, nasal resistance decreased and airflow increased. However, the surface area where heat fluxes exceed 50 W/m 2 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.