PMID- 37137797
OWN - NLM
STAT- MEDLINE
DCOM- 20230911
LR  - 20230911
IS  - 1879-1476 (Electronic)
IS  - 0385-8146 (Linking)
VI  - 50
IP  - 6
DP  - 2023 Dec
TI  - Modelling the effects of post-FESS middle turbinate synechiae on sinonasal 
      physiology: A computational fluid dynamics study.
PG  - 911-920
LID - S0385-8146(23)00087-1 [pii]
LID - 10.1016/j.anl.2023.04.003 [doi]
AB  - OBJECTIVE(S): Chronic rhinosinusitis (CRS) is common and often requires surgical 
      intervention. Surgical failure may lead to persistent symptoms and recalcitrant 
      disease, often secondary to synechiae between the middle turbinate (MT) and 
      lateral nasal wall. Synechiae prevention techniques have been extensively 
      investigated, however evidence for the effect of synechiae on sinonasal 
      physiology is lacking. We aimed to model the effects of MT synechiae on a 
      post-functional endoscopic sinus surgery (FESS) sinonasal cavity using 
      computational fluid dynamics (CFD). METHODS: DICOM data from a CT-sinus of a 
      healthy 25-year-old female was segmented to create a three-dimensional model. 
      Virtual surgery was performed to simulate a "full-house" FESS procedure. Multiple 
      models were created, each with a single unilateral virtual MT synechia of varying 
      extent. CFD analysis was performed on each model and compared with a post-FESS 
      control model without synechiae. Airflow velocity, humidity and mucosal surface 
      and air temperature values were calculated. RESULTS: All synechiae models 
      demonstrated aberrant downstream sinonasal airflow. There was reduced ventilation 
      of the ipsilateral frontal, ethmoid and sphenoid sinuses, with a concentrated 
      central "jet" in the middle meatus region. Effects were proportionate to the size 
      of synechiae. The impact on bulk inspired airflow was negligible. CONCLUSION: 
      Post-FESS synechiae between the MT and lateral nasal wall significantly disrupt 
      local downstream sinus ventilation and nasal airflow. These findings may explain 
      the persistent symptoms seen in post-FESS CRS patients with MT synechiae, 
      reinforcing the importance of prevention and adhesiolysis. Larger cohort studies 
      with multiple models of actual post-FESS patients with synechiae are required to 
      validate these findings.
CI  - Copyright (c) 2023. Published by Elsevier B.V.
FAU - Khatri, Hershil
AU  - Khatri H
AD  - Department of Otolaryngology, University of Sydney, Sydney, NSW, Australia.
FAU - Salati, Hana
AU  - Salati H
AD  - School of Engineering, Royal Melbourne Institute of Technology, Melbourne, Vic, 
      Australia.
FAU - Wong, Eugene
AU  - Wong E
AD  - Department of Otolaryngology, University of Sydney, Sydney, NSW, Australia.
FAU - Bradshaw, Kimberley
AU  - Bradshaw K
AD  - Department of Otolaryngology, University of Sydney, Sydney, NSW, Australia.
FAU - Inthavong, Kiao
AU  - Inthavong K
AD  - School of Engineering, Royal Melbourne Institute of Technology, Melbourne, Vic, 
      Australia. Electronic address: kiao.inthavong@rmit.edu.au.
FAU - Sacks, Raymond
AU  - Sacks R
AD  - Department of Otolaryngology, University of Sydney, Sydney, NSW, Australia.
FAU - Singh, Narinder
AU  - Singh N
AD  - Department of Otolaryngology, University of Sydney, Sydney, NSW, Australia.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20230501
PL  - Netherlands
TA  - Auris Nasus Larynx
JT  - Auris, nasus, larynx
JID - 7708170
SB  - IM
MH  - Female
MH  - Humans
MH  - Adult
MH  - Turbinates/diagnostic imaging/surgery
MH  - Hydrodynamics
MH  - Endoscopy/methods
MH  - *Paranasal Sinuses/diagnostic imaging/surgery
MH  - Nasal Cavity/surgery
MH  - *Sinusitis/surgery
OTO - NOTNLM
OT  - Adult rhinology
OT  - Computational fluid dynamics
OT  - Simulation of surgery of the paranasal sinuses
COIS- Declaration of Competing Interest The authors of this manuscript have no 
      conflicts of interest to disclose.
EDAT- 2023/05/04 00:42
MHDA- 2023/09/11 06:43
CRDT- 2023/05/03 21:57
PHST- 2022/11/20 00:00 [received]
PHST- 2023/03/23 00:00 [revised]
PHST- 2023/04/11 00:00 [accepted]
PHST- 2023/09/11 06:43 [medline]
PHST- 2023/05/04 00:42 [pubmed]
PHST- 2023/05/03 21:57 [entrez]
AID - S0385-8146(23)00087-1 [pii]
AID - 10.1016/j.anl.2023.04.003 [doi]
PST - ppublish
SO  - Auris Nasus Larynx. 2023 Dec;50(6):911-920. doi: 10.1016/j.anl.2023.04.003. Epub 
      2023 May 1.