Grutzenmacher S, Robinson D M, Grafe K, Lang C, Mlynski G
Department of Otorhinolaryngology, Head and Neck Surgery, Ernst Moritz Arndt University, Greifswald, Germany.
ORL J Otorhinolaryngol Relat Spec. 2006;68(4):199-205. doi: 10.1159/000091473. Epub 2006 Feb 13.
The nasal septal deviation is a common cause of nasal obstruction. On the other hand, many septal deviations are asymptomatic. It seems a physiological adaptation occurs on both sides. Septal deviation leads to internal nasal asymmetry, which in turn causes compensatory change in turbinate morphology (e.g. turbinate hypertrophy respectively hypotrophy). This mechanism is investigated with the help of fluid dynamic experiments and functional rhinologic diagnostics.
Functional models of the nose (modified Mink's boxes) were used and assessment was made by acoustic rhinometry and rhinoresistometry, followed by flow dynamic investigations. Septal deviations of varying position, together with turbinates of differing grades of hypertrophy, were simulated and assessed.
We observed in models of septal deviation an increase in flow resistance on the ipsilateral side as a result of friction of flow particles in the narrowing. Furthermore, on the opposite side of the deviation, the enlargement of the stream channel did not generally lead to a reduction in flow resistance, but rather to a 'dead space', where only a slow-circling eddy was observed. This eddy causes an increase in turbulence. In vivo turbinate hypertrophy occurs to fill this dead space, thereby reducing turbulent flow without a significant increase in resistance. In cases of moderate septal deviation, compensatory mechanisms of the turbinates can lead to a normalization of nasal airflow and surgical therapy would not be indicated. Deviations in the anterior part of the septum seem to be more symptomatic, because the mechanism is missing and due to the physiological narrowing of the nasal isthmus. To differ between physiologic and pathologic deviation, functional diagnostics are needed.
鼻中隔偏曲是鼻塞的常见原因。另一方面，许多鼻中隔偏曲并无症状。似乎两侧都发生了生理适应性变化。鼻中隔偏曲导致鼻腔内部不对称，进而引起鼻甲形态的代偿性改变（如鼻甲肥大或萎缩）。借助流体动力学实验和功能性鼻科学诊断对这一机制进行了研究。
使用改良的明克盒式鼻功能模型，通过鼻声反射和鼻阻力测量进行评估，随后进行流体动力学研究。模拟并评估了不同位置的鼻中隔偏曲以及不同程度肥大的鼻甲。
在鼻中隔偏曲模型中，我们观察到同侧由于狭窄处流动颗粒的摩擦导致流动阻力增加。此外，在偏曲的对侧，流道扩大通常并未导致流动阻力降低，而是形成了一个“死腔”，在其中仅观察到缓慢旋转的涡流。这种涡流导致湍流增加。在活体中，鼻甲肥大发生以填充这个死腔，从而减少湍流且阻力无显著增加。在中度鼻中隔偏曲的情况下，鼻甲的代偿机制可导致鼻气流正常化，无需进行手术治疗。鼻中隔前部的偏曲似乎症状更明显，因为该机制缺失且由于鼻峡部的生理狭窄。为区分生理性和病理性偏曲，需要进行功能性诊断。
