The Hamner Institutes for Health Sciences, Research Triangle Park, North Carolina, USA.
Am J Rhinol Allergy. 2010 Jan-Feb;24(1):e46-53. doi: 10.2500/ajra.2010.24.3428.
Septal deviation is an extremely common anatomic variation in healthy adults. However, there are no standard criteria to determine when a deviated septum is clinically relevant. Presently, selection of patients for septoplasty is based on mostly clinical examination, which is prone to observer bias and may lead to unsuccessful treatment. The objective of this article is twofold. First, we investigate whether the location of a septal deviation within the nasal passages affects nasal resistance. Second, we test whether computer simulations are consistent with rhinomanometry studies in predicting that anterior septal deviations increase nasal resistance more than posterior deviations.
A three-dimensional computational model of a healthy nose was created from computed tomography scans. Geometry-deforming software was used to produce models with septal deviations. Computational fluid dynamics techniques were used to simulate nasal airflow and compute nasal resistance.
Our results revealed that the posterior nasal cavity can accommodate significant septal deviations without a substantial increase in airway resistance. In contrast, a deviation in the nasal valve region more than doubled nasal resistance. These findings are in good agreement with the rhinomanometry literature and with the observation that patients with anterior septal deviations benefit the most from septoplasty.
In the model, anterior septal deviations increased nasal resistance more than posterior deviations. This suggests, in agreement with the literature, that other causes of nasal obstruction (dysfunction of the nasal valve, allergy, etc.) should be carefully considered in patients with posterior septal deviations because such deviations may not affect nasal resistance. This study illustrates how computational modeling and virtual manipulation of the nasal geometry are useful to investigate nasal physiology.
鼻中隔偏曲在健康成年人中是一种极其常见的解剖变异。然而，目前尚无确定鼻中隔偏曲何时具有临床相关性的标准。目前，鼻中隔成形术患者的选择主要基于临床检查，这容易受到观察者偏倚的影响，并可能导致治疗失败。本文的目的有两个。首先，我们研究鼻中隔在鼻腔内的位置是否会影响鼻阻力。其次，我们测试计算机模拟是否与鼻阻力测量研究一致，以预测前鼻中隔偏曲比后鼻中隔偏曲更能增加鼻阻力。
从计算机断层扫描中创建了一个健康鼻子的三维计算模型。使用几何变形软件来产生鼻中隔偏曲模型。使用计算流体动力学技术模拟鼻气流并计算鼻阻力。
我们的结果表明，后鼻腔可以容纳明显的鼻中隔偏曲而不会显著增加气道阻力。相比之下，鼻中隔在鼻阀区的偏曲会使鼻阻力增加一倍以上。这些发现与鼻阻力测量文献一致，并且与观察到的前鼻中隔偏曲患者受益于鼻中隔成形术最多的观察结果一致。
在模型中，前鼻中隔偏曲比后鼻中隔偏曲增加了鼻阻力。这表明，与文献一致，对于后鼻中隔偏曲的患者，应仔细考虑其他引起鼻阻塞的原因（鼻阀功能障碍、过敏等），因为这些偏曲可能不会影响鼻阻力。本研究说明了计算建模和虚拟操纵鼻腔几何形状如何有助于研究鼻腔生理学。
