Identifying patients who may benefit from inferior turbinate reduction using computer simulations.

OBJECTIVES/HYPOTHESIS: (1) To determine objective criteria to predict which patients may benefit most from inferior turbinate reduction surgery. (2) To test whether the site of turbinate reduction, either along the nasal floor (bottom resection) or along the septal side (medial resection), impacts the extent to which nasal resistance is reduced.

STUDY DESIGN

Case series.

METHODS

Three-dimensional reconstructions of the nasal anatomy of five nasal airway obstruction patients were created based on presurgical computed tomography scans. Inferior turbinate reduction models were created for each patient using virtual surgery. Airflow, heat transfer, and humidity transport during inspiration were simulated using computational fluid dynamics (CFD).

RESULTS

Nasal resistance curves revealed little to no difference between bottom resection and medial resection models. In two patients, little change was observed in nasal resistance after virtual inferior turbinate reduction, which was attributed to the narrowest cross-sections being restricted to the anterior nose (i.e., anterior to the inferior turbinate). The three patients whose nasal resistances decreased substantially after virtual inferior turbinate reduction had a narrower airspace in the turbinate region and higher nasal resistance presurgery. Nasal air conditioning capacity was more affected by medial resections.

CONCLUSIONS

CFD simulations predicted no significant difference in the decrease in nasal resistance between virtual inferior turbinate reductions performed by bottom versus medial resection of the turbinate. However, bottom resections better preserved the calculated humidification efficiency. The simulations predicted that the greatest reduction in nasal resistance occurs in patients with the highest presurgical resistance in the turbinate region.

LEVEL OF EVIDENCE