Zhao Kai, Craig John R, Cohen Noam A, Adappa Nithin D, Khalili Sammy, Palmer James N
Department of Otolaryngology-Head & Neck Surgery, Ohio State University, Columbus, OH.
Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania.
Laryngoscope. 2016 Mar;126(3):E90-6. doi: 10.1002/lary.25666. Epub 2015 Oct 15.
OBJECTIVES/HYPOTHESIS: Topical sinus irrigations play a critical role in the management of sinonasal disease, and the improvement in irrigant penetration into the sinuses postoperatively greatly contributes to the success of endoscopic sinus surgery. Prior investigations on postoperative sinus irrigations have been mostly limited to cadaver studies, which are labor intensive and do not capture the full dynamics of the flows. A pilot study was conducted to investigate the impact of surgery on sinus irrigation through computational fluid dynamics (CFD) simulations.
Retrospective computational study.
Pre- and postoperative computed tomography (CT) scans were obtained on a patient who underwent standard endoscopic surgeries for all sinuses, including a Draf III frontal sinusotomy. CT-based pre- and postoperative CFD models then simulated irrigations of 120 mL saline per nostril at 12 mL/s (typical of Sinugator) and 60 mL/s (SinusRinse Bottle), in two head positions: face parallel and at a 45° angle to the ground.
Overall, surgery most significantly improved frontal sinus irrigation, but surprisingly resulted in less maxillary and ethmoid sinuses penetration. This may due to the partial removal of the septum during the Draf III, causing most fluid to exit prematurely across the resected septum. Higher flow rate slightly improved ethmoid sinus irrigation, but resulted in less preoperative contralateral maxillary sinus penetration.
CFD modeling of sinonasal irrigations is a novel technique for evaluating irrigant penetration of individual sinus cavities. It may prove useful in determining the optimal degree of surgery or the ideal irrigation strategy to allow for maximal and targeted sinus irrigant penetration.
NA Laryngoscope, 126:E90-E96, 2016.
目的/假设：局部鼻窦冲洗在鼻窦疾病的治疗中起着关键作用，术后冲洗液进入鼻窦的改善对鼻内镜鼻窦手术的成功有很大贡献。先前关于术后鼻窦冲洗的研究大多局限于尸体研究，这些研究劳动强度大，且无法捕捉流动的全部动态。进行了一项初步研究，通过计算流体动力学（CFD）模拟来研究手术对鼻窦冲洗的影响。
回顾性计算研究。
对一名接受所有鼻窦标准内镜手术（包括Draf III型额窦切开术）的患者进行术前和术后计算机断层扫描（CT）。然后基于CT的术前和术后CFD模型模拟在两个头部位置（面部平行和与地面成45°角）以12 mL/s（Sinugator典型速度）和60 mL/s（鼻窦冲洗瓶速度）每侧鼻孔冲洗120 mL盐水。
总体而言，手术最显著地改善了额窦冲洗，但令人惊讶的是，上颌窦和筛窦的冲洗液渗透减少。这可能是由于在Draf III手术过程中部分鼻中隔被切除，导致大部分液体过早地通过切除的鼻中隔流出。较高的流速略微改善了筛窦冲洗，但导致术前对侧上颌窦的冲洗液渗透减少。
鼻窦冲洗的CFD建模是一种评估单个鼻窦腔冲洗液渗透的新技术。它可能有助于确定最佳手术程度或理想的冲洗策略，以实现最大程度和有针对性的鼻窦冲洗液渗透。
无。《喉镜》，2016年，第126卷，E90 - E96页。
