Garcia Guilherme J M, Rhee John S, Senior Brent A, Kimbell Julia S
Am J Rhinol Allergy. 2010 Jan 1;24(1):46-53. 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极为常见的解剖变异。然而，目前尚无标准来判定何时鼻中隔偏曲具有临床相关性。目前，鼻中隔成形术患者的选择主要基于临床检查，而这容易出现观察者偏差，可能导致治疗失败。本文有两个目的。其一，我们研究鼻道内鼻中隔偏曲的位置是否会影响鼻阻力。其二，我们测试计算机模拟在预测鼻中隔前部偏曲比后部偏曲更能增加鼻阻力方面是否与鼻阻力测量研究结果一致。
利用计算机断层扫描创建健康鼻腔的三维计算模型。使用几何变形软件生成具有鼻中隔偏曲的模型。采用计算流体动力学技术模拟鼻腔气流并计算鼻阻力。
我们的结果显示，后鼻腔能够容纳显著的鼻中隔偏曲，而气道阻力不会大幅增加。相比之下，鼻瓣膜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以及鼻中隔前部偏曲患者从鼻中隔成形术中获益最大的观察结果高度一致。
在该模型中，鼻中隔前部偏曲比后部偏曲更能增加鼻阻力。这表明，与文献一致，对于鼻中隔后部偏曲的患者，应仔细考虑其他导致鼻塞的原因（鼻瓣膜功能障碍、过敏等），因为此类偏曲可能不会影响鼻阻力。本研究说明了鼻腔几何结构的计算建模和虚拟操作在研究鼻腔生理学方面的作用。
