School of Biomedical Engineering, Capital Medical University, Beijing, China; Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China.
School of Biomedical Engineering, Capital Medical University, Beijing, China; Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China.
J Biomech. 2020 Jan 23;99:109503. doi: 10.1016/j.jbiomech.2019.109503. Epub 2019 Nov 12.
Surgical reductions of the hypertrophied inferior turbinate (HIT) can improve nasal obstruction. However, there is currently a lack of personalized and objective methods to guide surgical operations, which results in the excessive or inadequate resection of HIT. In this study, we proposed an optimizing method based on homotopy deformation to determine the resected amount and shape of the tissue by matching the flow resistance in the two nasal passageways. The simulation results obtained using computational fluid dynamics showed that after such an optimization procedure, the most obstructed nasal side could have a similar air flux as the less obstructed side. A 35% and a 56% less tissue resection in the optimizing operation compared to that in the total turbinectomy could well balance the air flow between the two nasal cavities in the simulations for patients 1 and 2 with unilateral nasal obstruction respectively. Compared with the optimization operation, the total turbinectomy made a more aggressive resection of HIT, which could worsen the air conditioning capacity of the nose. A sensitivity test indicated that in the optimization operation, the most constricted region in the nasal cavity should be adequately enlarged. However, more tissue resection than is required for the optimization operation did not improve the flow in the obstructed side strikingly. Simulations of the optimization operation in both nasal cavities for a patient with bilateral nasal obstruction were also performed. The flow rate could reach the normal level and be well balanced in the two sides after such an optimization procedure.
手术缩小肥大的下鼻甲（HIT）可以改善鼻塞。然而，目前缺乏个性化和客观的方法来指导手术操作，导致 HIT 的切除过多或不足。在这项研究中，我们提出了一种基于同伦变形的优化方法，通过匹配两个鼻腔通道中的流动阻力来确定组织的切除量和形状。使用计算流体动力学获得的模拟结果表明，经过这样的优化过程后，最阻塞的鼻腔侧可以具有与阻塞较小的一侧相似的气流。与总鼻甲切除术相比，在模拟单侧鼻塞的患者 1 和 2 中，优化手术可分别减少 35%和 56%的组织切除量，从而在两个鼻腔之间很好地平衡气流。与优化手术相比，总鼻甲切除术对 HIT 进行了更激进的切除，这可能会恶化鼻子的空气调节能力。敏感性测试表明，在优化手术中，鼻腔中最狭窄的区域应充分扩大。然而，切除比优化手术所需的更多组织并不会显著改善阻塞侧的流量。还对双侧鼻塞患者的两个鼻腔的优化手术进行了模拟。经过这样的优化过程后，流速可以达到正常水平，并在两侧得到很好的平衡。
