Siu Joey, Shrestha Kendra, Inthavong Kiao, Shang Yidan, Douglas Richard
Department of Surgery, The University of Auckland, Auckland, New Zealand.
Mechanical & Automotive Engineering, School of Engineering, RMIT University, Bundoora, Victoria, 3083, Australia.
Comput Biol Med. 2020 Jan;116:103573. doi: 10.1016/j.compbiomed.2019.103573. Epub 2019 Dec 4.
Optimizing intranasal distribution and retention of topical therapy is essential in the management of patients with chronic rhinosinusitis, including those that have had functional endoscopic sinus surgery (FESS). Computational fluid dynamics analysis has not previously been used to investigate sinus nasal spray delivery in the complete post-operative sinonasal geometries of patients who have undergone FESS. Models of sinonasal cavities were created from postoperative magnetic resonance imaging scans in four patients, three of whom underwent a comprehensive FESS, the other a modified endoscopic Lothrop procedure. Spray simulations were conducted at different flow rates (5 L/min, 10 L/min and 15 L/min) using sixteen particle sizes ranging from 4 μm to 70μm, spray velocity of 10 m/s and plume angle of 15°. Two different spray insertion angles were compared. Airflow distribution in the sinuses was closely related to the patient's nasal geometry and surgical intervention, in particular a unique crossflow between nasal chambers was present for the Lothrop patient. Sinus deposition was generally more effective with inhalational transport of low-inertia particles outside of the range produced by many standard nasal sprays or nebulizer. This was true except in the Lothrop patient, since previous surgery had been performed removing most of the septum where high-inertia particles would normally deposit. For sinuses receiving minimal airflow, particle penetration was diminished and successful deposition in the region became more restricted by device parameters. Further research is needed to validate these findings and explore other spray variables in a wider spectrum of patients to ascertain a multi-level approach to optimizing drug delivery in the sinuses.
优化局部治疗药物在鼻腔内的分布和留存，对于慢性鼻窦炎患者的管理至关重要，包括那些接受过功能性鼻内镜鼻窦手术（FESS）的患者。此前，计算流体动力学分析尚未用于研究接受FESS手术患者术后完整鼻窦鼻腔几何结构中的鼻窦鼻腔喷雾给药情况。通过对四名患者的术后磁共振成像扫描创建鼻窦鼻腔模型，其中三名患者接受了全面的FESS手术，另一名患者接受了改良的内镜Lothrop手术。使用16种粒径范围从4μm到70μm的颗粒、10m/s的喷雾速度和15°的羽流角度，在不同流速（5L/min、10L/min和15L/min）下进行喷雾模拟。比较了两种不同的喷雾插入角度。鼻窦内的气流分布与患者的鼻腔几何结构和手术干预密切相关，特别是Lothrop手术患者的鼻腔腔室之间存在独特的横流。对于许多标准鼻喷雾剂或雾化器产生范围之外的低惯性颗粒，通过吸入传输在鼻窦内沉积通常更有效。除了Lothrop手术患者外都是如此，因为之前的手术已切除了大部分鼻中隔，而高惯性颗粒通常会沉积在此处。对于气流最少的鼻窦，颗粒穿透减少，该区域的成功沉积受设备参数的限制更大。需要进一步研究来验证这些发现，并在更广泛的患者群体中探索其他喷雾变量，以确定一种优化鼻窦给药的多层次方法。
