全鼻甲切除术是否总会导致空鼻综合征？一项计算机虚拟手术研究。
Does Total Turbinectomy Always Lead to Empty Nose Syndrome? A Computational Virtual Surgery Study.
作者信息
Odeh Ahmad, Wen Raymond, Wu Zhenxing, Schneller Aspen R, Root Zachary T, Hittle Bradley, Wiet Gregory J, Otto Bradley A, Kelly Kathleen M, Zhao Kai
机构信息
Department of Otolaryngology-Head & Neck Surgery, The Ohio State University, Columbus, Ohio, U.S.A.
The Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A.
出版信息
Laryngoscope. 2025 Feb;135(2):562-569. doi: 10.1002/lary.31757. Epub 2024 Sep 21.
INTRODUCTION
Computational fluid dynamic (CFD) modeling has previously indicated that distorted nasal airflow patterns may contribute to empty nose syndrome (ENS); however, no data show that aggressive turbinate surgery always leads to ENS. We aim to use virtual surgery planning (VSP) to investigate how a total inferior turbinectomy affects airflow parameters compared with ENS patients.
METHODS
We retrospectively recruited six nasal obstruction patients who underwent turbinate reduction surgery. We virtually performed total inferior turbinectomy on these patients to compare CFD modeling results to patients' actual surgical outcomes and to that of a previously collected ENS patient cohort (n = 27).
RESULTS
Patients' actual surgery outcomes were excellent, with Nasal-Obstruction Symptom Evaluation (NOSE) score (pre: 72.5 ± 13.2 vs post-surgery: 10.8 ± 9.8, p < 0.001) and unilateral visual analog scale (VAS) scores of nasal obstruction (pre: 6 ± 2.56 vs post-surgery: 1.2 ± 1, p < 0.001) improved and was statistically significant. The virtual turbinectomy does not create the same distorted nasal airflow patterns as seen in ENS patients, with no statistically significant difference in nasal resistance as compared with post-actual surgery (virtual turbinectomy: 0.10 ± 0.03 Pa/mL*s; actual surgery: 0.12 ± 0.04 Pa/mL*s; ENS: 0.11 ± 0.04, p > 0.05) nor in regional wall shear force distribution, an important indicator of air/mucosa stimulation (inferior turbinate WSF%: virtual 47.3% ± 11.3% vs actual 51.5% ± 15.1%, p > 0.05); however, both are statistically significant higher than that of ENS patients (WSF: 32.2% ± 12.5%, p < 0.001), despite ENS cohort having wider inferior airway cross-sectional area (CSA) than actual surgeries.
CONCLUSION
Empty nose syndrome is likely a multifactorial disease process that cannot be solely attributed to aggressive turbinate reduction surgery.
LEVEL OF EVIDENCE
3 Laryngoscope, 135:562-569, 2025.
引言
计算流体动力学（CFD）建模先前表明，鼻腔气流模式异常可能与空鼻综合征（ENS）有关；然而，尚无数据表明激进的鼻甲手术总会导致空鼻综合征。我们旨在使用虚拟手术规划（VSP）来研究下鼻甲全切除术与空鼻综合征患者相比如何影响气流参数。
方法
我们回顾性招募了6例接受鼻甲缩小手术的鼻阻塞患者。我们对这些患者进行了虚拟下鼻甲全切除术，以将CFD建模结果与患者的实际手术结果以及先前收集的空鼻综合征患者队列（n = 27）的结果进行比较。
结果
患者的实际手术效果极佳，鼻阻塞症状评估（NOSE）评分（术前：72.5±13.2 vs术后：10.8±9.8，p <0.001）和单侧鼻阻塞视觉模拟量表（VAS）评分（术前：6±2.56 vs术后：1.2±1，p <0.001）均有所改善，且具有统计学意义。虚拟鼻甲切除术不会产生与空鼻综合征患者相同的鼻腔气流模式异常，与实际手术后相比，鼻腔阻力无统计学显著差异（虚拟鼻甲切除术：0.10±0.03 Pa/mL*s；实际手术：0.12±0.04 Pa/mL*s；空鼻综合征：0.11±0.04，p>0.05），区域壁面切应力分布也无差异，区域壁面切应力分布是空气/黏膜刺激的重要指标（下鼻甲壁面切应力百分比：虚拟47.3%±11.3% vs实际51.5%±15.1%，p>0.05）；然而，尽管空鼻综合征队列的下气道横截面积（CSA）比实际手术患者宽，但两者均显著高于空鼻综合征患者（壁面切应力：32.2%±12.5%，p < 0.001）。
结论
空鼻综合征可能是一个多因素疾病过程，不能仅归因于激进的鼻甲缩小手术。
证据级别
3《喉镜》，135:562 - 569，2025年。
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