Dennis O Frank-Ito1, Julia S Kimbell2, Azadeh A T Borojeni3, Guilherme J M Garcia3, John S Rhee4. 1. Division of Head and Neck Surgery & Communication Sciences, Durham, NC, USA; Computational Biology & Bioinformatics Program, Duke University, Durham, NC, USA; Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA. Electronic address: dennis.frank@duke.edu. 2. Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA. 3. Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA; Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, USA. 4. Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA.
Abstract
BACKGROUND: Despite advances in medicine and expenditures associated in treatment of nasal airway obstruction, 25-50% of patients undergoing nasal surgeries complain of persistent obstructive symptoms. Our objective is to develop a "stepwise virtual surgery" method that optimizes surgical outcomes for treatment of nasal airway obstruction. METHODS: Pre-surgery radiographic images of two subjects with nasal airway obstruction were imported into Mimics imaging software package for three-dimension reconstruction of the airway. A hierarchical stepwise approach was used to create seven virtual surgery nasal models comprising individual (inferior turbinectomy or septoplasty) procedures and combined inferior turbinectomy and septoplasty procedures via digital modifications of each subject's pre-surgery nasal model. To evaluate the effects of these procedures on nasal patency, computational fluid dynamics modeling was used to perform steady-state laminar inspiratory airflow and heat transfer simulations in every model, at resting breathing. Airflow-related variables were calculated for virtual surgery models and compared with dataset containing results of healthy subjects with no symptoms of nasal obstruction. FINDINGS: For Subject 1, nasal models with virtual septoplasty only and virtual septoplasty plus inferior turbinectomy on less obstructed side were within the healthy reference thresholds on both sides of the nasal cavity and across all three computed variables. For Subject 2, virtual septoplasty plus inferior turbinectomy on less obstructed side model produced the best result. INTERPRETATION: The hierarchical stepwise approach implemented in this preliminary report demonstrates computational fluid dynamics modeling ability to evaluate the efficiency of different surgical procedures for nasal obstruction in restoring nasal patency to normative level.
BACKGROUND: Despite advances in medicine and expenditures associated in treatment of nasal airway obstruction, 25-50% of patients undergoing nasal surgeries complain of persistent obstructive symptoms. Our objective is to develop a "stepwise virtual surgery" method that optimizes surgical outcomes for treatment of nasal airway obstruction. METHODS: Pre-surgery radiographic images of two subjects with nasal airway obstruction were imported into Mimics imaging software package for three-dimension reconstruction of the airway. A hierarchical stepwise approach was used to create seven virtual surgery nasal models comprising individual (inferior turbinectomy or septoplasty) procedures and combined inferior turbinectomy and septoplasty procedures via digital modifications of each subject's pre-surgery nasal model. To evaluate the effects of these procedures on nasal patency, computational fluid dynamics modeling was used to perform steady-state laminar inspiratory airflow and heat transfer simulations in every model, at resting breathing. Airflow-related variables were calculated for virtual surgery models and compared with dataset containing results of healthy subjects with no symptoms of nasal obstruction. FINDINGS: For Subject 1, nasal models with virtual septoplasty only and virtual septoplasty plus inferior turbinectomy on less obstructed side were within the healthy reference thresholds on both sides of the nasal cavity and across all three computed variables. For Subject 2, virtual septoplasty plus inferior turbinectomy on less obstructed side model produced the best result. INTERPRETATION: The hierarchical stepwise approach implemented in this preliminary report demonstrates computational fluid dynamics modeling ability to evaluate the efficiency of different surgical procedures for nasal obstruction in restoring nasal patency to normative level.
Authors: Dennis O Frank-Ito; Julia S Kimbell; Purushottam Laud; Guilherme J M Garcia; John S Rhee Journal: Otolaryngol Head Neck Surg Date: 2014-08-28 Impact factor: 3.497
Authors: Masoud Gh Moghaddam; Guilherme J M Garcia; Dennis O Frank-Ito; Julia S Kimbell; John S Rhee Journal: Int J Comput Assist Radiol Surg Date: 2020-02-20 Impact factor: 2.924
Authors: Emily M DeBoer; Julia S Kimbell; Kaci Pickett; Joseph E Hatch; Kathryn Akers; John Brinton; Graham L Hall; Louise King; Fiona Ramanauskas; Tim Rosenow; Stephen M Stick; Harm A Tiddens; Thomas W Ferkol; Sarath C Ranganathan; Stephanie D Davis Journal: Respir Physiol Neurobiol Date: 2021-06-19 Impact factor: 1.931