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Purpose. To use computational fluid dynamics (CFD) technology to fundamentally understand (1) the effect of surgical treatments on nasal physiology for secondary atrophic rhinitis and (2) the priority of operations. Subjects and Methods: With the aid of medical imaging and CFD modeling, three virtual operations (nasoseptal perforation repair, cavity narrowing, and a combination of both) were performed to analyze airflow, nasal resistance, and wall shear stress. Results. Compared with the cavity-narrowing virtual operation, nasal resistance was not significantly altered by septal perforation repair virtual operation. Airflow allocation changed with more air flowing through the olfactory area and less though the nasal floor after all operations, especially the cavity-narrowing operation. Wall shear stress at the original epistaxis area and the nasal floor was reduced after the cavity-narrowing operation. Conclusions. Simulation results suggest that the cavity-narrowing operation takes priority over septal perforation repair if a staged surgery approach is adopted. If only one operation can be chosen, the cavity-narrowing operation is better than the septal perforation repair. This work shows that CFD-based modeling may aid precision medicine.

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