A CFD approach to understand nasoseptal perforations

Burgos, Manuel A.; Sanmiguel‐Rojas, E.; Rodríguez, Rosario Oliva; Esteban-Ortega, Francisco

doi:10.1007/s00405-018-5073-6

Cited by 7 publications

(15 citation statements)

References 31 publications

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“…The posterior margin of the perforation consistently presented the highest WSS. Burgos et al evaluated the location effects of NSP on the nasal airflow patterns, again using a virtual surgical tool. The NSPs were virtually created on 4 subjects, with 2 patients with healthy noses and 2 non‐NSP patients with nasal obstruction.…”

Section: Discussionmentioning

confidence: 99%

“…Using fluid flow properties such as airflow velocity, wall shear stress, and heat flux, CFD has demonstrated utility in assessment of upper respiratory tract and airway reconstructive procedures . However, most previous CFD studies on NSPs addressed virtual perforations of non‐NSP subjects or involved a single NSP patient model . In our previous CFD analysis of nasal airflow in 10 NSP patients we found that the high wall shear stress along the posterior margin of the NSP may lead to symptomatology.…”

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confidence: 95%

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Asymptomatic vs symptomatic septal perforations: a computational fluid dynamics examination

Maza

Farag

et al. 2019

Int Forum Allergy Rhinol

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Background: A nasal septal perforation (NSP) can lead to frustrating symptoms for some patients while remaining completely asymptomatic for others, without a clear mechanism differentiating them. Methods:We applied individual computed tomography (CT)-based computational fluid dynamics (CFD) to examine the nasal aerodynamics differences between 5 asymptomatic and 15 symptomatic NSP patients. Patients' symptoms were confirmed through interviews, 22-item Sino-Nasal Outcome Test score (asymptomatic, 25 ± 18.8; symptomatic, 53.7 ± 18.2), nasal obstruction symptom evaluation score (asymptomatic, 28.0 ± 32.1; symptomatic, 62.2 ± 32.2), and review of medical history. Results:No statistical differences were found in perforation location, size (asymptomatic, 1.94 ± 1.88 cm 2 ; symptomatic, 1.36 ± 1.44 cm 2 ), nasal resistance (asymptomatic, 0.059 ± 0.012 Pa·s/mL; symptomatic, 0.063 ± 0.022 Pa·s/mL), and computed flow rate shunting across the perforation (asymptomatic, 52.9 ± 30.9 mL/s; symptomatic, 27.4 ± 23.6 mL/s; p > 0.05). However, symptomatic patients had significantly higher wall shear stress (WSS) and heat flux, especially along the posterior perforation margin (WSS, 0.54 ± 0.12 vs 1.15 ± 0.49 Pa, p < 0.001; heat flux, 0.21 ± 0.05 vs 0.37 ± 0.14 W/cm 2 , p < 0.01). A WSS cutoff at 0.72 Pa can separate asymptomatic vs symptomatic NSP with 87% sensitivity and 100% specificity. Flow visualization showed flow peaks toward the posterior margin that may be responsible for the high WSS and heat flux among symptomatic NSPs. Conclusion:This study is the first CFD examination of asymptomatic and symptomatic NSP with regional aerodynamics and stress abnormalities, beyond size or location, being implicated as the mechanism behind the symptomology of NSP. This finding could serve as an objective basis for future personalized treatment decisions and optimization. C 2019 ARS-AAOA, LLC. Key Words: nasal septal perforation; computational fluid dynamics; CT-based modeling; nasal airflow; nasal wall shear stress How to Cite this Article: Li C, Maza G, Farag AA, et al. Asymptomatic vs symptomatic septal perforations: a computational fluid dynamics examination. Int Forum Allergy Rhinol. 2019;9: 883-890.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 95%

Asymptomatic vs symptomatic septal perforations: a computational fluid dynamics examination

Maza

Farag

et al. 2019

Int Forum Allergy Rhinol

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“…It is widely used in engineering fields such as hydrodynamics [17,18]. Recently, CFD has also been used in the medical field for flow analysis [19][20][21][22][23][24]. We used CFD to understand the blood flow patterns in FAPs to obtain helpful information or clues for performing the PTI procedure [16].…”

Section: Development Of the Pti Methods Based On A Cfd Studymentioning

confidence: 99%

Percutaneous Thrombin Injection Based on Computational Fluid Dynamics of Femoral Artery Pseudoaneurysms

Kim

Lee

et al. 2021

Korean J Radiol

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Objective:To analyze the computational fluid dynamics (CFD) of femoral artery pseudoaneurysm (FAP), identify a suitable location and timing for percutaneous thrombin injection (PTI) based on this analysis, and report our clinical experience with the procedure. Materials and Methods: CFD can be used to analyze the hemodynamics of the human body. An analysis using CFD recommended that the suitable location of the needle tip for PTI is at the center of the aneurysm sac and the optimal timing for starting PTI is during the early inflow phase of blood into the sac. Since 2011, seven patients (three male and four female; median age, 60 years [range, 43-75 years]) with FAP were treated with PTI based on the devised suitable location and time. Prior to the procedure, color Doppler ultrasonography was performed to determine the location and timing of the thrombin injection. Results:The technical success rate of the PTI was 100%. The amount of thrombin used for the procedure ranged from 200 IU to 1000 IU (median, 500 IU). None of the patients experienced any symptoms or signs of embolic complications during the procedure. Follow-up CT images did not reveal any embolism in the lower extremities and showed complete thrombosis of the pseudoaneurysm. Conclusion:Based on our study of CFD, PTI administered centrally in the FAP during early inflow, as seen on color Doppler, can be an effective technique.

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“…Those parameters allow to distinguish between healthy or diseased nasal cavities, and had been used in a number of studies. 16,18 Both parameters R À ϕ were also used in the present work to investigate from an objective approach the relationship between COM and nasal obstruction.…”

Section: Computational Fluid Dynamicsmentioning

confidence: 99%

“…In previous articles, the authors had introduced the use of nondimensional parameters 15 based on quantities obtained from CFD analysis and geometric quantities. Those parameters allow to distinguish between healthy or diseased nasal cavities, and had been used in a number of studies 16,18 . Both parameters

R - ϕ

were also used in the present work to investigate from an objective approach the relationship between COM and nasal obstruction.…”

Section: Computational Fluid Dynamicsmentioning

confidence: 99%

Linking Chronic Otitis Media and Nasal Obstruction: A CFD Approach

et al. 2021

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Objectives: To investigate a possible relationship between altered nasal flow and chronic otitis media (COM) using computational fluid dynamics (CFD).Study Design: Retrospective case series. Methods: Retrospective cohort sample of CT scans from patients with COM and controls without COM to compare the results of various nasal airflow parameters determined by CFD between a group of patients with COM (N = 60) and a control group of subjects without any evidence of ear disease (N = 81).The CT were subjected to various procedures to carry out CFD studies, determining the resistance to nasal flow, the proportion of flow through the right and left nasal cavity, and two nondimensional estimators. The results of CFD studies between patients with COM and controls were compared.Results: Whereas only 12.3% of the controls had CFD alteration (10 out of 81), 43.3% of the patients suffering COM displayed alterations of our nondimensional parameters R À ϕ (26 out of 60).Conclusions: According to our results, the incidence of alterations in nasal airflow by studying with CFD is significantly higher in patients with COM than in controls. To our knowledge, this is the first article linking nasal cavity and COM using a CFD approach. Our results support the hypothesis that nasal flow alterations could be implicated in the etiopathogenesis of the COM.

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A CFD approach to understand nasoseptal perforations

Cited by 7 publications

References 31 publications

Asymptomatic vs symptomatic septal perforations: a computational fluid dynamics examination

Asymptomatic vs symptomatic septal perforations: a computational fluid dynamics examination

Percutaneous Thrombin Injection Based on Computational Fluid Dynamics of Femoral Artery Pseudoaneurysms

Linking Chronic Otitis Media and Nasal Obstruction: A CFD Approach

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