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A CFD approach to understand nasoseptal perforations

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Introduction

Nasoseptal perforations (NSP) are becoming common in the modern world, and can cause a wide variety of symptoms, including a sensation of nasal obstruction, epistaxis, crusting, dryness, headache, nasal pain and a whistling sound. There is an extensive range of surgical treatment techniques, but reported results were rarely statistically significant. The lack of consistent surgical results may be related to the lack of knowledge about the pathophysiology of NSP and how they affect the nasal flow. Computational fluid dynamics (CFD) has proved to be a very useful tool to study nasal function.

Methods

We have used CFD software (the program MECOMLAND® and the Digbody® tool for virtual surgery) to investigate the behaviour of the parameters R–\(\phi\) based on CFD results, when four subjects underwent virtual surgery to induce a septal perforation: two subjects with healthy noses and two patients suffering from nasal airway obstruction. For each case a CFD study was performed, before and after creating an anterior (close to nostrils) or a posterior (close to choanae) NSP.

Results

In all cases analyzed, a posterior septal perforation did not result in a significant volumetric flow rate \({Q_{{\text{R}} \leftrightarrow {\text{L}}}}\) through the perforation between nasal passages. However, for anterior defects only in those nasal cavities considered diseased or unhealthy, high values of \({Q_{{\text{R}} \leftrightarrow {\text{L}}}}\) were found.

Conclusion

The induced NSP only rendered significant flow alterations in noses with preexisting nasal airway obstruction alterations, whereas in nasal cavities considered as normal the creation of a NSP did not produce significant differences between both sides. We strongly suggest that this finding can explain the variety of symptoms and the number of asymptomatic patients bearing NSP.

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Acknowledgements

The authors acknowledge the access to the patient database of the University Hospital Virgen del Rocío of Sevilla (Spain).

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Correspondence to E. Sanmiguel-Rojas.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Burgos, M.A., Sanmiguel-Rojas, E., Rodríguez, R. et al. A CFD approach to understand nasoseptal perforations. Eur Arch Otorhinolaryngol 275, 2265–2272 (2018). https://doi.org/10.1007/s00405-018-5073-6

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  • DOI: https://doi.org/10.1007/s00405-018-5073-6

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