Computational Fluid Dynamics to Evaluate the Effectiveness of Inferior Turbinate Reduction Techniques to Improve Nasal Airflow

Abstract

Importance

Inferior turbinate reduction (ITR) is a commonly performed procedure for the treatment of nasal obstruction. Which portion of the inferior turbinates should be surgically addressed to improve nasal airflow has yet to be determined.

Objective

To use computational fluid dynamics (CFD) analysis to evaluate the airflow changes after reduction along different portions of the inferior turbinate.

Design, Setting, and Participants

Computed tomographic scans of 5 patients were selected. Seven CFD models were created for each patient: 1 unaltered and 6 various ITRs, including 3 one-third ITRs (anterior, middle, and posterior one-third); 2 two-thirds ITRs (anterior and posterior two-thirds); and 1 full-length ITR model. Total airflow rate and nasal resistance was obtained through CFD analysis, and regression analysis was performed on the increased nasal volume, locations, and nasal resistance for all 5 patients.

Main Outcomes and Measures

Total airflow rate and nasal resistance was obtained through CFD analysis, and regression analysis was performed on the increased nasal volume, locations, and nasal resistance for all 5 patients.

Results

Full ITR over the whole length was consistently most effective to improve nasal airflow and resistance for all 5 patients (2 men and 3 women), adjusted for the volume. Regression analysis showed a strong linear (R²≥0.79) relationship between nasal volume changes and nasal airflow. However, the most effective location of partial turbinate reduction was not consistent among patients. Surprisingly, for some patients, posterior ITRs were more effective than anterior ITRs. The site of most effective partial ITR differed from 1 side to the other even in the same individual.

Conclusions and Relevance

The effectiveness of partial ITR and target location likely depends on individual patient anatomy. The fact that full ITRs were consistently most effective and the linear regression between flow and nasal volume changes may indicate that the entire length of the IT has a functional impact on nasal airflow and resistance.

Level of Evidence

NA.