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Quantification of airflow into the maxillary sinuses before and after functional endoscopic sinus surgery.
Int Forum Allergy Rhinol. 2013 Oct; 3(10):834-40.IF

Abstract

BACKGROUND

The effects of increases in maxillary sinus (MS) airflow following functional endoscopic sinus surgery (FESS) are unknown. The goal of this study was to quantify the effects of FESS on airflow into the MS in a cohort of patients with chronic rhinosinusitis, and compare MS flow rate with patient-reported outcome measures.

METHODS

A pilot study was conducted in which preoperative and postoperative computed tomography scans of 4 patients undergoing bilateral or unilateral FESS were used to create 3-dimensional (3D) reconstructions of the nasal airway and paranasal sinuses using Mimics™ (Materialise, Inc.). The size of the maxillary antrostomies post-FESS ranged from 107 to 160 mm(2). Computational meshes were generated from the 3D reconstructions, and steady-state, laminar, inspiratory airflow was simulated in each mesh using the computational fluid dynamics (CFD) software Fluent™ (ANSYS, Inc.) under physiologic, pressure-driven conditions. Airflow into the MS was estimated from the simulations and was compared preoperatively and postoperatively. In addition, patients completed preoperative and postoperative Rhinosinusitis Outcome Measure-31 (RSOM-31) questionnaires and scores were compared with MS airflow rates.

RESULTS

CFD simulations predicted that average airflow rate into post-FESS MS increased by 18.5 mL/second, and that average flow velocity into the MS more than quadrupled. Simulation results also showed that MS flow rate trended with total RSOM-31 and all domain scores.

CONCLUSION

CFD simulations showed that the healed maxillary antrostomy after FESS can greatly enhance airflow into the MS. Our pilot study suggests that to some extent, increasing airflow into the MS may potentially improve chronic rhinosinusitis patients' quality of life pre-FESS and post-FESS.

Links

PMC Free PDF

Authors+Show Affiliations

Frank DO
Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Zanation AM
No affiliation info available
Dhandha VH
No affiliation info available
McKinney KA
No affiliation info available
Fleischman GM
No affiliation info available
Ebert CS
No affiliation info available
Senior BA
No affiliation info available
Kimbell JS
No affiliation info available

MeSH

AdultAgedChronic DiseaseComputer SimulationEndoscopyFemaleHumansMaleMaxillary SinusMiddle AgedPatient SatisfactionPilot ProjectsPostoperative CarePreoperative CareProspective StudiesPulmonary VentilationQuality of LifeRhinitisSinusitisTomography, X-Ray Computed

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24009143

Citation

Frank, Dennis O., et al. "Quantification of Airflow Into the Maxillary Sinuses Before and After Functional Endoscopic Sinus Surgery." International Forum of Allergy & Rhinology, vol. 3, no. 10, 2013, pp. 834-40.
Frank DO, Zanation AM, Dhandha VH, et al. Quantification of airflow into the maxillary sinuses before and after functional endoscopic sinus surgery. Int Forum Allergy Rhinol. 2013;3(10):834-40.
Frank, D. O., Zanation, A. M., Dhandha, V. H., McKinney, K. A., Fleischman, G. M., Ebert, C. S., Senior, B. A., & Kimbell, J. S. (2013). Quantification of airflow into the maxillary sinuses before and after functional endoscopic sinus surgery. International Forum of Allergy & Rhinology, 3(10), 834-40. https://doi.org/10.1002/alr.21203
Frank DO, et al. Quantification of Airflow Into the Maxillary Sinuses Before and After Functional Endoscopic Sinus Surgery. Int Forum Allergy Rhinol. 2013;3(10):834-40. PubMed PMID: 24009143.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Quantification of airflow into the maxillary sinuses before and after functional endoscopic sinus surgery. AU - Frank,Dennis O, AU - Zanation,Adam M, AU - Dhandha,Vishal H, AU - McKinney,Kibwei A, AU - Fleischman,Gitanjali M, AU - Ebert,Charles S,Jr AU - Senior,Brent A, AU - Kimbell,Julia S, Y1 - 2013/09/05/ PY - 2012/08/24/received PY - 2013/05/24/revised PY - 2013/06/18/accepted PY - 2013/9/7/entrez PY - 2013/9/7/pubmed PY - 2014/5/16/medline KW - FESS KW - chronic rhinosinusitis KW - computational fluid dynamics KW - maxillary sinus KW - nasal airflow SP - 834 EP - 40 JF - International forum of allergy & rhinology JO - Int Forum Allergy Rhinol VL - 3 IS - 10 N2 - BACKGROUND: The effects of increases in maxillary sinus (MS) airflow following functional endoscopic sinus surgery (FESS) are unknown. The goal of this study was to quantify the effects of FESS on airflow into the MS in a cohort of patients with chronic rhinosinusitis, and compare MS flow rate with patient-reported outcome measures. METHODS: A pilot study was conducted in which preoperative and postoperative computed tomography scans of 4 patients undergoing bilateral or unilateral FESS were used to create 3-dimensional (3D) reconstructions of the nasal airway and paranasal sinuses using Mimics™ (Materialise, Inc.). The size of the maxillary antrostomies post-FESS ranged from 107 to 160 mm(2). Computational meshes were generated from the 3D reconstructions, and steady-state, laminar, inspiratory airflow was simulated in each mesh using the computational fluid dynamics (CFD) software Fluent™ (ANSYS, Inc.) under physiologic, pressure-driven conditions. Airflow into the MS was estimated from the simulations and was compared preoperatively and postoperatively. In addition, patients completed preoperative and postoperative Rhinosinusitis Outcome Measure-31 (RSOM-31) questionnaires and scores were compared with MS airflow rates. RESULTS: CFD simulations predicted that average airflow rate into post-FESS MS increased by 18.5 mL/second, and that average flow velocity into the MS more than quadrupled. Simulation results also showed that MS flow rate trended with total RSOM-31 and all domain scores. CONCLUSION: CFD simulations showed that the healed maxillary antrostomy after FESS can greatly enhance airflow into the MS. Our pilot study suggests that to some extent, increasing airflow into the MS may potentially improve chronic rhinosinusitis patients' quality of life pre-FESS and post-FESS. SN - 2042-6984 UR - https://www.unboundmedicine.com/medline/citation/24009143/Quantification_of_airflow_into_the_maxillary_sinuses_before_and_after_functional_endoscopic_sinus_surgery_ DB - PRIME DP - Unbound Medicine ER -