Assessment of airflow ventilation in human nasal cavity and maxillary sinus before and after targeted sinonasal surgery: A numerical case study

• We modeled nasal and sinus airflow in a subject before and after targeted sinonasal surgery.
• The operation changed nasal airflow patterns by altering airflow partitioning between the two airways, decreasing nasal resistance and changing airflow distribution.
• Sinus airflow rate increased during inspiration after uncinectomy, while during expiration after balloon surgery.
• The sinus airflow always entered natural ostium and exited from accessory ostium during both inspiration and expiration in both the left and right sinuses.

In this study, we evaluated the effects of targeted sinonasal surgery on nasal and maxillary sinus airflow patterns. A patient, who underwent right balloon sinuplasty and left uncinectomy for recurrent maxillary sinus barometric pressure, and concomitant septoplasty and bilateral inferior turbinate reduction for deviated nasal septum and inferior turbinate hypertrophy, was selected. Two 3D models representing both pre- and post-operative sinonasal morphology were constructed. The models were then used to evaluate nasal and maxillary sinus airflow patterns during respiration at ventilation rates of 7.5 L/min, 15 L/min and 30 L/min using computational fluid dynamics. The results showed that septoplasty and inferior turbinate reduction increased the nasal volume by 13.6%. The airflow patterns in the nasal cavity showed reasonably decreased resistance and slightly more even flow partitioning after the operation. Maxillary sinus ventilation significantly increased during inspiration in the left sinus after uncinectomy, and during expiration in right sinus after balloon sinuplasty. This study demonstrates computational fluid dynamics simulation is a tool in the investigation of outcomes after targeted, minimally invasive sinonasal surgery.