鼻甲中部切除术对嗅裂气流影响的计算流体动力学研究。
Impact of Middle Turbinectomy on Airflow to the Olfactory Cleft: A Computational Fluid Dynamics Study.
机构信息
1 Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia.
2 Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, Ohio.
出版信息
Am J Rhinol Allergy. 2019 May;33(3):263-268. doi: 10.1177/1945892418816841. Epub 2018 Dec 13.
BACKGROUND
The impact of middle turbinate resection (MTR) on olfaction remains a point of debate in the current literature. Few studies have objectively evaluated olfactory cleft airflow following MTR; thus, the mechanism by which MTR may impact olfaction is poorly understood. It is not known whether the postsurgical changes in airway volume, flow, and resistance increase odorant transport or disrupt the patterns of normal airflow. Computational fluid dynamics can be used to study the nasal airway and predict responses to surgical intervention.
OBJECTIVE
To evaluate the functional impact of MTR on nasal airflow, resistance, and olfaction.
METHODS
Five maxillofacial computed tomography scans of patients without signs of significant sinusitis or nasal polyposis were used. Control models for each patient were compared to their corresponding model after virtual total MTR. For each model, nasal airway volume, nasal resistance, and air flow rate were determined. Odorant transport of 3 different odorants in the nasal cavity was simulated based on the computed steady airflow field.
RESULTS
Total airflow significantly increased following bilateral MTR in all patient models ( P < .05). Consistent with our airflow results, we found a decrease in nasal resistance following MTR. MTR significantly increased area averaged flux to the olfactory cleft when compared to controls for phenylethyl alcohol (high-sorptive odorant). Results for carvone (medium sorptive) were similarly elevated. MTR impact on limonene, a low flux odorant, was equivocal.
CONCLUSION
MTR increases nasal airflow while decreasing the nasal resistance. Overall, olfactory flux increased for high sorptive (phenylethyl alcohol) and medium sorpitve (l-carvone) odorants. However, the significant variation observed in one of our models suggests that the effects of MTR on the nasal airflow and the resultant olfaction can vary between individuals based on individual anatomic differences.
背景
中鼻甲切除术（MTR）对嗅觉的影响在当前文献中仍是一个争论点。很少有研究客观评估 MTR 后嗅觉裂的气流；因此，MTR 影响嗅觉的机制尚未完全了解。目前尚不清楚气道体积、流量和阻力的术后变化是否会增加气味的输送，或者是否会扰乱正常气流的模式。计算流体动力学可用于研究鼻腔气道并预测手术干预的反应。
目的
评估 MTR 对鼻腔气流、阻力和嗅觉的功能影响。
方法
使用 5 名无明显鼻窦炎或鼻息肉迹象的颌面计算机断层扫描。每位患者的对照模型与他们相应的虚拟总 MTR 后模型进行比较。对于每个模型，确定鼻腔气道体积、鼻腔阻力和气流速率。根据计算的稳态气流场模拟 3 种不同气味在鼻腔中的气味输送。
结果
在所有患者模型中，双侧 MTR 后总气流明显增加（P <.05）。与我们的气流结果一致，我们发现 MTR 后鼻腔阻力下降。与对照相比，MTR 显著增加了苯乙醇（高吸收性气味）到达嗅裂的平均通量。MTR 对柠檬烯（低通量气味）的影响则不确定。
结论
MTR 增加了鼻腔气流，同时降低了鼻腔阻力。总的来说，高吸收性（苯乙醇）和中吸收性（l-香芹酮）气味的嗅觉通量增加。然而，我们的一个模型中观察到的显著差异表明，MTR 对鼻腔气流和嗅觉的影响可能因个体解剖差异而在个体之间有所不同。
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