title: Sinus irrigations before and after surgery-Visualization through computational fluid dynamics simulations.
abstract: OBJECTIVE
  Topical sinus irrigations play a critical role in the management of sinonasal disease, and the improvement in irrigant penetration into the sinuses postoperatively greatly contributes to the success of endoscopic sinus surgery. Prior investigations on postoperative sinus irrigations have been mostly limited to cadaver studies, which are labor intensive and do not capture the full dynamics of the flows. A pilot study was conducted to investigate the impact of surgery on sinus irrigation through computational fluid dynamics (CFD) simulations.
  
  
  METHODS
  Retrospective computational study.
  
  
  METHODS
  Pre- and postoperative computed tomography (CT) scans were obtained on a patient who underwent standard endoscopic surgeries for all sinuses, including a Draf III frontal sinusotomy. CT-based pre- and postoperative CFD models then simulated irrigations of 120 mL saline per nostril at 12 mL/s (typical of Sinugator) and 60 mL/s (SinusRinse Bottle), in two head positions: face parallel and at a 45° angle to the ground.
  
  
  RESULTS
  Overall, surgery most significantly improved frontal sinus irrigation, but surprisingly resulted in less maxillary and ethmoid sinuses penetration. This may due to the partial removal of the septum during the Draf III, causing most fluid to exit prematurely across the resected septum. Higher flow rate slightly improved ethmoid sinus irrigation, but resulted in less preoperative contralateral maxillary sinus penetration.
  
  
  CONCLUSIONS
  CFD modeling of sinonasal irrigations is a novel technique for evaluating irrigant penetration of individual sinus cavities. It may prove useful in determining the optimal degree of surgery or the ideal irrigation strategy to allow for maximal and targeted sinus irrigant penetration.
  
  
  METHODS
  NA Laryngoscope, 126:E90-E96, 2016.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Ohio State University, Columbus, OH.
authors.forename: Kai
authors.initials: K
authors.lastname: Zhao
authors.affiliation: Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: John R
authors.initials: JR
authors.lastname: Craig
authors.affiliation: Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania.|Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, U.S.A.
authors.forename: Noam A
authors.initials: NA
authors.lastname: Cohen
authors.affiliation: Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Nithin D
authors.initials: ND
authors.lastname: Adappa
authors.affiliation: Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Sammy
authors.initials: S
authors.lastname: Khalili
authors.affiliation: Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: James N
authors.initials: JN
authors.lastname: Palmer
mesh_terms: D003198:Computer Simulation; D004724:Endoscopy / Q000379:methods*; D005005:Ethmoid Sinus / Q000000981:diagnostic imaging / Q000601:surgery; D005626:Frontal Sinus / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D057446:Hydrodynamics; D008297:Male; D008443:Maxillary Sinus / Q000000981:diagnostic imaging / Q000601:surgery; D008875:Middle Aged; D009296:Nasal Cavity / Q000000981:diagnostic imaging / Q000601:surgery; D010254:Paranasal Sinus Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D010865:Pilot Projects; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D007507:Therapeutic Irrigation / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Nasal irrigation; computational fluid dynamics; frontal; head position; maxillary; modeling; sinus surgery; sinusitis; sphenoid