title: Characterizing airflow profile in the postoperative maxillary sinus by using computational fluid dynamics modeling: A pilot study.
abstract: BACKGROUND
  Maxillary antrostomy is commonly performed during endoscopic sinus surgery. Little is known about the association surrounding recalcitrant maxillary sinusitis, antrostomy size, and intranasal airflow changes. Furthermore, the interaction between sinus mucosa and airflow is poorly understood. This study used computational fluid dynamics (CFD) modeling to investigate postoperative airflow characteristics between diseased and nondiseased maxillary sinuses in subjects with recurrent disease.
  
  
  METHODS
  A retrospective review of patients from a tertiary-level academic rhinology practice was performed. Seven subjects with endoscopic evidence of postoperative maxillary sinus disease that presented as chronic unilateral crusting at least 1 year after bilateral maxillary antrostomies were selected. A three-dimensional model of each subject's sinonasal cavity was created from postoperative computed tomographies and used for CFD analysis.
  
  
  RESULTS
  Although the variables investigated between diseased and nondiseased sides were not statistically significant, the diseased side in six subjects had a smaller antrostomy, and five of these subjects had both reduced nasal unilateral airflow and increased unilateral nasal resistance on the diseased side. The ratio of posterior wall shear stress (WSS) of the maxillary sinus to the total WSS was higher on the diseased side in six subjects. Results also showed strong correlations between antrostomy and CFD variables on the diseased side than on the nondiseased side.
  
  
  CONCLUSIONS
  This pilot study showed that the majority of the simulated sinonasal models exhibited common characteristics on the side with persistent disease, such as smaller antrostomy, reduced nasal airflow, increased nasal resistance, and increased posterior WSS. Although statistical significance was not established, this study provided preliminary insight into variables to consider in a larger cohort study.
authors: Department of Surgery, Division of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA.
authors: Kevin J
authors: KJ
authors: Choi
authors: David W
authors: DW
authors: Jang
authors: Matthew D
authors: MD
authors: Ellison
authors: Dennis O
authors: DO
authors: Frank-Ito
mesh_terms: D000328:Adult; D000368:Aged; D003198:Computer Simulation; D004724:Endoscopy; D005260:Female; D006801:Humans; D057446:Hydrodynamics; D008297:Male; D008443:Maxillary Sinus / Q000473:pathology* / Q000601:surgery; D015523:Maxillary Sinusitis / Q000175:diagnosis* / Q000601:surgery; D008875:Middle Aged; D008954:Models, Biological; D009297:Nasal Mucosa / Q000502:physiology; D015508:Nasal Obstruction / Q000209:etiology / Q000473:pathology*; D010865:Pilot Projects; D011183:Postoperative Complications / Q000473:pathology*; D012123:Pulmonary Ventilation; D012008:Recurrence; D012189:Retrospective Studies; D012225:Rhinoplasty