title: Impact of Middle versus Inferior Total Turbinectomy on Nasal Aerodynamics.
abstract: This computational study aims to (1) use virtual surgery to theoretically investigate the maximum possible change in nasal aerodynamics after turbinate surgery, (2) quantify the relative contributions of the middle and inferior turbinates to nasal resistance and air conditioning, and (3) quantify to what extent total turbinectomy impairs the nasal air-conditioning capacity.
  
  
  
  Virtual surgery and computational fluid dynamics.
  
  
  
  Academic tertiary medical center.
  
  
  
  Ten patients with inferior turbinate hypertrophy were studied. Three-dimensional models of their nasal anatomies were built according to presurgery computed tomography scans. Virtual surgery was applied to create models representing either total inferior turbinectomy (TIT) or total middle turbinectomy (TMT). Airflow, heat transfer, and humidity transport were simulated at a steady-state inhalation rate of 15 L/min. The surface area stimulated by mucosal cooling was defined as the area where heat fluxes exceed 50 W/m(2).
  
  
  
  In both virtual total turbinectomy models, nasal resistance decreased and airflow increased. However, the surface area where heat fluxes exceed 50 W/m(2) either decreased (TIT) or did not change significantly (TMT), suggesting that total turbinectomy may reduce the stimulation of cold receptors by inspired air. Nasal heating and humidification efficiencies decreased significantly after both TIT and TMT. All changes were greater in the TIT models than in the TMT models.
  
  
  
  TIT yields greater increases in nasal airflow but also impairs the nasal air-conditioning capacity to a greater extent than TMT. Radical resection of the turbinates may decrease the surface area stimulated by mucosal cooling.
authors.affiliation: Biotechnology and Bioengineering Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: Anupriya
authors.initials: A
authors.lastname: Dayal
authors.affiliation: Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: John S
authors.initials: JS
authors.lastname: Rhee
authors.affiliation: Biotechnology and Bioengineering Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA ggarcia@mcw.edu.
authors.forename: Guilherme J M
authors.initials: GJ
authors.lastname: Garcia
mesh_terms: D000403:Airway Resistance; D003198:Computer Simulation; D006801:Humans; D006813:Humidity; D057446:Hydrodynamics; D008953:Models, Anatomic; D008962:Models, Theoretical; D015508:Nasal Obstruction / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014420:Turbinates / Q000601:surgery*
keywords: computational fluid dynamics simulations; empty nose syndrome; inferior turbinate reduction; middle turbinate resection; mucosal cooling; nasal airflow sensation; nasal airway obstruction; secondary atrophic rhinitis