Abstract
Purpose
Individuals with unilateral cleft lip nasal deformity (uCLND) often require rhinoplasty in adolescence to correct nasal obstruction. The intent of this study is to identify sites of greatest nasal obstruction and evaluate the effects of isolated and combinations of simulated surgical procedures on these sites using computational fluid dynamics (CFD).
Methods
Computed tomography imaging of an adolescent subject with uCLND was converted to an anatomically accurate three-dimensional nasal airway model. Initial analysis was performed to identify anatomic sites of obstruction based on CFD computed resistance values. Virtual surgery procedures corresponding to common uCLND surgical interventions were simulated. Resulting airspace models were then analyzed after conducting airflow and heat transfer simulations.
Results
The preoperative model had 21 obstructed sites with a nasal resistance of 0.075 Pa s/mL. Following simulated surgical procedures with functional interventions alone and in combinations, the three virtual surgery models with most improved nasal airflow were inferior turbinate reduction (ITR) with posterior septoplasty (resistance = 0.054 Pa s/ml, reduction in 14 of 21 obstructed sites), ITR with anterior septoplasty (resistance = 0.058 Pa s/ml, reduction in 8 of 21 obstructed sites), and ITR with both anterior and posterior septoplasty (resistance = 0.052 Pa s/ml, reduction in 17 of 21 obstructed sites).
Conclusion
This study introduces a new technique for analysis of the impact of different simulated surgical interventions on uCLND-induced nasal obstruction. In this subject, simulated septoplasty with ITR on the non-cleft side provided maximal relief of nasal obstruction. The proposed technique can be further studied for possible utility in analyzing potential surgical interventions for optimal relief of nasal obstruction in patients with uCLND.
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Acknowledgements
Research reported in this publication was supported by the National Institute of Dental & Craniofacial Research of the National Institutes of Health under Award Number R01DE028554. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. In addition, special thanks to ANSYS, ANSYS Global Academic Program, and Dr. Paolo Maccarini (Duke University) for support and strategic donation.
Funding
Research reported in this publication was supported by the National Institute of Dental and Craniofacial Research of the National Institutes of Health under Award Number R01DE028554.
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This study was approved by the DUHS Institutional Review Board under protocol Pro00102005.
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Tillis, R.T., Shah, R., Martin, H.L. et al. A systematic analysis of surgical interventions for the airway in the mature unilateral cleft lip nasal deformity: a single case study. Int J CARS 17, 41–53 (2022). https://doi.org/10.1007/s11548-021-02396-z
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DOI: https://doi.org/10.1007/s11548-021-02396-z