Changes in nasolabial angle may alter nasal valve morphology and airflow: a computational fluid dynamics study
Abstract
Aim: Nasal valve (NV) dysfunctions are a significant cause of nasal obstruction. Changes in the nasolabial angle (NLA) may also cause changes in NV morphology. The effect of changes in the 3D structure of the nasal valve region (NVR) on nasal airflow has yet to be studied sufficiently. The accuracy of computational fluid dynamics (CFD) simulation results of nasal airflow has been confirmed by in vitro tests. Therefore, this study aimed to evaluate the effect of changes in NV structure and volume on nasal airflow based on the CFD method.
Material and Method: We used CT images to create a 3D structural model of the NVR. First, CT images were transferred to MIMICS® software, and the nasal air passage was modeled. A solid reference model of the NVR was then created using SolidWorks software. Five different solid 3D nasal valve models were created with nasolabial angles of 85˚ in Model 1, 90˚ in Model 2, 95˚ in Model 3, 100˚ in Model 4, and 105˚ in Model 5. To simulate breathing during rest and exercise using the CFD method, the unilateral nasal airflow rates were set at 150 ml/s and 500 ml/s, respectively. The CFD method was then used to calculate each model’s airflow properties. Finally, the volumes of the models, pressure at the NV outlet, and airflow velocity were evaluated and calculated to investigate each model’s NV airflow characteristics.
Results: Our study found a significant correlation between the nasolabial angle (NLA) and NVR volume (r=-0.998, p=0.000), flow rate and velocity (r=0.984, p=0.000), velocity and maximum pressure (r=0.920, p=0.000), velocity and minimum pressure (r=-0.969, p=0.000), flow rate and maximum pressure (r=0.974, p=0.000), and flow rate and minimum pressure (r=-0.950, p=0.000). There was no correlation between NLA increase and nasal airflow velocity. We determined that the highest pressure and lowest airflow velocity values were in the upper angle region and that the lowest pressure and highest airflow velocity values were at the bottom of the NVR in all models.
Conclusion: Using the CFD method, we found a decrease in NVR volume and an increase in airflow velocity with an increase in NLA. In addition, we found that the pressure values in the NVR did not change significantly with the increase in NLA.
Thanks
The authors thank Prof.Dr. Mehmet Topal for his contributions to statistical evaluations.
References
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- Keskin G, Kaya AT. Evaluation of the pressure and wall shear stress on the aneurysm wall according to the growth position of a femoral artery pseudoaneurysm by numerical analysis. Eur J Sci Technol 2022; 34: 800-4.
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- Garcia GJM, Rhee JS, Senior BA, Kimbell JS. Septal Deviation and Nasal Resistance: An Investigation using Virtual Surgery and Computational Fluid Dynamics. Am J Rhinol Allergy 2010; 24: 46-53.
- Bucher S, Kunz S, Deggeller M, Holzmann D, Soyka MB. Open rhinoplasty using a columellar strut: Effects of the graft on nasal tip projection and rotation. Eur Arch Otorhinolaryngol 2020; 277: 1371-7.
- Rho NK, Park JY, Youn CS, Lee SK, Kim HS. Early changes in facial profile following structured filler rhinoplasty: an anthropometric analysis using a 3-dimensional imaging system. Dermatol Surg 2017; 43: 255-63.
- Hsu DW, Suh JD. Anatomy and physiology of nasal obstruction. Otolaryngol Clin North Am 2018; 51: 853-65.
- Gagnieur P, Fieux M, Louis B, Bequignon E, Bartier S, Vertu-Ciolino D. Objective diagnosis of internal nasal valve collapse by four-phase rhinomanometry. Laryngoscope Investig Otolaryngol 2022; 7: 388-94.
- Li L, Han D, Zang H, London NR. Aerodynamics analysis of the impact of nasal surgery on patients with obstructive sleep apnea and nasal obstruction. ORL J Otorhinolaryngol Relat Spec 2022; 84: 62-9.
- Zhou B, Huang Q, Cui S, Liu Y, Han D. Impact of airflow communication between nasal cavities on nasal ventilation. ORL J Otorhinolaryngol Relat Spec 2013; 75: 301-8.
Abstract
References
- Barrett DM, Casanueva FJ, Cook TA. Management of the Nasal Valve. Facial Plast Surg Clin North Am 2016; 24: 219-34.
- Schriever VA, Hummel T, Lundstrom JN, Freiherr J. Size of nostril opening as a measure of intranasal volume. Physiol Behav 2013; 110-111: 3-5.
- Farina R, Gonzalez A, Toledo X, Villanueva R, Martinez B, Perez H. Relationship between nostril, nasal valve and minimal cross-sectional area in functional upper airway. J Craniofac Surg 2019; 30: 2202-6.
- Gelardi M, Ciprandi G. The clinical importance of the nasal valve. Acta Biomed 2019; 90: 31-3.
- Hamilton GS, 3rd. The external nasal valve. Facial Plast Surg Clin North Am 2017; 25: 179-94.
- Tripathi PB, Elghobashi S, Wong BJF. The myth of the internal nasal valve. JAMA Facial Plast Surg 2017; 19: 253-4.
- Armijo BS, Brown M, Guyuron B. Defining the ideal nasolabial angle. Plast Reconstr Surg 2012; 129: 759-64.
- Harris R, Nagarkar P, Amirlak B. Varied definitions of nasolabial angle: searching for consensus among rhinoplasty surgeons and an algorithm for selecting the ideal method. Plast Reconstr Surg Glob Open 2016; 4: e752.
- Doorly DJ, Taylor DJ, Gambaruto AM, Schroter RC, Tolley N. Nasal architecture: form and flow. Philos Trans A Math Phys Eng Sci 2008; 366: 3225-46.
- Leite SHP, Jain R, Douglas RG. The clinical implications of computerised fluid dynamic modelling in rhinology. Rhinology 2019; 57: 2-9.
- Berger M, Pillei M, Mehrle A, et al. Nasal cavity airflow: Comparing laser doppler anemometry and computational fluid dynamic simulations. Respir Physiol Neurobiol 2021; 283: 103533.
- André RF, Vuyk HD, Ahmed A, Graamans K, Nolst Trenité GJ. Correlation between subjective and objective evaluation of the nasal airway. A systematic review of the highest level of evidence. Clin Otolaryngol 2009; 34: 518-25.
- Zhu JH, Lee HP, Lim KM, Lee SJ, San LT, Wang de Y. Inspirational airflow patterns in deviated noses: a numerical study. Comput Methods Biomech Biomed Engin 2013; 16: 1298-306.
- Segal RA, Kepler GM, Kimbell JS. Effects of differences in nasal anatomy on airflow distribution: a comparison of four individuals at rest. Ann Biomed Eng 2008; 36: 1870-82.
- Radulesco T, Meister L, Bouchet G, et al. Correlations between computational fluid dynamics and clinical evaluation of nasal airway obstruction due to septal deviation: An observational study. Clin Otolaryngol 2019; 44: 603-11.
- Li C, Jiang J, Dong H, Zhao K. Computational modeling and validation of human nasal airflow under various breathing conditions. J Biomech 2017; 64: 59-68.
- Li L, London NR, Jr., Zang H, Han D. Impact of posterior septum resection on nasal airflow pattern and warming function. Acta Otolaryngol 2020; 140: 51-7.
- Borojeni AAT, Garcia GJM, Moghaddam MG, et al. Normative ranges of nasal airflow variables in healthy adults. Int J Comput Assist Radiol Surg 2020; 15: 87-98.
- Ansys I. ANSYS fluent user’s guide, release 19.0. ANSYS Inc, Canonsburg. 2018.
- Sharp KV, Adrian RJ. Transition from laminar to turbulent flow in liquid filled microtubes. Experiments in Fluids 2004; 36: 741-7.
- Zhao K, Jiang J. What is normal nasal airflow? A computational study of 22 healthy adults. Int Forum Allergy Rhinol 2014; 4: 435-46.
- Kelly J, Prasad A, Wexler A. Detailed flow patterns in the nasal cavity. J Appl Physiol 2000; 89: 323-37.
- Keskin G, Kaya AT. Evaluation of the pressure and wall shear stress on the aneurysm wall according to the growth position of a femoral artery pseudoaneurysm by numerical analysis. Eur J Sci Technol 2022; 34: 800-4.
- Naughton JP, Lee AY, Ramos E, Wootton D, Stupak HD. Effect of nasal valve shape on downstream volume, airflow, and pressure drop: importance of the nasal valve revisited. Ann Otol Rhinol Laryngol 2018; 127: 745-53.
- Rhee JS, Weaver EM, Park SS, et al. Clinical consensus statement: Diagnosis and management of nasal valve compromise. Otolaryngol Head Neck Surg 2010; 143: 48-59.
- Garcia GJM, Rhee JS, Senior BA, Kimbell JS. Septal Deviation and Nasal Resistance: An Investigation using Virtual Surgery and Computational Fluid Dynamics. Am J Rhinol Allergy 2010; 24: 46-53.
- Bucher S, Kunz S, Deggeller M, Holzmann D, Soyka MB. Open rhinoplasty using a columellar strut: Effects of the graft on nasal tip projection and rotation. Eur Arch Otorhinolaryngol 2020; 277: 1371-7.
- Rho NK, Park JY, Youn CS, Lee SK, Kim HS. Early changes in facial profile following structured filler rhinoplasty: an anthropometric analysis using a 3-dimensional imaging system. Dermatol Surg 2017; 43: 255-63.
- Hsu DW, Suh JD. Anatomy and physiology of nasal obstruction. Otolaryngol Clin North Am 2018; 51: 853-65.
- Gagnieur P, Fieux M, Louis B, Bequignon E, Bartier S, Vertu-Ciolino D. Objective diagnosis of internal nasal valve collapse by four-phase rhinomanometry. Laryngoscope Investig Otolaryngol 2022; 7: 388-94.
- Li L, Han D, Zang H, London NR. Aerodynamics analysis of the impact of nasal surgery on patients with obstructive sleep apnea and nasal obstruction. ORL J Otorhinolaryngol Relat Spec 2022; 84: 62-9.
- Zhou B, Huang Q, Cui S, Liu Y, Han D. Impact of airflow communication between nasal cavities on nasal ventilation. ORL J Otorhinolaryngol Relat Spec 2013; 75: 301-8.
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| Primary Language | English |
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| Subjects | Health Care Administration |
| Journal Section | Original Article |
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| Publication Date | March 27, 2023 |
| Published in Issue | Year 2023 Volume: 6 Issue: 2 |
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