What is it about?

Endoscopic medial maxillectomy is a common ENT procedure which allows entering the maxillary sinus for removal of tumors. The standard procedure required removal of the inferior turbinate, while more recent proposal advise sparing part of the inferior turbinate for better preservation of the nasal cavity conditioning function. This is the first article to address this issue on a theoretical basis, motivating the surgical choice with a fluid dynamics explanation obtained via a detailed and innovative in silico model.

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Why is it important?

No study ever explored the fluid dynamics theoretical basis on which endoscopic maxillectomy lies. Furthermore is the first time that advance computational fluid models are employed on such specific procedures. The combination of computational fluid dynamics and otolaryngological knowledge allowed us to show a possible causal link bewtween the common alterations observed in the nasal fossa after EMM and the changes in vorticity in the nasal airflow. Furthermore our observation show how these alterations are more striking with modified EMM, where the anteriormost part of the turbinate is left intact. The importance of these observations is not limited to EMM: showing how vorticity and velocity changes in the airflow impact on nasal crusting can allow further CFD researches explaining the role of nasal wall structures and their surgery, aimed to maximize benefits to patients while reducing invasivity and chances for complications.

Perspectives

The importance of computational fluid dynamics in understanding how the nose works is indeed proven by many works and many authors. Nevertheless is somewhat difficult to translate CFD findings in the clinical and surgical setting. Studying such a specific task such as endoscopic maxillectomy allows a direct comparison between CFD alterations in terms of vorticity and what most ENT surgeons are accustomed to observe in their daily practice.

Dr alberto maria saibene
Universita degli Studi di Milano

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This page is a summary of: Partial Preservation of the Inferior Turbinate in Endoscopic Medial Maxillectomy: A Computational Fluid Dynamics Study, American Journal of Rhinology and Allergy, January 2020, SAGE Publications, DOI: 10.1177/1945892420902005.
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