A computational study of functional endoscopic sinus surgery and maxillary sinus drug delivery

Area of Science:

• Otolaryngology
• Drug Delivery Systems
• Computational Fluid Dynamics

Background:

• Topical medication use is rising post-functional endoscopic sinus surgery (FESS).
• Optimal particle size for maxillary sinus (MS) drug delivery remains unclear.
• The impact of antrostomy size on MS drug delivery is not well-defined.

Purpose of the Study:

• To investigate the influence of antrostomy size on topical drug delivery to the MS.
• To determine the effect of particle size on MS drug deposition following FESS.

Main Methods:

• Created sinonasal models from pre- and post-FESS CT scans of chronic rhinosinusitis patients.
• Simulated airflow and particle deposition using computational fluid dynamics for nebulized and sprayed delivery.
• Evaluated four different antrostomy sizes in post-FESS models.

Main Results:

• FESS enhances MS ventilation and topical drug delivery.
• The largest simulated antrostomy resulted in the greatest MS drug delivery.
• Peak MS deposition occurred for particle sizes of 5-18 μm (nebulized) and 5-20 μm (sprayed).
• Post-FESS drug delivery improvements varied individually and by antrostomy type.

Conclusions:

• FESS, especially with larger antrostomies, enhances topical drug delivery to the MS.
• Specific particle size ranges optimize MS drug deposition.
• Further research is required to understand these findings in the context of other post-surgical outcomes.