The impact of nasal adhesions on airflow and mucosal cooling - A computational fluid dynamics analysis

Nasal adhesions are a known postoperative complication following surgical procedures for nasal airway obstruction (NAO); and are a common cause of surgical failure, with patients often reporting significant NAO, despite relatively minor adhesion size. Division of such nasal adhesions often provides much greater relief than anticipated, based on the minimal reduction in cross-sectional area associated with the adhesion. The available literature regarding nasal adhesions provides little evidence examining their quantitative and qualitative effects on nasal airflow using objective measures. This study examined the impact of nasal adhesions at various anatomical sites on nasal airflow and mucosal cooling using computational fluid dynamics (CFD). A high-resolution CT scan of the paranasal sinuses of a 25-year-old, healthy female patient was segmented to create a three-dimensional nasal airway model. Virtual nasal adhesions of 2.5 mm diameter were added to various locations within the nasal cavity, representing common sites seen following NAO surgery. A series of models with single adhesions were created. CFD analysis was performed on each model and compared with a baseline no-adhesion model, comparing airflow and heat and mass transfer. The nasal adhesions resulted in no significant change in bulk airflow patterns through the nasal cavity. However, significant changes were observed in local airflow and mucosal cooling around and immediately downstream to the nasal adhesions. These were most evident with anterior nasal adhesions at the internal valve and anterior inferior turbinate. Postoperative nasal adhesions create local airflow disruption, resulting in reduced local mucosal cooling on critical surfaces, explaining the exaggerated perception of nasal obstruction. In particular, anteriorly located adhesions created greater disruption to local airflow and mucosal cooling, explaining their associated greater subjective sensation of obstruction.