Does Total Turbinectomy Always Lead to Empty Nose Syndrome? A Computational Virtual Surgery Study

Area of Science:

• Otolaryngology
• Biomedical Engineering
• Computational Fluid Dynamics

Background:

• Distorted nasal airflow patterns from computational fluid dynamic (CFD) modeling have been linked to empty nose syndrome (ENS).
• However, evidence directly linking aggressive turbinate surgery to ENS is lacking.
• This study investigates the airflow effects of total inferior turbinectomy using virtual surgery planning (VSP).

Purpose of the Study:

• To compare airflow parameters after virtual total inferior turbinectomy with actual surgical outcomes and a cohort of ENS patients.
• To determine if virtual total inferior turbinectomy replicates the airflow distortions observed in ENS.
• To investigate the role of turbinate reduction surgery in the development of ENS.

Main Methods:

• Retrospective analysis of six nasal obstruction patients undergoing turbinate reduction surgery.
• Virtual total inferior turbinectomy performed on patient data.
• Comparison of CFD modeling results with actual surgical outcomes and a previously collected ENS patient cohort (n=27).

Main Results:

• Actual surgery significantly improved patient-reported outcomes (NOSE and VAS scores).
• Virtual turbinectomy did not produce the distorted nasal airflow patterns characteristic of ENS patients.
• No significant differences in nasal resistance or wall shear force distribution were found between virtual turbinectomy and actual surgery, but both differed significantly from ENS patients.

Conclusions:

• Empty nose syndrome is likely a multifactorial condition.
• Aggressive turbinate reduction surgery alone may not be the sole cause of ENS.
• Further research is needed to understand the complex etiology of ENS.