Does Total Inferior and Middle Turbinectomy Always Lead to Empty Nose Syndrome?

Area of Science:

• Otolaryngology
• Biomedical Engineering
• Computational Fluid Dynamics

Background:

• Empty Nose Syndrome (ENS) is a paradoxical complication of turbinate reduction surgery.
• Previous computational fluid dynamic (CFD) studies suggest distorted nasal airflow contributes to ENS.
• However, direct evidence linking aggressive turbinate reductions to ENS development is lacking.

Purpose of the Study:

• To investigate the relationship between aggressive turbinate reduction and Empty Nose Syndrome (ENS) using CFD modeling.
• To compare airflow patterns and wall shear force (WSF) in patients undergoing virtual turbinectomy versus actual surgery and published ENS cases.

Main Methods:

• Retrospective case series of 6 nasal obstruction patients undergoing total inferior and middle turbinectomies using a virtual surgical simulator.
• Comparison of CFD modeling results (airflow, nasal resistance, WSF) with pre- and post-surgery data and published ENS patient data.
• Analysis of inferior and middle turbinate wall shear force (WSF) distribution as an indicator of mucosal stimulation.

Main Results:

• Virtual turbinectomy significantly expanded nasal airway cross-sectional area but did not replicate the distorted airflow patterns seen in ENS patients.
• No significant difference in nasal resistance was found between actual surgery, virtual surgery, and ENS patients.
• Patients undergoing surgery exhibited significantly higher inferior turbinate WSF compared to ENS patients, while middle turbinate WSF was significantly lower in surgical cases than in ENS patients.

Conclusions:

• Empty Nose Syndrome (ENS) cannot be solely attributed to aggressive turbinate reduction surgeries.
• Various factors likely contribute to the development of ENS.
• CFD analysis reveals distinct airflow and WSF patterns in surgical patients compared to ENS patients, suggesting multifactorial etiology.