1
|
Almeida PRL, Person OC, Puga ME, Atallah ÁN, Trevisani VF. Surgery for nasal polyposis in cystic fibrosis. Cochrane Database Syst Rev 2023; 12:CD014084. [PMID: 38063253 PMCID: PMC10704557 DOI: 10.1002/14651858.cd014084.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND Cystic fibrosis (CF) is a life-shortening, autosomal recessive disease that leads to abnormal electrolyte concentration in exocrine secretions. Secretion stasis in paranasal sinuses determines chronic rhinosinusitis (CRS) and nasal polyposis. Endoscopic sinus surgery is used to open the sinuses and allow medical treatment to work properly. OBJECTIVES To determine the effects of sinus surgery alone or in combination with medical treatment (non-surgical) compared to medical treatment (non-surgical) alone on both nasal and pulmonary function in people with CF diagnosed with CRS with nasal polyposis. Further, to evaluate the impact of sinus surgery (with or without medical treatment) on hospitalization rates, use of antibiotics and pulmonary exacerbation rates. SEARCH METHODS We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and hand searching of journals and conference abstract books. Date of last search: 4 July 2022. We also searched other databases (Pubmed, Embase, World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), Virtual Health Library and ClinicalTrials.gov). Date of last search: 18 September 2022. SELECTION CRITERIA Randomized controlled trials (RCTs) comparing groups who underwent endoscopic sinus surgery and groups with medical treatment alone. DATA COLLECTION AND ANALYSIS The review authors independently selected studies, extracted data, assessed the risk of bias and evaluated the certainty of the evidence using GRADE. They contacted the authors of the included study for additional information. MAIN RESULTS We identified 66 publications relating to 50 studies from electronic searches. Only one study fulfilled the inclusion criteria, and only limited information was available. In this study, 28 participants aged 19 to 28 years were randomized in equal numbers to either nasal irrigation alone or nasal irrigation with surgery (endoscopic polypectomy with extended sinusotomy). The certainty of the evidence was very low according to the GRADE approach. We are uncertain whether, compared to medical treatment alone, the addition of surgical intervention improves nasal symptoms, or reduces bacterial colonization, the use of antibiotics and pulmonary exacerbations. We are also uncertain whether the addition of surgery to medical treatment leads to changes in pulmonary function. There was one episode of bleeding during surgery that was corrected during the procedure with no further consequences. The study did not report on survival. AUTHORS' CONCLUSIONS Very low-certainty evidence means we are not certain if endoscopic sinus surgery to treat chronic rhinosinusitis with nasal polyposis in cystic fibrosis is effective. Future research should be multicentric to increase the number of participants and increase statistical power. Adequate randomization and allocation concealment are important to guarantee that the groups are similar. Blinding, however, may not be possible in an ethical trial; even without blinding, results can achieve high-level evidence if the outcomes used are objective parameters. Future research should follow participants of all ages for at least 12 months to evaluate the evolution of nasal polyposis, its recurrence and how symptoms may return. We also consider mortality an important outcome to be assessed. Future clinical research should consider the effects of cystic fibrosis transmembrane conductance regulators, a new group of drugs that may affect the development of nasal polyps.
Collapse
Affiliation(s)
- Paula Ribeiro Lopes Almeida
- Collaborator of the Department of Otorhinolaryngology at Mario Covas State Hospital, School of Medicine ABC, Santo André - São Paulo, Brazil
- Postgraduate student at the Department of Emergency Medicine and Evidence-Based Medicine of the Federal Universitiy of São Paulo - UNIFESP, São Paulo, Brazil
| | - Osmar C Person
- Collaborator of the Department of Otorhinolaryngology at Mario Covas State Hospital, School of Medicine ABC, Santo André - São Paulo, Brazil
| | - Maria Es Puga
- Cochrane Brazil, Center for Studies in Evidence-Based Medicine and Health Technology Assessment, São Paulo, Brazil
| | - Álvaro N Atallah
- Cochrane Brazil, Center for Studies in Evidence-Based Medicine and Health Technology Assessment, São Paulo, Brazil
| | - Virginia Fm Trevisani
- Cochrane Brazil, Center for Studies in Evidence-Based Medicine and Health Technology Assessment, São Paulo, Brazil
- Head Professor at the Department of Rheumatology, University of Santo Amaro, São Paulo, Brazil
- Assistant Professor at the Department of Emergency Medicine and Evidence-Based Medicine, Federal University of São Paulo - UNIFESP, São Paulo, Brazil
| |
Collapse
|
2
|
Abstract
OBJECTIVES While surgeries to correct the anatomical malformations that cause nasal airway obstruction (NAO) are generally successful, the outcomes of such procedures are often unsatisfactory. The aim of the present study was to assess the value of opening the middle meatus in patients with NAO. METHODS Thirty-four patients with nasal obstruction due to nasal septal deviation were included in this study. After randomization, the middle meatus was either opened or not opened during septoplasty. The patients were evaluated through pre- and postoperative rhinomanometry and acoustic rhinometry. The Visual Analog Scale (VAS) scores of subjective symptoms along with responses to the 20-item Sinonasal Outcome Test (SNOT-20) were obtained before surgery and three months after surgery. RESULTS The VAS scores and SNOT-20 responses improved significantly in both groups after surgery. The effective treatment rate based on the nasal congestion score (NCS) was 64.7% in the single group (septoplasty alone) and 100% in the combined group (septoplasty in conjunction with opening the middle meatus), and the difference was statistically significant (P = .018). In both groups, surgery significantly improved nasal flow, resistance, minimal cross-sectional area, cross-sectional area 6 cm (CA6) from the anterior nostril and nasal volume. Nasal volume and CA6 after surgery were statistically different between the 2 groups (P = .004 and .019, respectively). CONCLUSIONS Opening the middle meatus may further improve the subjective perception of patency on the basis of septoplasty.
Collapse
Affiliation(s)
- Hongzheng Wei
- Department of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing Tongren Hospital, Beijing, People's Republic of China
- Department of Allergy, Capital Medical University, Beijing Tongren Hospital, Beijing, People's Republic of China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, People's Republic of China
| | - Lianqi Wan
- Department of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing Tongren Hospital, Beijing, People's Republic of China
- Department of Allergy, Capital Medical University, Beijing Tongren Hospital, Beijing, People's Republic of China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, People's Republic of China
| | - Yuan Zhang
- Department of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing Tongren Hospital, Beijing, People's Republic of China
- Department of Allergy, Capital Medical University, Beijing Tongren Hospital, Beijing, People's Republic of China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, People's Republic of China
| | - Yanru Li
- Department of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing Tongren Hospital, Beijing, People's Republic of China
| | - Wen Xu
- Department of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing Tongren Hospital, Beijing, People's Republic of China
| | - Yunchuan Li
- Department of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing Tongren Hospital, Beijing, People's Republic of China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, People's Republic of China
| | - Demin Han
- Department of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing Tongren Hospital, Beijing, People's Republic of China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, People's Republic of China
| |
Collapse
|
3
|
Salati H, Singh N, Khamooshi M, Vahaji S, Fletcher DF, Inthavong K. Nasal Irrigation Delivery in Three Post-FESS Models From a Squeeze-bottle Using CFD. Pharm Res 2022; 39:2569-2584. [PMID: 36056272 PMCID: PMC9556402 DOI: 10.1007/s11095-022-03375-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/17/2022] [Indexed: 11/30/2022]
Abstract
Purpose Nasal saline irrigation is highly recommended in patients following functional endoscopic sinus surgery (FESS) to aid the postoperative recovery. Post-FESS patients have significantly altered anatomy leading to markedly different flow dynamics from those found in pre-op or non-diseased airways, resulting in unknown flow dynamics. Methods This work investigated how the liquid stream disperses through altered nasal cavities following surgery using Computational Fluid Dynamics (CFD). A realistic squeeze profile was determined from physical experiments with a 27-year-old male using a squeeze bottle with load sensors. The administration technique involved a head tilt of 45-degrees forward to represent a head position over a sink. After the irrigation event that lasted 4.5 s, the simulation continued for an additional 1.5 s, with the head orientation returning to an upright position. Results The results demonstrated that a large maxillary sinus ostium on the right side allows saline penetration into this sinus. The increased volume of saline entering the maxillary sinus limits the saline volume available to the rest of the sinonasal cavity and reduces the surface coverage of the other paranasal sinuses. The average wall shear stress was higher on the right side than on the other side for two patients. The results also revealed that head position alters the sinuses’ saline residual, especially the frontal sinuses. Conclusion While greater access to sinuses is achieved through FESS surgery, patients without a nasal septum limits posterior sinus penetration due to the liquid crossing over to the contralateral cavity and exiting the nasal cavity early.
Collapse
Affiliation(s)
- Hana Salati
- Mechanical & Automotive Engineering, School of Engineering, RMIT University, 3083, Bundoora, Victoria, Australia
| | - Narinder Singh
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, 2145, Westmead, New South Wales, Australia
| | - Mehrdad Khamooshi
- Cardio-Respiratory Engineering and Technology Laboratory (CREATElab), Department of Mechanical and Aerospace Engineering, Monash University, 3004, Melbourne, Victoria, Australia
| | - Sara Vahaji
- Mechanical & Automotive Engineering, School of Engineering, RMIT University, 3083, Bundoora, Victoria, Australia
| | - David F Fletcher
- School of Chemical and Biomolecular Engineering, The University of Sydney, 2145, New South Wales, Australia
| | - Kiao Inthavong
- Mechanical & Automotive Engineering, School of Engineering, RMIT University, 3083, Bundoora, Victoria, Australia.
| |
Collapse
|
4
|
Cochrane Cystic Fibrosis and Genetic Disorders Group, Paula Ribeiro Lopes Almeida, Osmar C Person, Renata Ribeiro de Mendonca Pilan, Maria ES Puga, Álvaro N Atallah, Virginia FM Trevisani. Surgery for nasal polyposis in cystic fibrosis. Cochrane Database Syst Rev 2022; 2022:CD014084. [ DOI: 10.1002/14651858.CD014084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To determine the effects of sinus surgery alone or in combination with medical treatment (non‐surgical) compared to medical treatment (non‐surgical) alone on both nasal and pulmonary function in people with cystic fibrosis diagnosed with CRS with nasal polyposis. Further, to evaluate the impact of sinus surgery (with or without medical treatment) on hospitalization rates, use of antibiotics and pulmonary exacerbation rates.
Collapse
|
5
|
Becker S, Huppertz T, Möller W, Havel M, Schuster M, Becker AM, Sailer M, Schuschnig U, Johnson TR. Xenon-Enhanced Dynamic Dual-Energy CT Is Able to Quantify Sinus Ventilation Using Laminar and Pulsating Air-/Gas Flow Before and After Surgery: A Pilot Study in a Cadaver Model. Front Allergy 2022; 3:829898. [PMID: 35386654 PMCID: PMC8974739 DOI: 10.3389/falgy.2022.829898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background Chronic rhinosinusitis is a common disease with a significant impact on the quality of life. Topical drug delivery to the paranasal sinuses is not efficient to prevent sinus surgery or expensive biologic treatment in a lot of cases as the affected mucosa is not reached. More efficient approaches for topical drug delivery are, therefore, necessary. In the current study, dual-energy CT (DECT) imaging was used to examine sinus ventilation before and after sinus surgery using a pulsating xenon gas ventilator in a cadaver head. Methods Xenon gas was administered to the nasal cavity of a cadaver head with a laminar flow of 7 L/min and with pulsating xenon-flow (45 Hz frequency, 25 mbar amplitude). Nasal cavity and paranasal sinuses were imaged by DECT. This procedure was repeated after functional endoscopic sinus surgery (FESS). Based on the enhancement levels in the different sinuses, regional xenon concentrations were calculated. Results Xenon-related enhancement could not be detected in most of the sinuses during laminar gas flow. By superimposing laminar flow with pulsation, DECT imaging revealed a xenon wash-in and wash-out in the sinuses. After FESS, xenon enhancement was immediately seen in all sinuses and reached higher concentrations than before surgery. Conclusion Xenon-enhanced DECT can be used to visualize and quantify sinus ventilation. Pulsating air-/gas flow was superior to laminar flow for the administration of xenon to the paranasal sinuses. FESS leads to successful ventilation of all paranasal sinuses.
Collapse
Affiliation(s)
- Sven Becker
- Department of Otolaryngology, Head and Neck Surgery, Tübingen University Hospital, Tübingen, Germany
- *Correspondence: Sven Becker
| | - Tilman Huppertz
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Winfried Möller
- Institute of Lung Biology and Disease, Helmholtz Center München, Helmholtz Association of German Research Centres (HZ), Munich, Germany
| | - Miriam Havel
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - Maria Schuster
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - Anne Merle Becker
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - Martin Sailer
- Department of Otolaryngology, Head and Neck Surgery, Tübingen University Hospital, Tübingen, Germany
| | | | - Thorsten R. Johnson
- Institute for Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany
| |
Collapse
|
6
|
Siu J, van Strien J, Campbell R, Roberts P, Tingle MD, Inthavong K, Douglas RG. Comparison of Sinus Deposition from an Aqueous Nasal Spray and Pressurised MDI in a Post-Endoscopic Sinus Surgery Nasal Replica. Pharm Res 2022. [PMID: 35137359 DOI: 10.1007/s11095-021-03129-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/17/2021] [Indexed: 11/16/2022]
Abstract
Background Optimising intranasal distribution and retention of topical therapy is essential for effectively managing patients with chronic rhinosinusitis, including those that have had functional endoscopic sinus surgery (FESS). This study presents a new technique for quantifying in vitro experiments of fluticasone propionate deposition within the sinuses of a 3D-printed model from a post-FESS patient. Methods Circular filter papers were placed on the sinus surfaces of the model. Deposition of fluticasone on the filter paper was quantified using high-performance liquid chromatography (HPLC) assay-based techniques. The deposition patterns of two nasal drug delivery devices, an aqueous nasal spray (Flixonase) and metered dose inhaler (Flixotide), were compared. The effects of airflow (0 L/min vs. 12 L/min) and administration angle (30° vs. and 45°) were evaluated. Results Inhaled airflow made little difference to sinus deposition for either device. A 45° administration angle improved frontal sinus deposition with the nasal spray and both ethmoidal and sphenoidal deposition with the inhaler. The inhaler provided significantly better deposition within the ethmoid sinuses (8.5x) and within the maxillary sinuses (3.9x) compared with the nasal spray under the same conditions. Conclusion In the post-FESS model analysed, the inhaler produced better sinus deposition overall compared with the nasal spray. The techniques described can be used and adapted for in vitro performance testing of different drug formulations and intranasal devices under different experimental conditions. They can also help validate computational fluid dynamics modelling and in vivo studies.
Collapse
|
7
|
Abstract
We look back at the end of what soon will be seen as an historic year, from COVID-19 to real-world introduction of biologicals influencing the life of our patients. This review describes the important findings in Rhinology over the past year. A large body of evidence now demonstrates loss of sense of smell to be one of the most common symptoms of COVID-19 infection; a meta-analysis of 3563 patients found the mean prevalence of self-reported loss to be 47%. A number of studies have now shown long-term reduced loss of smell and parosmia. Given the high numbers of people affected by COVID-19, even with the best reported recovery rates, a significant number worldwide will be left with severe olfactory dysfunction. The most prevalent causes for olfactory dysfunction, besides COVID-19 and upper respiratory tract infections in general, are trauma and CRSwNP. For these CRSwNP patients a bright future seems to be starting with the development of treatment with biologics. This year the Nobel prize in Medicine 2021 was awarded jointly to David Julius and Ardem Patapoutian for their discoveries of receptors for temperature and touch which has greatly enhanced our understanding of nasal hyperreactivity and understanding of intranasal trigeminal function. Finally, a new definition of chronic rhinitis has been proposed in the last year and we have seen many papers emphasizing the importance of endotyping patients in chronic rhinitis and rhinosinusitis in order to optimise treatment effect.
Collapse
Affiliation(s)
- W J Fokkens
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands
| | - B N Landis
- Department of Otorhinolaryngology, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - C Hopkins
- Department of Otorhinolaryngology, Guy's Hospital, London, UK
| | - S Reitsma
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands
| | - A R Sedaghat
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| |
Collapse
|
8
|
Inthavong K, Shang Y, Del Gaudio JM, Wise SK, Edwards TS, Bradshaw K, Wong E, Smith M, Singh N. Inhalation and deposition of spherical and pollen particles after middle turbinate resection in a human nasal cavity. Respir Physiol Neurobiol 2021; 294:103769. [PMID: 34352383 DOI: 10.1016/j.resp.2021.103769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/22/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022]
Abstract
Middle turbinate resection significantly alters the anatomy and redistributes the inhaled air. The superior half of the main nasal cavity is opened up, increasing accessibility to the region. This is expected to increase inhalation dosimetry to the region during exposure to airborne particles. This study investigated the influence of middle turbinate resection on the deposition of inhaled pollutants that cover spherical and non-spherical particles (e.g. pollen). A computational model of the nasal cavity from CT scans, and its corresponding post-operative model with virtual surgery performed was created. Two constant flow rates of 5 L/min, and 15 L/min were simulated under a laminar flow field. Inhaled particles including pollen (non-spherical), and a spherical particle with reference density of 1000 kg/m3 were introduced in the surrounding atmosphere. The effect of surgery was most prominent in the less patent cavity side, since the change in anatomy was proportionally greater relative to the original airway space. The left cavity produced an increase in particle deposition at a flow rate of 15 L/min. The main particle deposition mechanisms were inertial impaction, and to a lesser degree gravitational sedimentation. The results are expected to provide insight into inhalation efficiency of different aerosol types, and the likelihood of deposition in different nasal cavity surfaces.
Collapse
Affiliation(s)
- Kiao Inthavong
- Mechanical & Automotive Engineering, School of Engineering, RMIT University, Bundoora, Victoria 3083, Australia.
| | - Yidan Shang
- Mechanical & Automotive Engineering, School of Engineering, RMIT University, Bundoora, Victoria 3083, Australia
| | - John M Del Gaudio
- Department of Otolaryngology-Head and Neck Surgery Emory University, Atlanta, GA, USA
| | - Sarah K Wise
- Department of Otolaryngology-Head and Neck Surgery Emory University, Atlanta, GA, USA
| | - Thomas S Edwards
- Department of Otolaryngology-Head and Neck Surgery Emory University, Atlanta, GA, USA
| | - Kimberley Bradshaw
- Faculty of Medicine & Health, The University of Sydney, NSW 2006, Australia
| | - Eugene Wong
- Faculty of Medicine & Health, The University of Sydney, NSW 2006, Australia
| | - Murray Smith
- Faculty of Medicine & Health, The University of Sydney, NSW 2006, Australia
| | - Narinder Singh
- Faculty of Medicine & Health, The University of Sydney, NSW 2006, Australia; Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Westmead, NSW 2145, Australia
| |
Collapse
|
9
|
Moniripiri M, Amjadimanesh H, Faramarzi M, Sadrizadeh S, Abouali O. Numerical simulation of unsteady airflow in a nasal cavity for various sizes of maxillary sinus opening in a virtual endoscopic surgery. Respir Physiol Neurobiol 2021; 291:103690. [PMID: 33989811 DOI: 10.1016/j.resp.2021.103690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/01/2021] [Accepted: 05/09/2021] [Indexed: 11/22/2022]
Abstract
Functional endoscopic sinus surgery (FESS) is performed to treat sinusitis when treatment with medication fails. In the present study, three different virtual maxillary sinus endoscopic surgeries were performed on a realistic 3-D computational model of the nasal cavity of an adult male under the supervision of a specialist. They included only uncinectomy, uncinectomy + 8mm Middle Meatal Antrostomy (MMA) and uncinectomy + 18 mm MMA. Simulations were performed for two human activity respiratory rates, including rest and moderate activities, and effects of different surgeries and respiratory rates on maxillary sinus were investigated. It was found that after endoscopic sinus surgery, the volume of air entering the maxillary sinus increased significantly, and as the size of the MMA increased, or the breathing condition changed from rest to moderate activity, this volume of air increased. For the rest condition, on average for both nasal passages, for uncinectomy +8 mm MMA, around 15 % of the inhaled flow and 7 % of the exhaled flow enter the maxillary sinuses. For uncinectomy +18 mm MMA, these values are 24 % and 14 %, respectively. As human activity increases, a lower portion of inhaled and exhaled air enters the maxillary sinuses. For the moderate activity condition, on average for both nasal passages, for uncinectomy +8 mm MMA, around 11 % of the inhaled flow and 6 % of the exhaled flow rate enters the maxillary sinus. For uncinectomy +18 mm MMA, these values are 16 % and 8%, respectively. Comparing the steady and unsteady simulation results showed that the quasi-steady flow assumption could predict the flow in the maxillary sinus and the volume of air entering the sinuses, almost at any moment of respiration, with acceptable accuracy.
Collapse
|