Comparison of Airflow Between Spreader Grafts and Butterfly Grafts Using Computational Flow Dynamics in a Cadaveric Model
Comparison of Airflow Between Spreader Grafts and Butterfly Grafts Using Computational Flow Dynamics in a Cadaveric Model
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DOI：
10.1001/jamafacial.2017.1994
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发表时间：
2018-05-01
影响因子：
--
通讯作者：
Clark, J. Madison
中科院分区：
文献类型：
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作者：
Brandon, Bryan M.;Austin, Grace K.;Clark, J. Madison
鼻瓣膜受损是鼻塞的主要原因，目前已经开发出多种方法来解决它。目的比较蝶型和展布型两种手术治疗鼻瓣膜妥协前后的鼻腔气流阻力、气流分配和粘膜冷却（热通量）。设计、环境和参与者在这项尸体组织研究中，2016年3月，4个新鲜的尸体头部交替进行了播散移植术和蝴蝶移植术。术前和术后使用计算机断层扫描生成鼻气道的三维（3d）模型。然后将这些模型用于吸气过程中气流和传热的稳态计算流体动力学模拟。介入蝶接枝嫁接技术。主要结果和测量：鼻腔气流阻力、气流分配和热通量。结果供体1、2、3为白人男性；捐赠者4，一位白人女性。在术前和术后4具尸体头部的计算机断层扫描生成的3d模型中，计算流体动力学模拟表明，蝶状移植物（范围，20%-51%）和扩张体移植物（范围，2%-29%）的鼻腔气流阻力较术前值有所降低。在所有4个尸体头部模型中，蝴蝶移植物与鼻腔气流阻力的更大降低有关。与术前相比，热通量（一种与鼻通畅主观感觉相关的生物物理变量）的变化更为多变，蝴蝶移植后为-11%至4%，扩张体移植后为-9%至10%。术前左右鼻孔气流分配与蝶形移植物一致改善。对于播散移植，供体1和4有改善，但供体2和3的分配更差。结论和相关性本研究的结果表明，最近发展的蝶形移植物技术可能与在鼻瓣膜妥协中使用扩张体移植物所观察到的相似水平的鼻气流改善有关。两种干预措施都与热通量变化相关。由于本研究仅涉及静态内鼻阀狭窄，因此在动态模型中可以预测两种技术之间在气流和热通量方面的更大差异。有必要对患者进行进一步调查。(C) 2017美国医学协会。版权所有。
IMPORTANCE Nasal valve compromise is a major cause of nasal obstruction, and multiple methods have been developed to address it.OBJECTIVE To compare nasal airflow resistance, airflow partitioning, and mucosal cooling (heat flux) before and after 2 surgical interventions, butterfly and spreader graft placement, used to treat nasal valve compromise.DESIGN, SETTING, AND PARTICIPANTS In this cadaveric tissue study, 4 fresh cadaveric heads underwent both spreader graft and butterfly graft surgical procedures in alternating sequence in March 2016. Preoperative and postoperative computed tomographic scans were used to generate 3-dimensional (3-D) models of the nasal airway. These models were then used in steady state computational fluid dynamics simulations of airflow and heat transfer during inspiration.INTERVENTION Butterfly and spreader graft techniques.MAIN OUTCOMES AND MEASURES Nasal airflow resistance, airflow partitioning, and heat flux.RESULTS Donors 1, 2, and 3 were white males; donor 4, a white female. Computational fluid dynamics simulations during inspiration in 3-D models generated from preoperative and postoperative computed tomographic scans of the 4 cadaveric heads indicated reductions from preoperative values in nasal airflow resistance associated with both butterfly grafts (range, 20%-51%) and spreader grafts (range, 2%-29%). Butterfly grafts were associated with a greater reduction in nasal airflow resistance in models of all 4 cadaveric heads. Changes from preoperative values for heat flux, a biophysical variable that correlates with the subjective sensation of nasal patency, were more variable, ranging from -11% to 4% following butterfly grafts and -9% to 10% following spreader grafts. The preoperative airflow allocation in the left and right nostrils improved consistently with the butterfly graft. With the spreader graft, there were improvements for donors 1 and 4, but the allocations were worse for donors 2 and 3.CONCLUSIONS AND RELEVANCE The results of this study suggest that the more recently developed butterfly graft technique may be associated with a similar level of improved nasal airflow as that observed with the use of a spreader graft in nasal valve compromise. Both interventions were associated with comparable changes in heat flux. Because this study addressed only static internal nasal valve stenosis, even greater differences in air flow and heat flux between the 2 techniques may be anticipated in a dynamic model. Further investigation in patients is warranted. (C) 2017 American Medical Association. All rights reserved.