Virtual surgery for patients with nasal obstruction: Use of computational fluid dynamics (MeComLand (R), Digbody (R) Et Noseland (R)) to document objective flow parameters and optimise surgical results

Introduction: Computational fluid dynamics (CFD) is a mathematical toot to analyse airflow. We present a novel CFD software package to improve results following nasal surgery for obstruction. Methods: A group of engineers in collaboration with otolaryngologists have developed a very intuitive CFD software package called MeComLand, which uses the patient's cross-sectional (tomographic) images, thus showing in detail results originated by CFD such as airflow distributions, velocity profiles, pressure, or wall shear stress. NOSELAND (R) helps medical evaluation with dynamic reports by using a 3 D endoscopic view. Using this CFD-based software a patient underwent virtual surgery (septoplasty, turbinoplasty, spreader grafts, lateral crurat J-flap and combinations) to choose the best improvement in nasal flow. Objective: To present a novel software package to improve nasal surgery results. To apply the software on CT slices from a patient affected by septal deviation. To evaluate several surgical procedures (septoplasty, turbinectomy, spreader-grafts, J-flap and combination among them) to find the best alternative with less morbidity. Results: The combination of all the procedures does not provide the best nasal flow improvement. Septoplasty plus turbinoplasty obtained the best results. Turbinoplasty alone rendered almost similar results to septoplasty in our simulation. Conclusions: CFD provides useful complementary information to cover diagnosis, prognosis, and follow-up of nasal pathologies based on quantitative magnitudes linked to fluid flow. MeComLancr (R), DigBody (R) and NoseLand (R) represent a non-invasive, low-cost alternative for the functional study of patients with nasal obstruction. (C) 2017 Elsevier Espana, S.L.U. and Sociedad Espanola de Otorrinolaringologia y Cirugia de Cabeza y Cuello. All rights reserved.