Numerical simulation of unsteady airflow in a nasal cavity for various sizes of maxillary sinus opening in a virtual endoscopic surgery.

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. They included only uncinectomy, uncinectomy +8 mm Middle Meatal Antrostomy (MMA), and uncinectomy +18 mm MMA on a realistic 3-D computational model of the nasal cavity of an adult male have been performed under the supervision of a specialist. 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.