Author(s)
Yang U Lee, BA
Jonas R. Miller, MD
Sarah M. Russel, MD, MPH
Joseph Madison Clark, MD
Dennis O. Frank-Ito, PhD
Affiliation(s)
University of North Carolina Chapel Hill; Duke University
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to understand how functional septorhinoplasty impacts intranasal drug penetration in the airway during nebulization.
Objectives: Effectiveness of topical intranasal medications, often prescribed to address various sinonasal diseases, is limited by their ability to penetrate posteriorly to their target site. This study investigates the effect of functional septorhinoplasty addressing nasal valve collapse on nebulized drug delivery to the posterior nasal airway.
Study Design: Computational study using parametric modeling to investigate intranasal drug transport.
Methods: Three fresh cadaveric heads underwent septoplasty, dorsal preservation rhinoplasty (DPR), and butterfly graft (BFG) placement. Radiographic images obtained preoperatively and after each intervention were used for three dimensional nasal airway reconstructions. Drug delivery simulations were performed under these conditions: particle size (1-30 µm), particle velocity of 1 and 5 m/s. Particle sizes were divided into three groups: small (1-10 µm), medium (11-20 µm), large (21-30 µm). Drug particle deposition to the posterior airway defined from the most anterior inferior turbinate region was calculated from simulation results.
Results: Preoperatively, 11-20 µm particles had the greatest median posterior deposition for both velocities (1 m/s = 3.6%; 5 m/s = 3.3%). Post-septoplasty, posterior deposition increased across all particle sizes but remained greatest for 11-20 µm particles (1 m/s = 7.0%; 5 m/s = 5.7%). Compared to preoperative values, 21-30 µm particles had improved posterior delivery with DPR alone (1 m/s = 2.8%; 5 m/s = 6.0%) and DPR+BFG (1 m/s = 9.7%; 5 m/s = 14.0%).
Conclusions: Nebulized drug delivery to the posterior nasal cavity improved across all three particle size groups after septoplasty, while DPR alone and DPR+BFG resulted in improved posterior deposition for medium and large particle size groups. In summary, our preliminary findings indicate that functional septorhinoplasty significantly improves drug delivery to the posterior nasal cavity for particle sizes ranging from 11 µm to 30 µm.