Abstract：
BACKGROUND: Topical intranasal medication is required following functional endoscopic sinus surgery (FESS). The optimal particle size of transnasal nebulization aimed at the sinonasal cavities is not conclusive. The current study aims to evaluate the effect of particle size and various surgery scope of middle turbinectomy (MT) on post-full FESS drug delivery to the sinonasal cavities.
METHODS: Sinonasal reconstructions were performed from post-full FESS CT scans in 6 chronic rhinosinusitis with nasal polyps (CRSwNP) patients. Four additional models representing alternative surgery scopes of MT were established from each post-FESS reconstruction for simulation data comparison. Airflow and particle deposition of nebulized delivery were simulated via computational fluid dynamics (CFD) and validated through in vitro experiments. The optimal particle sizes reaching a deposition of at least 75% of the maximum in the targeted regions were identified.
RESULTS: The drug deposition rate onto the targeted regions increased following MT, with the greatest deposition following posterior MT (P-MT). Droplets in the range of 18-26 μm reached a deposition of larger than 75% of the maximum onto the targeted regions. Drug delivery rate in the sinonasal cavities varied significantly among individuals and across different types of MT with varying surgical scopes.
CONCLUSIONS: This study is the first to investigate the effect of various surgery scope on drug delivery by transnasal nebulization to the sinonasal cavities. The findings strongly affirm the vast potential of transnasal nebulization as an effective post-FESS treatment option. Moreover, it emphasizes that the drug delivery process via atomizers to the nasal cavity and paranasal sinuses is highly sensitive to the particle size.
METHODS: Sinonasal reconstructions were performed from post-full FESS CT scans in 6 chronic rhinosinusitis with nasal polyps (CRSwNP) patients. Four additional models representing alternative surgery scopes of MT were established from each post-FESS reconstruction for simulation data comparison. Airflow and particle deposition of nebulized delivery were simulated via computational fluid dynamics (CFD) and validated through in vitro experiments. The optimal particle sizes reaching a deposition of at least 75% of the maximum in the targeted regions were identified.
RESULTS: The drug deposition rate onto the targeted regions increased following MT, with the greatest deposition following posterior MT (P-MT). Droplets in the range of 18-26 μm reached a deposition of larger than 75% of the maximum onto the targeted regions. Drug delivery rate in the sinonasal cavities varied significantly among individuals and across different types of MT with varying surgical scopes.
CONCLUSIONS: This study is the first to investigate the effect of various surgery scope on drug delivery by transnasal nebulization to the sinonasal cavities. The findings strongly affirm the vast potential of transnasal nebulization as an effective post-FESS treatment option. Moreover, it emphasizes that the drug delivery process via atomizers to the nasal cavity and paranasal sinuses is highly sensitive to the particle size.
摘要：
背景：功能性内窥镜鼻窦手术（FESS）后需要局部鼻内用药。针对鼻窦腔的经鼻雾化的最佳粒径尚无定论。本研究旨在评估中鼻甲切除术（MT）的粒径和各种手术范围对完整FESS药物递送至鼻窦腔的影响。
方法：对6例慢性鼻窦炎伴鼻息肉（CRSwNP）患者进行全FESSCT扫描后的鼻窦重建。从每个FESS后重建中建立了代表MT替代手术范围的四个附加模型，以进行模拟数据比较。通过计算流体动力学（CFD）模拟雾化输送的气流和颗粒沉积，并通过体外实验进行验证。确定了在目标区域中达到最大沉积的至少75%的最佳粒度。
结果：MT后，药物沉积到目标区域的速率增加，后MT（P-MT）后沉积最大。18-26μm范围内的液滴在目标区域上达到大于最大值的75%的沉积。在不同手术范围的不同类型的MT中，鼻腔腔中的药物递送率在个体之间以及不同类型的MT之间存在显着差异。
结论：本研究首次探讨了不同手术范围对鼻腔鼻腔雾化给药的影响。研究结果强烈肯定了经鼻雾化作为FESS后有效治疗选择的巨大潜力。此外，它强调了通过雾化器向鼻腔和鼻旁窦的药物递送过程对粒径高度敏感。
方法：对6例慢性鼻窦炎伴鼻息肉（CRSwNP）患者进行全FESSCT扫描后的鼻窦重建。从每个FESS后重建中建立了代表MT替代手术范围的四个附加模型，以进行模拟数据比较。通过计算流体动力学（CFD）模拟雾化输送的气流和颗粒沉积，并通过体外实验进行验证。确定了在目标区域中达到最大沉积的至少75%的最佳粒度。
结果：MT后，药物沉积到目标区域的速率增加，后MT（P-MT）后沉积最大。18-26μm范围内的液滴在目标区域上达到大于最大值的75%的沉积。在不同手术范围的不同类型的MT中，鼻腔腔中的药物递送率在个体之间以及不同类型的MT之间存在显着差异。
结论：本研究首次探讨了不同手术范围对鼻腔鼻腔雾化给药的影响。研究结果强烈肯定了经鼻雾化作为FESS后有效治疗选择的巨大潜力。此外，它强调了通过雾化器向鼻腔和鼻旁窦的药物递送过程对粒径高度敏感。
