Experimental and numerical investigation of pressure distribution in human upper airway passage before and after maxillary sinus surgery.

Sinusitis, a common disease of the maxillary sinus, is initially managed with saline solution and medication, resulting in the resolution of symptoms within a few days in most cases. However, Functional Endoscopic Sinus Surgeries are recommended if pharmacological treatments prove ineffective. This research aims to investigate the effects of maxillary sinus surgery on the airflow field, pressure distribution within the nasal cavity, and overall ventilation. This study utilized a three-dimensional realistic nasal cavity model constructed from CT images of a healthy adult. Virtual surgery including uncinectomy with Middle Meatal Antrostomy, two standard procedures performed during such surgeries, was performed on the model under the supervision of a clinical specialist. Two replicas representing pre- and post-operative cases were created using 3D printing for experimental purposes. Various breathing rates ranging from 3.8 to 42.6 L/min were examined through experimental and numerical simulations. To ensure the accuracy of the numerical simulations, the results were compared to measured pressure data, showing a reasonable agreement between the two. The findings demonstrate that uncinectomy and Middle Meatal Antrostomy significantly enhance the ventilation of the maxillary sinuses. Furthermore, increasing inspiratory rates leads to further improvements in ventilation. The static pressure distribution within the maxillary sinuses remains relatively uniform, except in regions close to the sinus ostium, even after surgical intervention.

A quasi-realistic computational model development and flow field study of the human upper and central airways.

The impact of drug delivery and particulate matter exposure on the human respiratory tract is influenced by various anatomical and physiological factors, particularly the structure of the respiratory tract and its fluid dynamics. This study employs computational fluid dynamics (CFD) to investigate airflow in two 3D models of the human air conducting zone. The first model uses a combination of CT-scan images and geometrical data from human cadaver to extract the upper and central airways down to the ninth generation, while the second model develops the lung airways from the first Carina to the end of the ninth generation using Kitaoka's deterministic algorithm. The study examines the differences in geometrical characteristics, airflow rates, velocity, Reynolds number, and pressure drops of both models in the inhalation and exhalation phases for different lobes and generations of the airways. From trachea to the ninth generation, the average air flowrates and Reynolds numbers exponentially decay in both models during inhalation and exhalation. The steady drop is the case for the average air velocity in Kitaoka's model, while that experiences a maximum in the 3rd or 4th generation in the quasi-realistic model. Besides, it is shown that the flow field remains laminar in the upper and central airways up to the total flow rate of 15 l/min. The results of this work can contribute to the understanding of flow behavior in upper respiratory tract.

Nanoparticle Diffusion in Respiratory Mucus Influenced by Mucociliary Clearance: A Review of Mathematical Modeling.

Background: Inhalation and deposition of particles in human airways have attracted considerable attention due to importance of particulate pollutants, transmission of infectious diseases, and therapeutic delivery of drugs at targeted areas. We summarize current state-of-the art research in particle deposition on airway surface liquid (ASL) influenced by mucociliary clearance (MCC) by identifying areas that need further investigation. Methodology: We aim to review focus on governing and constitutive equations describing MCC geometry followed by description of mathematical modeling of ciliary forces, mucus rheology properties, and numerical approaches to solve modified time-dependent Navier-Stokes equations. We also review mathematical modeling of particle deposition in ASL influenced by MCC, particle transport in ASL in terms of Eulerian and Lagrangian approaches, and discuss the corresponding mass transport issues in this layer. Whenever required, numerical predictions are contrasted with the pertinent experimental data. Results: Results indicate that mean mucus and periciliary liquid velocities are strongly influenced by mucus rheological characteristics as well as ciliary abnormalities. However, most of the currently available literature on mucus fiber spacing, ciliary beat frequency, and particle surface chemistry is based on particle deposition on ASL by considering a fixed value of ASL velocity. The effects of real ASL flow regimes on particle deposition in this layer are limited. In addition, no other study is available on modeling nonhomogeneous and viscoelastic characteristics of mucus layer on ASL drug delivery. Conclusion: Simplification of assumptions on governing equations of drug delivery in ASL influenced by MCC leads to imposing some limitations on numerical results.

3D numerical simulation of hot airflow in the human nasal cavity and trachea.

BACKGROUND AND OBJECTIVE: The primary function of the human respiratory system is gas and moisture exchange, and conditioning inhaled air to prevent damage to the lungs and alveoli. In a fire incident, exposed soft tissues contract and the respiratory system may be severely damaged, possibly leading to respiratory failure and even respiratory arrest. The purpose of this study is to numerically simulate hot airflow in the human upper airway and trachea to investigate heat and moisture transfer and induced thermal injuries. METHODS: For analysis, the airflow is assumed to be laminar and steady, and simulations have been carried out at volume flow rates of 5 and 10 L/min, inlet temperatures of 70-240 °C, and relative humidity up to 40%. The mucous layer and surrounding tissues are incorporated into the conducting zone of the model. The blood perfusion is considered at different rates up to 5(Kg/m3.s) to regulate the temperature, and the vapor concentration is coupled with the energy equation. RESULTS: The temperature and humidity distribution on the airway wall were calculated for all the studied conditions in order to find the mild and severe burn for different inhaled air temperatures. At the inlet temperatures of 70 and 100 °C, there are mild burns in several nasal cavity regions. At the higher temperatures of 160 and 200 °C, these areas suffer from severe burns and mild burns occur at the superior parts and nasopharynx. Rapid evaporation and tissue destruction will be observed if anyone breathes the 240 °C air. CONCLUSIONS: The results show that the hot inlet temperatures drop below 44 °C when passing through the upper airway, and the lower airway was not affected. Increasing the inlet temperature from 70 to 240 °C extends the burns from mild to severe and the affected areas from the beginning of the nasal cavity to the pharynx.

In-silico investigation of airflow and micro-particle deposition in human nasal airway pre- and post-virtual transnasal sphenoidotomy surgery.

Sphenoid sinus, located posterior to the nasal cavity, is difficult to reach for a surgery. Several operation procedures are available for sphenoidotomy, including endoscopic surgeries. Although the endoscopic sinus surgery is minimally invasive with low post-operative side effects, further optimization is required. Transnasal sphenoidotomy is a low invasive alternative to transethmoidal sphenoidotomy, but it still needs to be studied to understand its effects on the airflow pattern and the particle deposition. In this work, we simulated airflow and the micro-particle deposition in the nasal airway of a middle-aged man to investigate the change in particle deposition in the sphenoid sinus after virtual transnasal sphenoidotomy surgery. The results demonstrated that after transnasal sphenoidotomy, particle deposition in the targeted sphenoid sinus was an order of magnitude lower than that observed after virtual transethmoidal sphenoidotomy surgery. In addition, the diameter of the particles for the peak deposition fraction in the targeted sinus was shifted to smaller diameters after the transnasal sphenoidotomy surgery compared with that in the post-transethmoidal condition. These results suggest that the endoscopic transnasal sphenoidotomy can be a better procedure for sphenoid surgeries as it decreases the chance of bacterial contaminations and consequently lowers the surgical side effects and recovery time.

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

Regional deposition of the allergens and micro-aerosols in the healthy human nasal airways.

The nasal cavity is the inlet to the human respiratory system and is responsible for the olfactory sensation, filtering pollutant particulate matter, and humidifying the air. Many research studies have been performed to numerically predict allergens, contaminants, and/or drug particle deposition in the human nasal cavity; however, the majority of these investigations studied only one or a small number of nasal passages. In the present study, a series of Computed Tomography (CT) scan images of the nasal cavities from ten healthy subjects were collected and used to reconstruct accurate 3D models. All models were divided into twelve anatomical regions in order to study the transport and deposition features of different regions of the nasal cavity with specific functions. The flow field and micro-particle transport equations were solved, and the total and regional particle deposition fractions were evaluated for the rest and low activity breathing conditions. The results show that there are large variations among different subjects. The standard deviation of the total deposition fraction in the nasal cavities was the highest for 5 × 10 4

3D numerical investigation of the fluid mechanics in a partially liquefied vitreous humor due to saccadic eye movement.

Partial vitreous liquefaction (PVL) is a common physical and biochemical degenerative change in the vitreous body in which the liquid component becomes separated from collagen fiber network and this might form the pocket of liquefaction known as lacuna. The main objective of this research is to investigate how the saccade movements influence flow dynamics of the PVL. A three-dimensional model of the vitreous cavity is subjected to saccadic movement and the numerical simulations for various saccade amplitudes and volume fractions are performed. We consider concentric and eccentric configurations of the PVL with the initial spherical shape inside a spherical cavity. In this paper, a specific 3D numerical solver is developed to capture the interface effects and dynamic characteristics of a two-phase viscoelastic-Newtonian fluid flow by using the OpenFOAM CFD. The code is based on a set of time-dependent non-linear partial differential equations (PDE) such as continuity, momentum and constitutive relation for polymeric stresses tensor. The finite volume method with a modified volume-of-fluid model and dynamic mesh technique are used to solve PDEs. Firstly, the validity of the present numerical model was verified by comparing the obtained results with the analytical solutions which demonstrated remarkable agreement. Then, the time- and space-dependent velocity field, shear stress and normal stress distributions were computed and how the PVL responds to the saccadic motions was discussed.

Details of the physiology of the aerodynamic and heat and moisture transfer in the normal nasal cavity.

Anatomically accurate 3D models of 10 healthy nasal cavities are developed from computerized tomography (CT) scan images. Considering anatomical and physiological importance of different parts of the nasal cavity, the surface of each nasal passage is divided to eleven anatomical surfaces. Also the coronal cross sections in the nasal passage are divided to six sub-sections that share the total nasal passage airflow. The details of the flow field, heat transfer and water-vapor transport are numerically investigated for resting and low activity conditions. The mean and standard deviation of the different anatomical and air conditioning parameters such as: surface area, wall shear stress, heat and moisture transfer on different parts of the nasal passage surfaces and volume flow rates through different sections are presented. Results show that the percentages of airflow for inferior, middle and superior meatuses are 11.3 ± 6.4, 36.5 ± 9.5, 1.9 ± 0.81 % respectively and 4.1 ± 2.1 % of air passes through olfactory area. The inhaled air passing from the remaining surface (main passage) is 46.2 ± 10 %. Heat and moisture fluxes are highest in the anterior part of the nasal cavity, turbinates and lower part of the septum respectively. The percentage of the heat transfer from turbinates is 25.7 ± 3.9 % of total nasal heat transfer.

Airborne particle dispersion to an operating room environment during sliding and hinged door opening.

BACKGROUND: Operating rooms (ORs) are usually over-pressurized in order to prevent the penetration of contaminated air and the consequent risk of surgical site infection. However, a door-opening can result in the rapid disappearance of pressure and contaminants can then easily penetrate into the surgical zone. Therefore, a broad knowledge and understanding of OR ventilation systems and their protective potential is essential for optimizing the surgical environment. OBJECTIVES: This study investigated the air quality and level of airborne particles during a single and multiple door-opening cycles in an operating room supplied by a turbulent-mixing ventilation system. METHODS: The exploration was carried out numerically using computational fluid dynamics. Model validation was performed to ensure the validity of the achieved results. The OR was initially over-pressurized by approximately 15Pa, relative to the adjacent corridors. Both sliding and hinged doors were simulated and compared. RESULTS: Penetration of bacteria carrying particles from the corridors to the OR can be successfully restricted by using a positive-pressure system. However, the results clearly indicate that frequent door opening can interfere with airflow ventilation systems, alter the pressure gradient, and increase the infection risk for the patient undergoing surgical intervention. Door-opening disturbs the airflow field and could result in containment failure.

Numerical and analytical investigation of irrigant penetration into dentinal microtubules.

Irrigation is one of the most important steps in root canal therapy. Sodium hypochlorite is inserted into the root canal to eliminate bacteria and dissolve necrotic tissue. Dentinal tubules are micrometer sized channels along the dentin thickness. An irrigant should have the ability to penetrate into these tubules to remove bacteria residing in them. The difference between the concentrations of the inserted irrigant and the dentinal tubule fluid is the main factor of penetration. This study attempts to model dentinal tubules with precise dimensions and to study the time dependent irrigant penetration into them by using Computational Fluid Dynamics (CFD). The effects of needle type and position in the dentinal tubule were also considered. The results showed that concentration distribution would be different when the tubule was modeled as a frustum compared to the cylindrical shape tubule. Dentinal tubule curvature, however, did not have a noticeable effect in irrigant penetration. It was also concluded that when the needle working length is 3 mm, concentration can be considered constant at the tubule's entrance for tubules located at more than 1 mm from the apex. Moreover, by irrigating the root canal with a side-vented needle instead of an open-ended one, the concentration would be less for the tubules located in the apex region. Analytical solutions for different cases were also obtained, and their predictions were found to be in good agreement with the numerical results. Therefore, the presented analytical solutions can be directly used to obtain irrigant concentration in tubules with no need for additional computer simulations.

Numerical investigation of transient transport and deposition of microparticles under unsteady inspiratory flow in human upper airways.

In the present study, unsteady airflow patterns and particle deposition in healthy human upper airways were simulated. A realistic 3-D computational model of the upper airways including the vestibule to the end of the trachea was developed using a series of CT scan images of a healthy human. Unsteady simulations of the inhaled and exhaled airflow fields in the upper airway passages were performed by solving the Navier-Stokes and continuity equations for low breathing rates corresponding to low and moderate activities. The Lagrangian trajectory analysis approach was utilized to investigate the transient particle transport and deposition under cyclic breathing condition. Particles were released uniformly at the nostrils' entrance during the inhalation phase, and the total and regional depositions for various micro-particle sizes were evaluated. The transient particle deposition fractions for various regions of the human upper airways were compared with those obtained from the equivalent steady flow condition. The presented results revealed that the equivalent constant airflow simulation can approximately predict the total particle deposition during cyclic breathing in human upper airways. While the trends of steady and unsteady model predictions for local deposition were similar, there were noticeable differences in the predicted amount of deposition. In addition, it was shown that a steady simulation cannot properly predict some critical parameters, such as the penetration fraction. Finally, the presented results showed that using a detached nasal cavity (commonly used in earlier studies) for evaluation of total deposition fraction of particles in the nasal cavity was reasonably accurate for the steady flow simulations. However, in transient simulation for predicting the deposition fraction in a specific region, such as the nasal cavity, using the full airway system geometry becomes necessary.

In silico investigation of cornea deformation during irrigation/aspiration in phacoemulsification in cataract surgery.

To analyze the stress, strain and displacement of the human cornea under the action of negative intraocular pressure, which occurs during phacoemulsification in cataract surgery, a multidisciplinary approach including biomedical engineering, solid mechanics, numerical analysis, and fluid dynamics was used. Fluid-structure interaction method was implemented using 3-dimensional nonlinear finite element analysis of cornea tissue in conjunction with CFD analysis of anterior chamber fluid flow to study the deformation of the cornea under negative gage pressure during irrigation and aspiration (I/A). The computational model of the eye includes both cornea and sclera. To increase the accuracy of the computational model, both cornea hyperelasticity and thickness variation were included in the analysis. The simulation was performed for both coaxial and bimanual I/A systems with different flow rates. The cornea deformations for various flow rates were evaluated, and the possibility of an unstable anterior chamber was assessed. The results show that the critical pressure in the anterior chamber, which may lead to the surge condition due to buckling of the cornea, is sub-ambient (below zero gauge pressure). Anterior chamber instability occurs at higher volume flow rates for coaxial I/A system compared with that for bimanual system, but the deformation of the cornea is more intense for the bimanual system.

Relationship between saccadic eye movements and formation of the Krukenberg's spindle-a CFD study.

In this research, a series of numerical simulations for evaluating the effects of saccadic eye movement on the aqueous humour (AH) flow field and movement of pigment particles in the anterior chamber (AC) was performed. To predict the flow field of AH in the AC, the unsteady forms of continuity, momentum balance and conservation of energy equations were solved using the dynamic mesh technique for simulating the saccadic motions. Different orientations of the human eye including horizontal, vertical and angles of 10° and 20° were considered. The Lagrangian particle trajectory analysis approach was used to find the trajectories of pigment particles in the eye. Particular attention was given to the relation between the saccadic eye movement and potential formation of Krukenberg's spindle in the eye. The simulation results revealed that the natural convection flow was an effective mechanism for transferring pigment particles from the iris to near the cornea. In addition, the saccadic eye movement was the dominant mechanism for deposition of pigment particles on the cornea, which could lead to the formation of Krukenberg's spindle. The effect of amplitude of saccade motion angle in addition to the orientation of the eye on the formation of Krukenberg's spindle was investigated.

Numerical investigation of molecular nano-array in potential-energy profile for a single dsDNA.

A Rigorous numerical investigation on dsDNA translocation in quasi-2-dimensional nano-array filter is performed using Molecular Dynamics (MD) method. Various dsDNA molecules with different sizes are chosen in order to model Ogston sieving in a nano-array filter. The radius of gyration of dsDNA molecule is less than the characteristic length of the shallow region in nano-array. The dsDNA molecule is assumed to be in the 0.05M NaCl electrolyte. MD shows acceptable results for potential-energy profile for nano-array filter. According to the MD outcomes, the dsDNA electrophoretic mobility decreases almost linearly with dsDNA size and show the same trend as Ogston sieving for gel electrophoresis. In addition, different shapes for nano-array filter are studied for a unique dsDNA molecule. It is concluded that steeping the nano-array wall can cause the retardation of dsDNA translocation and decreases dsDNA electrophoretic mobility.

Computer simulations of pressure and velocity fields in a human upper airway during sneezing.

In this paper, the airflow field including the velocity, pressure and turbulence intensity distributions during sneezing of a female subject was simulated using a computational fluid dynamics model of realistic upper airways including both oral and nasal cavities. The effects of variation of reaction of the subject during sneezing were also investigated. That is, the impacts of holding the nose or closing the mouth during sneezing on the pressure and velocity distributions were studied. Few works have studied the sneeze and therefore different aspects of this phenomenon have remained unknown. To cover more possibilities about the inlet condition of trachea in different sneeze scenarios, it was assumed that the suppressed sneeze happens with either the same inlet pressure or the same flow rate as the normal sneeze. The simulation results showed that during a normal sneeze, the pressure in the trachea reaches about 7000Pa, which is much higher than the pressure level of about 200Pa during the high activity exhalation. In addition, the results showed that, suppressing the sneeze by holding the nose or mouth leads to a noticeable increase in pressure difference in the tract. This increase was about 5 to 24 times of that during a normal sneeze. This significant rise in the pressure can justify some reported damage due to suppressing a sneeze.

Rigorous study of molecular dynamics of a single dsDNA confined in a nanochannel: Introduction of a critical mobility behaviour.

The essential and effective characteristics of a double-stranded DNA (dsDNA) confined in a nanochannel is revisited by employing the rigorous full numerical approach of Molecular Dynamics (MD). The deformation of dsDNA and wall-biomolecule interaction which is critical in highly confined regime has been precisely imposed in numerical simulations. The numerical approach has been justified against available theoretical outcomes. A new and general expression for DNA electrophoretic mobility versus DNA length is extracted from numerical simulation which is out of reach of experimental methods due to practical shortcomings. The newly derived expression suggests an essential correction in the previously proposed expression for the critical case of small DNA molecules and reveals an astonishingly unbeknown trend of small DNA's mobility. Sub-molecular phenomenon of dsDNA melting under the condition of large external force is also studied. Assuming strong electric field exertion, the MD approach aptly demonstrates the elaborate melting phenomenon for dsDNA in sub-molecular scale.

Numerical simulation of airflow and micro-particle deposition in human nasal airway pre- and post-virtual sphenoidotomy surgery.

In the present study, the effects of endoscopic sphenoidotomy surgery on the flow patterns and deposition of micro-particles in the human nasal airway and sphenoid sinus were investigated. A realistic model of a human nasal passage including nasal cavity and paranasal sinuses was constructed using a series of CT scan images of a healthy subject. Then, a virtual sphenoidotomy by endoscopic sinus surgery was performed in the left nasal passage and sphenoid sinus. Transient airflow patterns pre- and post-surgery during a full breathing cycle (inhalation and exhalation) were simulated numerically under cyclic flow condition. The Lagrangian approach was used for evaluating the transport and deposition of inhaled micro-particles. An unsteady particle tracking was performed for the inhalation phase of the breathing cycle for the case that particles were continuously entering into the nasal airway. The total deposition pattern and sphenoid deposition fraction of micro-particles were evaluated and compared for pre- and post-surgery cases. The presented results show that sphenoidotomy increased the airflow into the sphenoid sinus, which led to increased deposition of micro-particles in this region. Particles up to 25 µm were able to penetrate into the sphenoid in the post-operation case, and the highest deposition in the sphenoid for the resting breathing rate occurred for 10 µm particles at about 1.5%.

Numerical simulation of wave propagation in a realistic model of the human external ear.

In this study, a numerical investigation is performed to evaluate the effects of high-pressure sinusoidal and blast wave's propagation around and inside of a human external ear. A series of computed tomography images are used to reconstruct a realistic three-dimensional (3D) model of a human ear canal and the auricle. The airflow field is then computed by solving the governing differential equations in the time domain using a computational fluid dynamics software. An unsteady algorithm is used to obtain the high-pressure wave propagation throughout the ear canal which is validated against the available analytical and numerical data in literature. The effects of frequency, wave shape, and the auricle on pressure distribution are then evaluated and discussed. The results clearly indicate that the frequency plays a key role on pressure distribution within the ear canal. At 4 kHz frequency, the pressure magnitude is much more amplified within the ear canal than the frequencies of 2 and 6 kHz, for the incident wave angle of 90° investigated in this study, attributable to the '4-kHz notch' in patients with noise-induced hearing loss. According to the results, the pressure distribution patterns at the ear canal are very similar for both sinusoidal pressure waveform with the frequency of 2 kHz and blast wave. The ratio of the peak pressure value at the eardrum to that at the canal entrance increases from about 8% to 30% as the peak pressure value of the blast wave increases from 5 to 100 kPa for the incident wave angle of 90° investigated in this study. Furthermore, incorporation of the auricle to the ear canal model is associated with centerline pressure magnitudes of about 50% and 7% more than those of the ear canal model without the auricle throughout the ear canal for sinusoidal and blast waves, respectively, without any significant effect on pressure distribution pattern along the ear canal for the incident wave angle of 90° investigated in this study.

Numerical investigation of the flow field in realistic nasal septal perforation geometry.

The computational fluid dynamics (CFD) are used to evaluate the physiological function of the nose. We evaluated the aerodynamics of the nasal cavity in a patient with septal perforation (SP), pre- and postvirtual repair. Three-dimensional nasal models were reconstructed, and then a wide range of the pressure drops and flow rates were analyzed. The airflow velocity is higher in the central region and is lower around the boundary of the SP. The air velocity in the SP increases as the pressure drop increases. Furthermore, at the anterior part of the SP, the shear stress is higher in the upper part. In addition, the repair of SP does not affect the total nasal airflow rate and the velocity contour patterns. The potential usage of the CFD technique as a predictive technique to explore the details and a preoperative assessment tool to help in clinical decision making in nasal surgery is emphasized.