| Objective To investigate the effect of middle turbinate morphology on Chronic Maxillary Sinusitis(CMS)and nasal-maxillary sinus flow field.Methods Methods: 90 cases of bilateral maxillary sinusitis group and 90 cases of control group(180 sides of normal maxillary sinus and 180 sides of maxillary sinus with CMS)were selected.The morphology of middle turbinate was observed in coronal view of sinus CT.According to the position relationship between middle turbinate and uncinate process and ethmoid bulla,they were divided into type I(the lateral side of middle turbinate free edge did not exceed ethmoid bulla and the medial side of uncinate process),type II(the lateral side of middle turbinate free edge exceeded the medial side of ethmoid bulla,but it did not exceed the medial edge of uncinate process)and type III(the lateral free edge of middle turbinate exceeded the medial edge of ethmoid bulla and uncinate process).Lund Mackay score was used to evaluate the severity of the disease in the CMS group,the incidence of each type in the two groups was counted,and the relationship between LM score and morphological classification of middle turbinate in the CMS group was analyzed;the morphological parameters of middle turbinate(including the height and curl degree of middle turbinate)in the CMS group and the control group were measured,and the relationship between morphological parameters of middle turbinate and CMS was analyzed;According to the CT data of a standard case,the normal three-dimensional model of nasal cavity and maxillary sinus and the three-dimensional model of nasal cavity and maxillary sinus after middle turbinectomy were reconstructed.The air flow of the three-dimensional model before and after operation was simulated by computational fluid dynamics method,and the air flow trace,pressure field and velocity field before and after operation were compared.Results The results were as follows: 1.There were 15 sides(8.33%),132 sides(73.33%)and 33 sides(18.33%)of middle turbinate of type I,type II and type III in180 sides of maxillary sinus in the control group,and 56 sides(31.11%),84 sides(46.67%)and 40 sides(22.22%)of type I,type II and type III in 180 sides of maxillary sinus in the 180 sides of CMS group,respectively(χ 2 = 35.014,P < 0.01);In CMS group,Lund Mackay scores of different types of middle turbinate were significantly different(P < 0.01).2.The height of middle turbinate in control group and CMS group was 9.94(8.45,12.77)mm and 8.97(7.05,11.69)mm,respectively,the difference was statistically significant(P < 0.01);the degree of middle turbinate curl was 5.47(3.82,7.29)mm and 5.22(3.11,6.84)mm,respectively,the difference was not statistically significant(P > 0.05);There was a negative correlation between middle turbinate height,middle turbinate curl and LM score(r =-0.186,P < 0.05;r =0.250,P < 0.01);Multiple linear regression showed that the degree of middle turbinate curl was the main influencing factor of LM score(P < 0.05).3.After excising the head of middle turbinate,the distribution of velocity and pressure nephogram was significantly different from that before operation.The air flow and velocity in middle nasal meatus were increased,and the pressure in nasal cavity and maxillary sinus was increased significantly.Conclusion The shape of middle turbinate has a certain influence on the occurrence and severity of CMS.The height and curl of middle turbinate are related to the occurrence and severity of CMS.The anterior end of middle turbinate plays an important role in the formation of airflow field in nasal cavity and maxillary sinus.Excising the head of middle turbinate will change the distribution of airflow velocity,flow and pressure in nasal cavity and maxillary sinus. |
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