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Fracturing the Flow: Computational Insights into Nasal Osteotomies and Airway Dynamics
Jade E. Smith^*1, Sujata Syamal², Noelle Garbaccio¹, Morvarid Mehdizadeh¹, Lacey Foster¹, Justin Cordero¹, Dorien I. Schonebaum¹, Samuel J. Lin^1
1Beth Israel Deaconess Medical Center, Boston, MA; ²Harvard University Division of Continuing Education, Cambridge, MA

Background:
Nasal osteotomies are integral to rhinoplasty, often used to modify the nasal bony framework for aesthetic and structural refinement. However, lateral osteotomies may cause medialization of the nasal turbinates, potentially compromising nasal aerodynamics postoperatively. This study employs Computational Fluid Dynamics (CFD) modeling to simulate airflow changes following different degrees of lateral osteotomy infracturing in rhinoplasty patients.

Methods:
Open-source midface skull and airflow cavity models were volume-rendered using 3D Slicer (version 5.6.2) and exported for further refinement. ANSYS SpaceClaim (v2024R2) was used to create 1mm, 2mm, and 3mm lateral osteotomies via a high-low-high trajectory outlined in previous literature and airflow volume changes were noted. Using ANSYS Fluent (v2024R2), CFD was conducted using the Finite Volume Method (FVM) with continuity and Navier-Stokes equations for steady-state, incompressible, laminar air flow to obtain velocity changes. Nasal cavity material properties were set based on prior literature and inlet velocity and outlet pressures were set based on physiological inspiratory conditions.

Results:
Compared to the control model, the 1mm, 2mm, and 3mm infracturing lateral nasal osteotomies exhibited airflow volume decreases of 1.2%, 2.5%, and 4.3% respectively. All models exhibited decreases in velocity at the airway-bone interfaces compared to control models. The 2mm model demonstrated velocity decreases along the full perimeter of the airflow cavity and the 3mm model exhibited significant changes in airflow velocity throughout the full airflow cavity.

Conclusions:
Utilizing computational simulations, we evaluated changes in nasal airflow with 1mm, 2mm, and 3mm infractured lateral osteotomies. Volumetric measurements revealed progressive decreases in airflow volume capacity compared to control models. Corresponding fluid flow analyses suggest that the measured volume changes from 2mm and 3mm osteotomies impact airflow velocity throughout the nasal airflow cavity, ultimately affecting breathing outcomes.