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Objective: To investigate the aerodynamic consequences of conservative unilateral inferior turbinate reduction using computational fluid dynamics methods to accomplish detailed nasal airflow simulations., Design: A high-resolution, finite-element mesh of the nasal airway was constructed from magnetic resonance imaging data of a healthy man. Steady-state, inspiratory airflow simulations were conducted at 15 L/min using the techniques of computational fluid dynamics., Intervention: Circumferential removal of 2 mm of soft tissue bulk along the length of the left inferior turbinate was modeled., Main Outcome Measures: Nasal airflow distribution and pressure profiles were computed before and after simulated left inferior turbinate reduction., Results: Simulated inferior turbinate reduction resulted in a broad reduction of pressure along the nasal airway, including the regions distant from the inferior turbinate vicinity. In contrast, relative airflow changes were regional: airflow was minimally affected in the valve region, increased in the lower portion of the middle and posterior nose, and decreased dorsally., Conclusion: Use of computational fluid dynamics methods should help elucidate the aerodynamic significance of specific surgical interventions and refine surgical approaches to the nasal airway.

Objective: To define, in a group of children with nasal obstruction, the anatomical differences that differentiate those with quiet, unobstructed nocturnal respiration from those with obstructive sleep-related breathing abnormalities (snoring and obstructive sleep apnea)., Design: Case series., Patients: Fifty-nine children aged 3 to 13 years (35 boys and 24 girls) with nasal obstruction and without tonsillar hypertrophy, known craniofacial syndromes, or neuromuscular diseases were included in the study., Main Outcome Measures: Each patient was categorized as to severity of nocturnal obstructive breathing symptoms. Angular and linear cephalometric measurements were used for assessment of craniofacial features. Clinical symptom scores were correlated with the cephalometric measurements., Results: Significant craniofacial abnormalities were identified in patients prone to obstructive breathing patterns: increased flexure of the cranial base and bony nasopharynx, opening of the gonial angle, shortened mandibular length, dorsocaudal location of the hyoid, reduced posterior airway space, and increased velar thickness., Conclusions: A number of anatomical abnormalities may contribute to sleep-related abnormal breathing in otherwise normal children with nasal obstruction. Our results suggest that symptomatic children show some of the same skeletal and soft-tissue configurations that are found in adults with obstructive sleep apnea. While adenoidectomy is generally an effective treatment in children with obstructive sleep-related breathing abnormalities, the underlying craniofacial variances that remain after adenoidectomy may predispose these patients to redevelopment of obstructive breathing abnormalities in adulthood.