Comparative Analysis of Septoplasty and Septorhinoplasty Using CFD techniques: Towards Personalized and Precision Nasal Surgery.

Nasal obstruction is a common complaint in otolaryngology. Choosing between septoplasty or septorhinoplasty may be challenging due to anatomical variability. Computational fluid dynamics (CFD) has emerged as a complementary, patient-specific tool enabling bilateral simulation and virtual planning, allowing simulation of post-surgical outcomes under physiological conditions. Virtual surgeries were performed on patients with nasal obstruction using Flowgy® software. For each patient, three anatomical models were simulated: baseline, virtual septoplasty, and virtual septorhinoplasty (with turbinoplasty when indicated). CFD analysis was used to assess pressure drop (ΔP), flow symmetry (Φ), and nasal resistance (R), among other airflow parameters. Comparative data were analysed to determine the functional impact of each intervention. In all five cases, septoplasty resulted in improvements in pressure drop ranging from 10.5% to 50.9%, as well as changes in resistance ranging from +2.98% to -64.3%. Septorhinoplasty provided additional functional gains in pressure (up to 44.8%) and resistance (up to 51%) in selected cases. Based on the analysis, surgical benefit thresholds were proposed: ≥30% improvement in ΔP or R from baseline to justify septoplasty, and ≥20-30% additional benefit over septoplasty to indicate septorhinoplasty. CFD analysis is a valuable adjunct in functional nasal surgery, enabling personalised decision-making. While not a substitute for clinical judgement, CFD-guided planning may enhance the selection of surgical strategy and reduce unnecessary interventions.