Abstract
Laryngotracheal stenosis (LTS) is a type of airway narrowing that is frequently caused by intubation-related trauma. LTS can occur at one or multiple locations in the larynx and/or trachea. This study characterizes airflow dynamics and drug delivery in patients with multilevel stenosis. Two subjects with multilevel stenosis (S1 = glottis + trachea, S2 = glottis + subglottis) and one normal subject were retrospectively selected. Computed tomography scans were used to create subject-specific upper airway models. Computational fluid dynamics modeling was used to simulate airflow at inhalation pressures of 10, 25, and 40 Pa, and orally inhaled drug transport with particle velocities of 1, 5, and 10 m/s, and particle size range of 100 nm–40 µm. Subjects had increased airflow velocity and resistance at stenosis with decreased cross-sectional area (CSA): S1 had the smallest CSA at trachea (0.23 cm2) and resistance = 0.3 Pa·s/mL; S2 had the smallest CSA at glottis (0.44 cm2), and resistance = 0.16 Pa·s/mL. S1 maximal stenotic deposition was 4.15% at trachea; S2 maximal deposition was 2.28% at glottis. Particles of 11–20 µm had the greatest deposition, 13.25% (S1-trachea) and 7.81% (S2-subglottis). Results showed differences in airway resistance and drug delivery between subjects with LTS. Less than 4.2% of orally inhaled particles deposited at stenosis. Particle sizes with most stenotic deposition were 11–20 µm and may not represent typical particle sizes emitted by current-use inhalers.
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Acknowledgements
This research was supported in part by the National Institute of Dental & Craniofacial Research of the National Institutes of Health under Award No. R01DE028554. The authors are solely responsible for the content which does not necessarily represent the official views of the National Institutes of Health. In addition, special thanks to ANSYS, ANSYS Global Academic Program, and Dr. Paolo Maccarini (Duke University) for the support and strategic donation. All authors gave final approval for publication.
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The authors have no competing interests to declare that are relevant to the content of this article. This study was approved by the Duke Institutional Review Board under protocol No. Pro00071991.
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Gosman, R.E., Sicard, R.M., Cohen, S.M. et al. A computational analysis on the impact of multilevel laryngotracheal stenosis on airflow and drug particle dynamics in the upper airway. Exp. Comput. Multiph. Flow 5, 235–246 (2023). https://doi.org/10.1007/s42757-022-0151-9
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DOI: https://doi.org/10.1007/s42757-022-0151-9