Virtual Surgery and CFD in Rhinology: A Scoping Review.

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Abstract

<b>Background:</b> Nasal obstruction is one of the most common reasons for which patients present to an otolaryngologist, yet the outcomes of operations aimed at improving nasal patency remain inconsistent, and the correlation between conventional objective measures and perceived patency is uncertain. Computational fluid dynamics (CFD) allows nasal airflow to be simulated from craniofacial computed tomography; combined with software that reconstructs and modifies sinonasal anatomy, it permits a planned procedure to be reproduced digitally and its functional impact predicted before any tissue is removed. This scoping review maps how CFD-based virtual surgery has been used in rhinology, how the simulations were validated, and which clinical outcomes were reported. <b>Methods:</b> Following the PRISMA extension for scoping reviews, PubMed and Scopus were searched in October 2025 for studies published between 2015 and 2025. Inclusion criteria restricted papers to English-language studies of virtual surgery tools involving CFD in humans or human-derived models. Pediatric (<18 years), sleep apnea, and orthognathic studies were excluded, as were studies of other parts of the respiratory tract and environmental or toxicological work. Duplicates were removed in Mendeley, and two authors independently screened titles and abstracts. Data were charted by two authors. The review was not registered. <b>Results:</b> Forty-one studies were included, covering the nasal septum, the inferior and middle turbinates, the ostiomeatal complex, the maxillary and sphenoid sinuses, septal perforations, and postoperative synechiae. Virtual results were compared with actual postoperative anatomy, airflow, or symptoms in only 7 of the 41 studies and agreed with them in most respects. In several small studies, a greater extent of resection did not improve airflow further and reduced mucosal heat and moisture exchange, wall shear stress, and regional cooling, but the extent that appeared best depended on the anatomy and the outcome considered. These parameters have been proposed as better correlates of the subjective sense of patency than resistance alone; this has rarely been tested in patients. The most recent work applies machine learning and adjoint optimization as research tools for planning support. <b>Conclusions:</b> CFD-based virtual surgery is a promising tool for planning the extent of rhinological procedures. Its routine use will require standardized methods, prospective validation, and correlation with patient-reported outcomes (NOSE, SNOT-22); larger studies with such endpoints are still lacking.

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