Learning-Based Approach for Personalized Craniomaxillofacial Surgical Planning

摘要： 该项目的主要临床目标是为患有以下疾病的患者提供个性化的精确护理： 颅颌面（CMF）畸形的显着改善手术计划方法。CMF 畸形包括颌和面部的先天性和后天性畸形。大量的病人在 美国和世界各地都患有CMF畸形。CMF手术的基本原理包括： 用自体骨截骨术将变形的CMF结构恢复到正常的解剖结构和功能 移植物或血管化游离皮瓣。CMF手术的成功不仅取决于手术的技术方面， 手术，而且，在很大程度上，精确制定手术计划。然而，CMF手术计划 由于CMF解剖结构和畸形的复杂性，在常规CMF期间 在外科手术计划中，外科医生首先获取患者颅骨的三维（3D）模型。然后他表演 3D头影测量分析以量化畸形。最后，通过虚拟切割3D模型来模拟手术。 模型分为多个骨段。然后，外科医生尽最大努力单独移动和旋转每个节段 在头影测量值的正常范围（当前护理标准）内的期望位置。这是 有问题的是，“正常”头影测量值是正常人群的平均值，其中每个值 有一个均值和一个标准差由于正常值内的变化，外科医生必须经常 猜一猜病人的头影测量值应该校正到什么精确值。此外，本发明还提供了一种方法， 头影测量是一组只有线性和角度的测量，当然不能代表复杂的 人类CMF结构的本质。因此，手术结果往往是主观的，并严重依赖于 外科医生的经验和艺术天赋因为每个人的脸是不同的，平均“正常” “值”不能表示每个个体面部的复杂形态。 为此，我们假设，如果外科医生能够预见患者的正常CMF形状， 手术计划将是客观和个性化的。因此，在本项目中，我们建议开发和 验证使用患者特异性和解剖学上正确的参考模型的新手术规划方法。 我们的初步研究已证明我们的方法是可行的。该项目的结果 将通过开发个性化和精确的外科手术， 客观地制定CMF手术计划。该结果将特别有益于颌骨畸形的患者， 综合症和非综合症颅面畸形、创伤和CMF癌症。在未来，我们的方法可以 也可用于设计和打印具有组织工程能力的3D患者特异性可吸收骨植入物 用于骨骼再生。

Abstract: Our main clinical objective for this project is to provide personalized precision care to patients with craniomaxillofacial (CMF) deformities by significantly improving the surgical planning method. CMF deformities involve congenital and acquired deformities of the jaws and face. A large number of patients in the US and around the world suffer from CMF deformities. The basic principles of CMF surgery involve the restoration of deformed CMF structures back to normal anatomy and functions with osteotomy, autologous, bone grafts, or vascularized free flaps. The success of CMF surgery depends on not only the technical aspects of the operation, but also, to a large extent, the precise formulation of a surgical plan. However, CMF surgical planning is extremely challenging due to the complex nature of CMF anatomy and deformity. During a routine CMF surgical planning, a surgeon first acquires a three-dimensional (3D) model of the patient's skull. He then performs 3D cephalometric analysis to quantify the deformity. Finally, the surgery is simulated by virtually cutting the 3D model into multiple bony segments. The surgeon then tries his best to move and rotate each segment individually to a desired position within the normal range of cephalometric values (the current standard of care). This is problematic as “normal” cephalometric values are the averageness of normal population, in which each value has a mean and a standard deviation. Due to the variation within the normal values, the surgeon must often guess what the exact value the patient's cephalometric measurement should be corrected to. In addition, cephalometry is a group of only linear and angular measurements, which certainly cannot represent the complex nature of human CMF structures. Therefore, surgical outcomes are often subjective and heavily dependent on the surgeons' experience and artistic talent. Because each human face is different, the average “normal values” cannot represent the complex morphology of each individual face. To this end, we hypothesize that if a surgeon can foresee what the normal CMF shape of the patient should be, the surgical plan will be objective and personalized. Therefore, in this project, we propose developing and validating a new surgical planning method of using patient-specific and anatomically-correct reference models. The feasibility of our approach has already been proven by our preliminary studies. The results of this project will significantly improve the quality of patient care by developing personalized and precise surgical plans for CMF surgery objectively. The results will be especially beneficial to patients with jaw deformities, syndromic and non-syndromic craniofacial deformities, trauma, and CMF cancer. In the future, our approach can also be used to design and print 3D patient-specific resorbable bone implants with tissue engineering capability for bone regeneration.