Outcome-Driven Approach to Minimize the Risks of Facial Distortion Following CMF Surgery

以结果为导向的方法，最大限度地降低 CMF 手术后面部变形的风险

• 批准号: 10451693
• 负责人: JAIME GATENO
• 金额: $ 63.91万
• 依托单位: METHODIST HOSPITAL RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-05-01 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10451693
• 关键词: 3-Dimensional; 3D Print; Achievement; Algorithms; American; Anatomy; Appearance; Biomechanics; Clinical; Complex; Computer Assisted; Computer software; Congenital Abnormality; Databases; Defect; Deformity; Development; Ear; Elements; Ensure; Face; Generations; Goals; Head; Hour; Individual; Jaw; Laboratories; Learning; Lip structure; Location; Machine Learning; Mandible; Maxilla; Methods; Modeling; Motivation; Movement; Operative Surgical Procedures; Outcome; Patient Care; Patients; Planning Techniques; Postoperative Period; Precision therapeutics; Process; Progress Reports; Psyche structure; Quality of Care; Reconstructive Surgical Procedures; Reporting; Residual state; Running; Shapes; Skeleton; Slide; Structure; Surgeon; Syndrome; System; Techniques; Testing; Time; Trauma; Treatment outcome; Validation; Work; base; bone; clinical practice; craniomaxillofacial; design; improved; learning network; orthognathic; personalized care; prevent; psychologic; risk minimization; skeletal; soft tissue; success; surgery outcome; treatment planning; virtual surgery

Abstract: Our main clinical motivation of this project is to provide personalized precision care to patients with jaw (both maxilla and mandible) deformities by significantly improving surgical planning method. The number of patients suffering from jaw deformities is escalating each year. Orthognathic surgery is a main surgical procedure to treat jaw deformities by repositioning bony segments of the jaws. The ultimate outcomes of orthognathic surgery are judged by the final facial appearance. Although the facial soft tissues are not directly operated on, the face changes “automatically” following the bony changes. Orthognathic surgery requires extensive surgical planning. While we can accurately plan the bony movements and transfer it to the patient during the surgery using computer-aided surgical simulation (CASS) and 3D printing, surgeons are still unable to practically predict the facial changes during the surgical planning, and just hope that a postoperative normal face will be “automatically” restored. However, this “mental-clue” approach is not reliable because the facial change does not exactly follow bony change. The problem is even bigger in patients with composite defects. For example, if a patient has a skeletal deformity and mild facial defect, a surgeon must know, before surgery, how to overcorrect the skeleton to camouflage the soft-tissue defect. But this information can only be attained by accurate method to predict facial changes. In addition, from patient’s perspective, the final facial appearance is great concern to them. Therefore, it is extremely important, for both doctors and patients, to accurately predict facial changes. In the previous project period, we have made significant achievements in predicting facial changes following bony movements using finite element (FE) method. However, this approach still requires a considerable amount of time to prepare FE models. In addition, rather than determining the ultimate surgical outcome (the postoperative facial appearance) first, the current method is still to predict the facial change passively following the bony surgery. These hurdles greatly prevent surgeons from practically using it in the clinical setting. Our hypothesis is that a personalized precision treatment outcome can only be achieved if surgeons are able to determine the final treatment outcome, a desired postoperative face, before planning the bony surgery. To test our hypothesis, we propose to integrate outcome-driven and machine learning-based techniques together to first estimate a desired postoperative face, and then plan the bony surgery. The proposed project will have a significant clinical impact on improving patient care quality. It will enable clinicians to develop an optimal surgical plan based on both facial and bony information, on-the-fly, using a single software in their routine clinical practice. It will also revolutionize the surgical planning technique using outcome- driven approach, i.e., to first estimate a desired postoperative face and then plan the bony surgery.

抽象的： 我们这个项目的主要临床动机是为患有以下疾病的患者提供个性化的精准护理 通过显着改进手术计划方法来治疗颌骨（上颌骨和下颌骨）畸形。数量 患有颌骨畸形的患者数量每年都在增加。 正颌手术是通过重新定位骨段来治疗颌畸形的主要外科手术 下巴的。正颌手术的最终结果取决于最终的面部外观。虽然 面部软组织不直接进行手术，面部会随着骨骼的变化而“自动”变化。 正颌手术需要广泛的手术计划。虽然我们可以准确地计划骨骼运动 并在手术期间使用计算机辅助手术模拟 (CASS) 和 3D 打印将其转移给患者， 外科医生在手术计划过程中仍然无法实际预测面部变化，只能 希望术后“自动”恢复正常脸型。然而，这个“心理线索” 这种方法并不可靠，因为面部变化并不完全跟随骨骼变化。问题甚至是 具有复合缺陷的患者更大。例如，如果患者有骨骼畸形和轻度面部缺陷， 外科医生在手术前必须知道如何过度矫正骨骼以掩盖软组织缺陷。但 这些信息只能通过准确的方法来预测面部变化才能获得。另外，从患者的 从角度来看，最终的面部外观是他们非常关心的。因此，对于双方来说，都极其重要 医生和患者，准确预测面部变化。 在之前的项目期间，我们在预测面部变化方面取得了重大成果 使用有限元 (FE) 方法跟踪骨骼运动。然而，这种方法仍然需要大量的 准备有限元模型的时间。此外，不是确定最终的手术结果（ 术后面部外观）首先，目前的方法仍然是被动预测面部变化 骨手术。这些障碍极大地阻碍了外科医生在临床环境中实际使用它。 我们的假设是，只有当外科医生 在计划骨科手术之前，能够确定最终的治疗结果，即理想的术后面部。 为了检验我们的假设，我们建议将结果驱动和基于机器学习的技术整合在一起 首先估计所需的术后面部，然后计划骨手术。 拟议的项目将对提高患者护理质量产生重大临床影响。它将启用 临床医生可以根据面部和骨骼信息，使用单一的即时制定最佳手术计划 软件在日常临床实践中的应用。它还将利用结果彻底改变手术计划技术—— 驱动方法，即首先估计所需的术后面部，然后计划骨手术。

项目成果

Accuracy of a computer-aided surgical simulation protocol for orthognathic surgery: a prospective multicenter study.

• DOI: 10.1016/j.joms.2012.03.027
• 发表时间: 2013-01
• 期刊: Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons
• 作者: Hsu SS;Gateno J;Bell RB;Hirsch DL;Markiewicz MR;Teichgraeber JF;Zhou X;Xia JJ
• 通讯作者: Xia JJ

Microscopic versus open approach to craniosynostosis: a long-term outcomes comparison.

显微手术与开放手术治疗颅缝早闭：长期结果比较。

• DOI: 10.1097/scs.0000000000000925
• 发表时间: 2014
• 期刊: The Journal of craniofacial surgery
• 作者: Teichgraeber,JohnF;Baumgartner,JamesE;Viviano,StephenL;Gateno,Jaime;Xia,JamesJ
• 通讯作者: Xia,JamesJ

Automated segmentation of CBCT image using spiral CT atlases and convex optimization.

• DOI: 10.1007/978-3-642-40760-4_32
• 发表时间: 2013
• 期刊: LECTURE NOTES IN ARTIFICIAL INTELLIGENCE
• 作者: Wang, Li;Chen, Ken Chung;Shi, Feng;Liao, Shu;Li, Gang;Gao, Yaozong;Shen, Steve G. F.;Yan, Jin;Lee, Philip K. M.;Chow, Ben;Liu, Nancy X.;Xia, James J.;Shen, Dinggang
• 通讯作者: Shen, Dinggang

Application of A Novel Three-dimensional Printing Genioplasty Template System and Its Clinical Validation: A Control Study.

• DOI: 10.1038/s41598-017-05417-7
• 发表时间: 2017-07-14
• 期刊: Scientific reports
• 影响因子: 4.6
• 作者: Li B;Wei H;Zeng F;Li J;Xia JJ;Wang X
• 通讯作者: Wang X

A new design of CAD/CAM surgical template system for two-piece narrowing genioplasty.

• DOI: 10.1016/j.ijom.2015.10.013
• 发表时间: 2016-05
• 期刊: International journal of oral and maxillofacial surgery
• 影响因子: 2.4
• 作者: Li B;Shen SG;Yu H;Li J;Xia JJ;Wang X
• 通讯作者: Wang X