IMPROVING TREATMENT OUTCOMES FOR PATIENTS WITH FACIAL DEFORMITY USING 3D IMAGING

描述(申请人提供)：颅面畸形或牙面畸形的外科矫正是一个复杂的过程，特别是在不对称的患者。即使在过去的几十年里，重点放在了手术后对硬组织和软组织的评估上，仍然有一些关键区域，如上颌骨旋转和髁突/升支吸收，不能用二维方法评估。这项结合了三维成像(3-D)技术的前瞻性观察性研究的目标是在手术前更准确地表征不对称，量化面部外科手术后的不稳定区域，并改进手术前的计划。由于不对称的确定和治疗计划特别困难，因此将评估不对称位置的临床评估与其3D特征之间的一致性。在三维特征化中，将使用两种不同的镜像技术，利用下颌受影响侧的三维模型与未受影响侧的反射镜像之间的表面距离来对不对称进行解剖定位和估计。一个附带的问题是，向外科医生提供这一信息是否会改变手术矫正的方法。外科医生将接受使用3D手术模拟的培训，并将实际手术结果与手术模拟进行比较，作为该方法验证的一个方面。此外，该项目将定量评估正颌外科手术矫正不对称和III类骨骼畸形后颌骨的3D移位和旋转。三维颅底表面的体素刚性配准将被用来避免依赖于观察者的叠加。这项拟议的工作是多学科的--包括颅面和牙面畸形的治疗、临床研究设计和计算机成像。更好的外科治疗计划和确定有助于最成功治疗的因素相结合，对于改进一些最困难的面部问题和颅颌面部畸形的治疗具有巨大的潜力。参与这些研究将加强候选人在颅颌面问题和3D成像方面的先前培训，同时为她配备工具，以患者为中心进行有意义的研究。

DESCRIPTION (provided by applicant): Surgical correction of a craniofacial anomaly or dentofacial deformity is a complex procedure, particularly in patients with asymmetries. Even with the focus on post-surgical assessments of hard and soft tissue over the past decades, there are critical areas, such as maxillomandibular rotations and condylar/ramus resorbtion, that can not be evaluated with two-dimensional methods. The objectives of this prospective observational study that incorporates three-dimensional imaging (3-D) techniques are to characterize asymmetries more precisely prior to surgery, quantify areas of instability following facial surgical procedures, and improve pre-operative surgical planning. Since asymmetries are particularly difficult to ascertain and treatment plan, the agreement between clinical assessment of asymmetry location and its 3D characterization will be evaluated. In the 3D characterization, the surface distances between the 3-D models of the "affected" side of the mandible and the reflected mirror image of the "unaffected" side will be used to anatomically locate and estimate the asymmetry with two different mirroring techniques. An ancillary question is whether providing this information to surgeons alters the approach to the surgical correction. Surgeons will be trained in the use of 3D surgical simulation and the actual surgical outcome compared to the surgical simulation as one aspect of the validation of this method. In addition, this project will quantitatively assess 3D displacement and rotations of the jaws following orthognathic surgery for correction of asymmetry and Class III skeletal deformities. Voxel-wise rigid registration of the 3D cranial base surfaces will be used to avoid observer-dependent superimposition. The proposed work is multidisciplinary - incorporating treatment of craniofacial and dentofacial deformities, clinical research design and computer imaging. The combination of better planning of surgical treatment and identification of factors that contribute to the most successful treatment has great potential to improve treatment for some of the most difficult facial problems and dysmorphisms in the cranio-maxillofacial region. Involvement in these studies will enhance the candidate's prior training in cranio-maxillofacial problems and 3D imaging, while equipping her with tools to perform meaningful studies centered around patient oriented clinical research.