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

描述（由申请人提供）：颅面畸形或牙面畸形的手术矫正是一个复杂的过程，特别是对于不对称的患者。尽管在过去的几十年里，人们一直关注于术后软硬组织的评估，但仍有一些关键区域，如上颌骨下颌骨旋转和髁突/支吸收，无法用二维方法进行评估。这项前瞻性观察性研究结合了三维成像（3d）技术，目的是在手术前更精确地表征面部不对称，量化面部手术后不稳定的区域，并改善术前手术计划。由于不对称特别难以确定和治疗计划，因此将评估临床评估不对称位置与其3D特征之间的一致性。在三维表征中，下颌骨“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将用于解剖定位和估计两种不同镜像技术的不对称性。一个附带的问题是，向外科医生提供这些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，该项目将定量评估矫正不对称和III类骨骼畸形的正颌手术后颌骨的3D位移和旋转。体素方向的3D颅底表面的刚性配准将被用来避免观察者相关的叠加。建议的工作是多学科-结合治疗颅面和牙面畸形，临床研究设计和计算机成像。结合更好的手术治疗计划和确定有助于最成功治疗的因素，对改善颅颌面区域一些最困难的面部问题和畸形的治疗具有很大的潜力。参与这些研究将增强候选人在颅颌面问题和3D成像方面的先前培训，同时为她提供以患者为导向的临床研究为中心进行有意义的研究的工具。

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.