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

描述（由申请人提供）：颅面异常或牙面畸形的手术矫正是一项复杂的手术，特别是在不对称患者中。即使在过去的几十年里，人们把重点放在硬组织和软组织的术后评估上，但仍有一些关键领域，如上下颌旋转和髁突/升支吸收，无法用二维方法进行评估。本前瞻性观察性研究结合了三维成像（3-D）技术，其目的是在手术前更精确地描述不对称性，量化面部手术后的不稳定区域，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，因此将评价不对称位置的临床评估与其3D表征之间的一致性。在3D表征中，下颌骨“受影响”侧的3D模型与“未受影响”侧的反射镜像之间的表面距离将用于通过两种不同的镜像技术在解剖学上定位和估计不对称性。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3D手术模拟使用培训，并将实际手术结果与手术模拟进行比较，作为该方法确认的一个方面。此外，该项目将定量评估正颌手术后颌骨的3D位移和旋转，以矫正不对称和III类骨骼畸形。将使用3D颅底表面的体素刚性配准来避免依赖于重叠的重叠。拟议的工作是多学科的-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识别有助于最成功的治疗的因素，有很大的潜力，以改善治疗一些最困难的面部问题和畸形的颅颌面区域。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，同时为她提供工具，以围绕以患者为中心的临床研究进行有意义的研究。

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.