Computational modeling of the mature unilateral cleft lip nasal deformity for objective assessment of patient nasal function and treatment outcomes

项目总结/摘要 在西方世界，唇裂修复的悠久手术历史可以追溯到世纪， 单侧唇裂鼻畸形（uCLND）的功能被认为是最困难的 剩下的手术挑战此外，与成熟uCLND畸形的美学方面相比， uCLND的功能影响受到了有限的关注。虽然唇裂和/或腭裂 鼻塞首次被描述超过86年前，几乎没有取得进展，以改善 与鼻呼吸相关的治疗结果。据估计，70%的唇腭裂患者 功能性鼻呼吸和80%以上的"口呼吸"。uCLND中的结构异常 多个气道阻塞部位;无法准确识别最相关的阻塞部位， 纠正以获得最佳的患者结果可以说是阻碍功能性心脏病的最大诊断困境。 治疗uCLND的进展。我们的长期目标是使鼻呼吸功能恢复到正常水平 通过开发一个计算建模平台，帮助外科医生优化 治疗结果。我们申请的基本原理是，一旦知道在多大程度上和 不同部位的气道阻塞性畸形的严重程度妨碍鼻呼吸，术后 在uCLND患者中，鼻功能改善至标准基线是可实现的。基于 根据我们初步数据的强度，提出了以下具体目标：[1]确定 目前用于鼻成熟uCLND患者将鼻功能恢复至健康的鼻外科手术 规范范围;和[2]通过识别和数字校正优化uCLND的治疗选择 最大的阻塞部位。这项研究的成果将为成功地 治疗唇腭裂引起的鼻呼吸功能障碍，因为，重要的是，我们的贡献将提供[1] 为什么目前的干预措施不能完全将鼻功能恢复到正常水平， 和[2]具有使用计算方法优化患者结果的潜力的治疗选择。

PROJECT SUMMARY / ABSTRACT In the Western world where the long surgical history of cleft lip repair dates back to 17th century, restoring form and function in the unilateral cleft lip nasal deformity (uCLND) is acknowledged as among the most difficult remaining surgical challenges. Further, compared to the aesthetic aspects of the mature uCLND deformity, the functional implications of uCLND have received limited attention. Although cleft-lip- and/or palate-induced nasal obstruction was first described over 86 years ago, almost no progress has been made to improve treatment outcomes associated with nasal breathing. An estimated 70% of cleft individuals have impaired functional nasal breathing and upwards of 80% “mouth-breathe”. Structural abnormalities in uCLND create multiple sites of airway obstruction; the inability to accurately identify the most relevant obstructive sites for correction to yield optimal patient outcome is arguably the biggest diagnostic dilemma hindering functional advancement in treating uCLND. Our long-term goal is to restore nasal breathing function to normative levels in post-surgical cleft patients by developing a computational modeling platform to aid surgeons to optimize treatment outcomes. The rationale underlying our application is that once it is known to what extent and severity each of the different sites of airway obstructive deformities impede nasal breathing, post-surgical improvement in nasal function to a normative baseline will be attainable in uCLND patients. Based on the strength of our preliminary data, the following Specific Aims are proposed: [1] Determine effectiveness of current nasal surgical procedure(s) for skeletally mature uCLND patients in restoring nasal function to healthy normative ranges; and [2] Optimize treatment options for uCLND via identification and digital correction of greatest obstructive sites. The culmination of this research will provide a scientific basis for successful treatment of cleft-induced nasal breathing dysfunction because, significantly, our contributions will provide [1] objective evidence for why current interventions may not completely restore nasal function to normative levels, and [2] treatment options with the potential to optimize patient outcomes using computational methods.