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

项目摘要/摘要 在西方世界，唇裂修复的悠久外科历史可以追溯到17世纪，修复形式 而单侧唇裂鼻畸形(UCLND)的功能被认为是最困难的之一 剩下的外科挑战。此外，与成熟的uCLND畸形的美学方面相比， UCLND的功能影响受到的关注有限。虽然唇裂和/或腭裂是由 鼻塞最早被描述在86年前，几乎没有任何改善的进展。 治疗结果与鼻腔呼吸有关。据估计，70%的唇裂患者 有功能的鼻式呼吸和80%以上的“口呼吸”。UCLND CREATE中的结构异常 多处呼吸道阻塞；无法准确识别最相关的阻塞部位 可以说，纠正以获得最佳患者结果是阻碍功能恢复的最大诊断难题 UCLND的治疗进展。我们的长期目标是将鼻呼吸功能恢复到正常水平 通过开发计算建模平台来帮助外科医生优化手术后裂隙患者 治疗结果。我们应用程序的基本原理是，一旦知道它在多大程度上和 手术后不同部位的呼吸道阻塞畸形阻碍鼻呼吸的严重程度 UCLND患者的鼻功能改善到标准基线是可以实现的。基于 根据我们的初步数据，提出了以下具体目标：[1]确定有效性 骨性成熟uCLND患者鼻功能恢复正常的现行鼻外科手术方法(S) 标准范围；以及[2]通过识别和数字校正来优化uCLND的治疗选择 最大的障碍物。这项研究的成果将为成功地 治疗裂隙引起的鼻呼吸功能障碍，因为我们的贡献将提供[1] 客观证据说明为什么目前的干预措施不能将鼻功能完全恢复到正常水平， 以及[2]有可能使用计算方法优化患者结果的治疗方案。

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.