Development of a Patient-Specific Surgical Planning Tool for Type I Laryngoplasty

项目摘要 嗓音障碍会使人虚弱，并可能导致严重的社会情感后果，收入损失，以及 长期残疾。在耳鼻咽喉科对发音困难的评估中，医源性病因(最主要的 甲状腺切除或颈椎前路融合术)约占单侧颈椎病新发病例的50%。 每年的外周声带麻痹(UVFP)。UVFP对患者的症状负担显著 据估计，100%的确诊病例经历了发音困难，60%的呼吸困难，75%的吞咽困难， 在严重的情况下，可能会导致吸入性肺炎和死亡。治疗需要中介化 瘫痪的声带以重建声门关闭。有几种方式可以实现收尾，包括在-- 投射增强。然而，注射增强仅在暂时缓解症状方面有效， 在被诊断为UVFP的患者中，超过一半的患者最终需要手术干预(Francis et 艾尔2016)。永久性支架手术仍然是超过年龄的患者的黄金标准 自然恢复(通常为6-12个月)。目前的提案特别侧重于框架手术， 其中I型喉成形术最常见。这一手术的适应症远远超出了UVFP的范围，包括越来越多的因其他原因(如老年音)而导致的声门功能不全患者。虽然这些患者受益于I型喉成形术，但手术技术和翻修率差异很大， 在很大程度上取决于音量和经验性。不幸的是，这种变异会产生不一致和不受欢迎的临床结果。因此，非常需要一种临床工具来帮助外科医生进行术前计划，并改善患者的预后。为了满足这种需要，我们召集了一个由工程师、科学家和外科医生组成的多学科小组，致力于开发一种针对患者的特定外科手术。 I型喉成形术的计划工具(PhonoSim)。据设想，一种结合了外科手术的工具 植入，并捕捉到患者特定的个体喉部解剖特征，可用于外科手术 计划优化用于I型喉成形术的植入物的形状、大小和位置以改善临床 结果。这一建议充分利用了微成像、计算建模和 支持开发和验证生物系统的高性能计算 I型喉成形术的手术计划工具。我们的前期工作主要集中在：1)开发了一种 用于模拟大变形的3D流体-结构相互作用的通用计算方法，以及2)发声计算模型的验证，以及首次对特定于对象的振动特性的建模。这项建议的目标是对我们在初步工作中开发的建模和验证方法进行实证测试，以产生一个临床工具，用于未来的人类研究。这个 在赠款完成后交付将是一种临床工具，将在未来的I/II阶段人体试验中进行严格测试。

Project Summary Voice disorders are debilitating and can lead to significant socioemotional consequences, loss of income, and long-term disability. Among otolaryngology evaluations for dysphonia, iatrogenic etiologies (most consequent from thyroidectomy or anterior cervical disc fusion surgery) account for an estimated 50% new cases of unilat- eral vocal fold paralysis (UVFP) annually. The symptomatic burden of UVFP on patients is significant with an estimated 100% of identified cases experiencing dysphonia, 60% dyspnea, and 75% dysphagia, which, in severe cases, can lead to aspiration pneumonia and death. Treatment requires medialization of the paralyzed vocal fold to reestablish glottal closure. Several modalities exist to achieve closure, including in- jection augmentation. However, injection augmentation is effective at only temporarily alleviating symptoms, and surgical intervention is ultimately necessary in more than half of patients diagnosed with UVFP (Francis et al. 2016). Permanent framework surgery remains the gold standard for patients that are beyond the period of spontaneous recovery (usually 6-12 months). The current proposal focuses specifically on framework surgery, of which type I laryngoplasty is most common. Indications for this procedure extend well beyond UVFP to include a growing population of patients with glottal insufficiency from other causes (e.g., presbyphonia). Although these patients benefit from type I laryngoplasty, surgical techniques and revision rates vary widely and are largely volume-dependent and experiential. Unfortunately, such variation produces inconsistent and undesirable clinical outcomes. Thus, there exists a significant need for a clinical tool to assist surgeons with pre-operative planning and to improve patient outcomes. To address this need, we have assembled a multidisciplinary group of engineers, scientists, and surgeons to work towards a patient-specific surgical planning tool for type I laryngoplasty (PhonoSim). It is envisioned that a tool that incorporates the surgical implant, and captures the individual-specific features of the patient’s laryngeal anatomy can be used in surgical planning to optimize the shape, size, and position of implants used in type I laryngoplasty to improve clinical outcomes. This proposal leverages current advances in microimaging, computational modeling, and high-performance computing of biological systems to support the development and validation of a surgical planning tool for type I laryngoplasty. Our preliminary work has focused on: 1) development of a versatile computational approach for the simulation of 3D fluid-structure interactions involving large deformations, and 2) validation of computational models of phonation and for the first time the modeling of subject-specific vibratory characteristics. The goal of this proposal is to empirically test the modeling and validation approaches developed in our preliminary work to produce a clinical tool to be used in future human studies. The deliverable upon grant completion will be a clinical tool to be rigorously tested in future phase I/II human trials.