A Computational Model of Velopharyngeal Closure for Simulating Cleft Palate Repair
A Computational Model of Velopharyngeal Closure for Simulating Cleft Palate Repair
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DOI：
10.1097/scs.0000000000001441
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发表时间：
2015-05-01
影响因子：
0.9
通讯作者：
Blemker, Silvia S.
中科院分区：
文献类型：
--
作者：
Inouye, Joshua M.;Pelland, Catherine M.;Blemker, Silvia S.
腭帆提肌（LVP）长期以来被认为是对腭咽闭合贡献最大的肌肉，因此对腭裂患者恢复正常语音至关重要。不同的外科重建手术可以利用不同程度的LVP重叠，本研究开发了一种新的VP闭合有限元模型，旨在了解LVP重叠的生物力学效应。根据成人解剖尺寸和文献中的参数创建三维有限元模型。模拟腭咽功能，并与先前研究中VP闭合力的实验测量值进行比较。模拟LVP的不同重叠和分离程度，并计算相应的闭合力。计算模型与文献中闭合力的实验测量值相比毫不逊色。此外，该模型预测存在最佳重叠水平，可使LVP产生闭合力的可能性最大化。该模型预测，与重叠太少或太多相比，实现最佳重叠可以将闭合力增加约100%。使用这种新的VP闭合模型的结果表明，由于肌肉的内在特性，优化LVP重叠可能会改善手术结果。未来的工作将比较这些模型预测与临床观察，并提供进一步的见解，以最佳腭裂修复和其他颅面手术。
The levator veli palatini (LVP) muscle has long been recognized as the muscle that contributes most to velopharyngeal (VP) closure and is therefore of principal importance for restoring normal speech in patients with a cleft palate. Different surgical reconstructive procedures can utilize varying degrees of LVP overlap, and this study developed a new finite-element model of VP closure designed to understand the biomechanical effects of LVP overlap. A three-dimensional finite-element model was created from adult anatomical dimensions and parameters taken from the literature. Velopharyngeal function was simulated and compared with experimental measurements of VP closure force from a previous study. Varying degrees of overlap and separation of the LVP were simulated, and the corresponding closure force was calculated. The computational model compares favorably with the experimental measurements of closure force from the literature. Furthermore, the model predicts that there is an optimal level of overlap that maximizes the potential for the LVP to generate closure force. The model predicts that achieving optimal overlap can increase closure force up to roughly 100% when compared with too little or too much overlap. The results of using this new model of VP closure suggest that optimizing LVP overlap may produce improved surgical outcomes due to the intrinsic properties of muscle. Future work will compare these model predictions with clinical observations and provide further insights into optimal cleft palate repair and other craniofacial surgeries.