Computer Modeling of Surgical Outcomes for Nasal Airway Obstruction

描述(申请人提供)：鼻呼吸道阻塞(NAO)是一种常见的健康状况，由许多医学专业治疗，经常需要手术矫正。鼻腔呼吸道的复杂性非常适合创建一种计算工具来帮助临床医生诊断和治疗NAO。在NAO治疗的手术失败率高达50%的背景下，现有的鼻腔气流开放的客观指标都没有被证明与患者的症状相一致，也没有被证明是手术干预成功的准确预测因素。这项研究的长期目标是开发一种临床医生普遍可用的工具，并准确预测患者的症状。更令人兴奋的是，将有一种工具帮助外科医生设计特定的手术技术或干预措施，以最大限度地提高成功结果的潜力。随着强大的生物工程计算机辅助设计软件的推出，可以从计算机断层扫描(CT)捕获的特定于患者的数字数据生成解剖学上准确的三维计算模型。计算流体动力学(CFD)技术通过创建鼻腔的虚拟模型以及气流、热传递和空气湿化的计算测量，实现了解剖学和生理学的结合。当CFD建模工具用于鼻部手术计划时，患者预后的改善潜力是巨大的，特别是对于以前具有挑战性的病例。此外，通过允许医生更好地选择可通过手术治疗的患者，并针对鼻瓣区内的特定关注区域，而不“猜测”哪种手术可能对患者最有益，可能潜在地减少不必要的外科手术。此外，计算的鼻部几何形状可以以一种反映手术技术的方式进行虚拟修改，并且可以预测新的气流、热量和水蒸气传输模式，从而有效地估计手术结果--即虚拟手术。这项研究建议评估这种新的生物工程工具(CFD)与患者报告的鼻塞主观测量之间的关联。此外，由于CFD建模允许以反映手术技术的方式虚拟地修改鼻部几何形状，因此本研究的结果将为未来的术前虚拟手术和术后结果的预测性建模奠定基础，最终的长期目标是改善鼻气道阻塞患者的手术结果。公共卫生相关性：鼻呼吸道阻塞(NAO)是一种常见的健康状况，跨越许多医学专业，影响所有年龄段。研究表明，NAO会影响情绪、精力、娱乐、睡眠和整体生活质量。据估计，每年有50亿美元用于治疗NAO的药物，另外还有6000万美元用于外科治疗。NAO的解剖学基础很常见；据报道，高达25%的人口患有鼻塞，原因是与过敏原因无关的解剖畸形。然而，鼻部解剖畸形的外科矫正在改善患者NAO症状方面并不总是成功的，据报道，手术失败率高达50%。计算流体动力学(CFD)技术是一种新的最先进的技术，它允许鼻部解剖学和生理学的结合。当CFD建模工具用于鼻部手术计划时，患者预后的改善潜力是巨大的，特别是对于以前具有挑战性的病例。此外，通过允许医生更好地选择可通过手术治疗的患者，并针对鼻瓣区内的特定关注区域，而不“猜测”哪种手术可能对患者最有益，可能潜在地减少不必要的外科手术。此外，医生使用电子病历将CT数据下载到用户友好的简化CFD软件包中，为每个患者快速创建CFD模型的未来场景并不太难想象。然后，医生可以通过立即计算鼻气道阻力、气流分布以及热湿变化来对模型进行更改。然后，将就适当的手术计划向患者提供咨询，医生可以使用虚拟手术模型来帮助计划他/她的手术方法。该建模工具不仅适用于个人患者级别，还可以作为培训医生和辅助医疗人员的强大教育工具。此外，随着CT扫描的普及和对原始数据进行后处理的能力，远程医疗会诊在疑难鼻呼吸道病例中的潜力也将变得更有吸引力和成果。

DESCRIPTION (provided by applicant): Nasal airway obstruction (NAO) is a common health condition that is treated by many specialties of medicine and often needs surgical correction. The complexity of the nasal airway lends itself perfectly to the creation of a computational tool to aid clinicians in the diagnosis and treatment of NAO. In the context of surgical failure rates for treatment of NAO reported as high as 50%, none of the existing objective measures of nasal airflow patency has been shown to consistently correlate with patient symptomatology or to be an accurate predictor of successful surgical intervention. The long-term goal of this study is to develop a tool that would be universally accessible to clinicians and be accurately predictive of patient's symptoms. Even more exciting would be a tool that would aid surgeons in designing specific surgical techniques or interventions that would maximize the potential for successful outcomes. With the availability of powerful bioengineering computer-aided design software, anatomically- accurate, three dimensional computational models can be generated from patient-specific digital data captured by computed tomography (CT) scans. Computational fluid dynamics (CFD) techniques allow for the merger of anatomy with physiology by creating a virtual model of the nasal cavity with computed measures of airflow, heat transfer, and air humidification. The potential for improvements in patient outcome when CFD modeling tools are used in nasal surgical planning is enormous, particularly for previously challenging cases. In addition, unnecessary surgical procedures may potentially be reduced by allowing the physician to better select surgically treatable patients and to target specific areas of concern within the nasal valve region without "guessing" which of the procedures may be most beneficial to the patient. Furthermore, the computed nasal geometry can be virtually modified in a manner reflecting surgical techniques and new patterns of airflow and heat and water vapor transport can be predicted that could effectively estimate surgical outcomes - i.e virtual surgery. This study proposes to evaluate the association between this novel bioengineering tool (CFD) with patient-reported subjective measures of nasal obstruction. Furthermore, because CFD modeling allows the nasal geometry to be virtually modified in a manner reflecting surgical techniques, the findings of this study would lay the groundwork for future pre-surgical virtual surgery and predictive modeling for post-surgical outcomes with the ultimate long-term goal of improved surgical outcomes for patients with nasal airway obstruction. PUBLIC HEALTH RELEVANCE: Nasal airway obstruction (NAO) is a common health condition that crosses many specialties of medicine and affects all age groups. NAO has been shown to impact mood, energy, recreation, sleep and overall quality of life. It is estimated that annually $5 billion is spent on medications to treat NAO and an additional $60 million is spent on surgical therapy. An anatomic basis for NAO is common; it has been reported that up to 25% of the population suffers from nasal obstruction due to anatomic deformities unrelated to allergic reasons. However, the surgical correction of nasal anatomic deformities has not always been successful in improving patient's symptoms of NAO, with reported surgical failure rates as high as 50%. Computational fluid dynamics (CFD) techniques is a novel state-of-the art technology that allows for the merger of nasal anatomy with physiology. The potential for improvements in patient outcome when CFD modeling tools are used in nasal surgical planning is enormous, particularly for previously challenging cases. In addition, unnecessary surgical procedures may potentially be reduced by allowing the physician to better select surgically treatable patients and to target specific areas of concern within the nasal valve region without "guessing" which of the procedures may be most beneficial to the patient. In addition, the futuristic scenario of a physician using electronic medical records to download CT data into a user-friendly, simplified CFD software package to rapidly create a CFD model for each patient is not too hard to conceive. The physician can then make changes to the model with immediate computations of changes of nasal airway resistance, airflow distributions, and heat and humidity alterations. The patient would then be counseled on the appropriate surgical plan and the physician can use the virtual surgery model to help plan his/her surgical approach. Extending beyond the individual patient level, this modeling tool can serve as a powerful educational tool for physicians- in-training and paramedical personnel. Furthermore, with the universality of CT scans and the ability to post-process the "raw data", the potential for telemedicine consulting for difficult nasal airway cases would also become more appealing and fruitful.