Model-based prediction of mastication and swallowing outcomes for head and neck surgery

解剖结构的三维计算机建模是手术规划不可或缺的工具。一个突出的例子是重建颌骨，这是一个复杂的几何手术。腓骨微血管游离皮瓣是颌骨重建的主力，在国际上广泛应用于头颈部肿瘤、创伤和某些先天性缺损的治疗。几何建模方法大大提高了这些复杂微血管重建过程的几何（解剖）可预测性。他们还能够引入手术创新，显著缩短治疗时间，从2-4年缩短到12周。这些程序的终点是改善护理的功能结果。然而，几何建模是静态的，并且不能预测功能结果，例如患者将如何有效地咀嚼或吞咽。这些结果极大地影响了患者的生活质量，吞咽缺陷产生了由于误吸导致的发病率和死亡率的显著风险。因此，我们建议创建动态的，三维的，患者特定的计算机模型的口腔和上呼吸道解剖预测功能咀嚼和吞咽的结果，头部和颈部手术。我们的预测将通过手术、手术导板、假体和植入物安装的模拟和设计来优化功能结果。我们的项目还将提供科学和工具，使动态生物力学建模用于其他外科手术，除了颌骨重建。我们组建了一支由调查人员、合作者和知识转移用户组成的世界级跨学科团队，他们拥有经过验证的技术专长、业绩记录和为该项目共同工作的能力。

Three-dimensional computer modeling of anatomical structures is an indispensable tool for surgical planning. An outstanding example is reconstruction of the jaws that is a complex geometric surgery. The microvascular fibular free flap is the workhorse for jaw reconstruction and is internationally pervasive for management of head/neck cancer, trauma and certain congenital defects. Geometric modeling methods have greatly improved the geometric (anatomical) predictability of these complex microvascular reconstructive procedures. They have also enabled the introduction of surgical innovations that reduce treatment time remarkably, from 2-4 years down to 12 weeks. The endpoint of these procedures is to improve functional outcomes of care. However, geometric modeling is static, and cannot predict functional outcomes such as how effectively a patient will chew or swallow. These outcomes enormously impact patient's quality of life, with swallowing deficits producing significant risk of morbidity and mortality due to aspiration. Thus, we propose creating dynamic, 3D, patient-specific computer models of oral and upper airway anatomy to predict functional mastication and swallowing outcomes for head and neck surgery. Our predictions will optimize functional outcomes through simulation and design of surgery, surgical guides, prostheses and implant installation. Our project will also provide the science and tools to enable dynamic biomechanical modeling used for other surgical procedures besides jaw reconstruction. We have assembled a world-class interdisciplinary team of investigators, collaborators and knowledge transfer users, with proven technical expertise, track record and ability to work together for this project.