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

开发针对 I 型喉成形术的患者特定手术计划工具

• 批准号: 9882979
• 负责人: Bernard Rousseau
• 金额: $ 45.77万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-12-20 至 2022-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9882979
• 关键词: 3-Dimensional; Address; Air Movements; Anatomy; Anterior; Area; Aspiration Pneumonia; Biomechanics; Cervical; Cervical spine; Cessation of life; Characteristics; Clinical; Computer Models; Computer Simulation; Deglutition Disorders; Development; Diagnosis; Disease; Dysphonia; Dyspnea; Engineering; Etiology; Evaluation; Frequencies; Future; Goals; Gold; Grant; Growth; High Performance Computing; Human; Iatrogenesis; Implant; Incidence; Income; Individual; Injections; Investigation; Larynx; Lead; Left; Liquid substance; Location; Medial; Medicine; Modality; Modeling; Operative Surgical Procedures; Oryctolagus cuniculus; Otolaryngology; Outcome; Paralysed; Patient-Focused Outcomes; Patients; Phase; Phonation; Positioning Attribute; Procedures; Recovery; Research; Respiration Disorders; Risk; Science; Scientist; Shapes; Spine surgery; Structure; Surgeon; System; Techniques; Testing; Thyroid Gland; Thyroidectomy; Time; Tissues; United States; Validation; Variant; Voice Disorders; Work; base; biological systems; disability; experience; high resolution imaging; improved; in vivo; innovation; microCT; multidisciplinary; patient population; pre-clinical; reduce symptoms; simulation; surgery outcome; tool; vibration; vocal cord

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.

项目摘要 语音障碍使人衰弱，并可能导致重大的社会情感后果，收入损失以及 长期残疾。在吞咽困难的局部性评估中，医源性病因（最大程度上最重要） 从甲状腺切除术或宫颈椎间盘融合手术中），估计有50％的新层新病例 ERA声带瘫痪（UVFP）每年。 UVFP对患者的有症状烧伤很重要 估计遇到吞咽困难，60％呼吸困难和75％吞咽困难的确定病例中，有100％ 在严重的情况下，这会导致肺炎和死亡。治疗需要内侧 瘫痪的声带折叠以重新建立全球封闭。存在几种模式以实现关闭，包括 jelection扩大。但是，注射量仅在暂时缓解症状时有效， 在诊断为UVFP的一半以上的患者中，最终需要手术干预（Francis et al。 2016）。永久性框架手术仍然是超出时间期的患者的黄金标准 赞助恢复（通常为6-12个月）。当前的提案专门针对框架手术， 其中最常见的是I型Larryngophastent。该程序的适应症远远超出了UVFP，其中包括越来越多的因其他原因（例如长孢子虫）的全球不足患者。尽管这些患者受益于I型Larryngophastast，手术技术和修订率差异很大，并且 在很大程度上取决于体积和经验。不幸的是，这种差异会产生不一致和不良的临床结果。这是对临床工具的重要需求，以帮助外科医生进行术前计划并改善患者预后。为了满足这一需求，我们组装了一个多学科的工程师，科学家和外科医生，为患者特定的外科手术努力 I型喉成形术（PhonoSim）的计划工具。可以预见的是，一种结合了手术的工具 植入物并捕获患者喉解剖的个人特定特征，可用于手术 计划优化I型喉成形术中用于改善临床成形术中使用的朝鲜的形状，大小和位置 结果。该提案利用了微观成像，计算建模和 生物系统的高性能计算，以支持开发和验证 I型喉成形术的手术计划工具。我们的初步工作重点是：1） 用于模拟涉及大变形的3D流体结构相互作用的多功能计算方法，以及2）验证语音的计算模型，以及首次对主题特定的振动特性的建模。该提案的目的是在初步工作中凭经验测试建模和验证方法，以生成用于未来人类研究的临床工具。 赠款完成后可交付的可交付是一种临床工具，将在未来的I/II阶段进行严格测试。