Luo Lanrui, Du Changjiang, Zhou Xia, Yang Shuang, Zhu Hongping, Cai Zhigang
{"title":"构建虚拟气道模型，辅助咽后皮瓣手术矫正咽喉发育不全。","authors":"Luo Lanrui, Du Changjiang, Zhou Xia, Yang Shuang, Zhu Hongping, Cai Zhigang","doi":"10.1016/j.jormas.2024.102099","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Posterior pharyngeal flap (PPF) is one of the most common surgical technique to correct velopharyngeal insufficiency(VPI), during which controlling the sizes of the lateral pharyngeal ports(LPP) is the key to outcomes. One innovative procedure was developed to well control the size of LPP.</p><p><strong>Materials and methods: </strong>40 patients with repaired cleft palate were collected from June 2022 to August 2023. All patients were diagnosed with VPI, and treated with modified PPF surgery. For each patient, upper airway model was reconstructed, and the virtual airway model of PPF was designed. The nasal valve area was measured as it was considered to be the narrowest part of the upper airway. The upper airway resistances under different sizes of LPP was predicted through computational fluid dynamics analysis. The minimum size of each lateral pharyngeal port without obviously increase of upper airway resistance was calculated through effect of lateral pharyngeal ports' size on upper airway resistance. Postoperative follow-up was 6-18 months, including speech outcome and respiration outcome. Resting soft palate length (RVL), effective working length of soft palate (EWL) and angle of soft palate elevation (AVL) were measured and compared according to the lateral cephalometric radiograph.</p><p><strong>Results: </strong>There was a linear relationship between the threshold value and nasal valve (R = 0.62). Among the forty patients, the average size of nasal valve was 47.81 mm<sup>2</sup>, the average size of the threshold value of LPP was 31.63mm<sup>2</sup>. The proportion of velopharyngeal closure competence after surgery was 95 %. Compared with the preoperative measurements, there were significantly increase of RVL, EWL and AVL (P < 0.05). There were significantly difference in the nasal obstruction symptom evaluation score in long-term follow-up compared to short-term follow-up (P < 0.05), and no one needed flap revision. There was no significant difference in nasal respiration and nasal resistance before and after surgery (P > 0.05).</p><p><strong>Conclusion: </strong>With the help of computer fluid dynamics analysis, it is possible to predict the threshold size of lateral pharyngeal port without obviously increasing upper airway resistance and reduce the risk of suffering from airway obstruction for patients undergoing PPF surgery.</p>","PeriodicalId":56038,"journal":{"name":"Journal of Stomatology Oral and Maxillofacial Surgery","volume":" ","pages":"102099"},"PeriodicalIF":2.2000,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Construction of virtual airway model to assist surgical correction of velopharyngeal insufficiency with posterior pharyngeal flap.\",\"authors\":\"Luo Lanrui, Du Changjiang, Zhou Xia, Yang Shuang, Zhu Hongping, Cai Zhigang\",\"doi\":\"10.1016/j.jormas.2024.102099\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Posterior pharyngeal flap (PPF) is one of the most common surgical technique to correct velopharyngeal insufficiency(VPI), during which controlling the sizes of the lateral pharyngeal ports(LPP) is the key to outcomes. One innovative procedure was developed to well control the size of LPP.</p><p><strong>Materials and methods: </strong>40 patients with repaired cleft palate were collected from June 2022 to August 2023. All patients were diagnosed with VPI, and treated with modified PPF surgery. For each patient, upper airway model was reconstructed, and the virtual airway model of PPF was designed. The nasal valve area was measured as it was considered to be the narrowest part of the upper airway. The upper airway resistances under different sizes of LPP was predicted through computational fluid dynamics analysis. The minimum size of each lateral pharyngeal port without obviously increase of upper airway resistance was calculated through effect of lateral pharyngeal ports' size on upper airway resistance. Postoperative follow-up was 6-18 months, including speech outcome and respiration outcome. Resting soft palate length (RVL), effective working length of soft palate (EWL) and angle of soft palate elevation (AVL) were measured and compared according to the lateral cephalometric radiograph.</p><p><strong>Results: </strong>There was a linear relationship between the threshold value and nasal valve (R = 0.62). Among the forty patients, the average size of nasal valve was 47.81 mm<sup>2</sup>, the average size of the threshold value of LPP was 31.63mm<sup>2</sup>. The proportion of velopharyngeal closure competence after surgery was 95 %. Compared with the preoperative measurements, there were significantly increase of RVL, EWL and AVL (P < 0.05). There were significantly difference in the nasal obstruction symptom evaluation score in long-term follow-up compared to short-term follow-up (P < 0.05), and no one needed flap revision. There was no significant difference in nasal respiration and nasal resistance before and after surgery (P > 0.05).</p><p><strong>Conclusion: </strong>With the help of computer fluid dynamics analysis, it is possible to predict the threshold size of lateral pharyngeal port without obviously increasing upper airway resistance and reduce the risk of suffering from airway obstruction for patients undergoing PPF surgery.</p>\",\"PeriodicalId\":56038,\"journal\":{\"name\":\"Journal of Stomatology Oral and Maxillofacial Surgery\",\"volume\":\" \",\"pages\":\"102099\"},\"PeriodicalIF\":2.2000,\"publicationDate\":\"2024-09-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Stomatology Oral and Maxillofacial Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.jormas.2024.102099\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"Dentistry\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Stomatology Oral and Maxillofacial Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jormas.2024.102099","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"Dentistry","Score":null,"Total":0}
Construction of virtual airway model to assist surgical correction of velopharyngeal insufficiency with posterior pharyngeal flap.
Objective: Posterior pharyngeal flap (PPF) is one of the most common surgical technique to correct velopharyngeal insufficiency(VPI), during which controlling the sizes of the lateral pharyngeal ports(LPP) is the key to outcomes. One innovative procedure was developed to well control the size of LPP.
Materials and methods: 40 patients with repaired cleft palate were collected from June 2022 to August 2023. All patients were diagnosed with VPI, and treated with modified PPF surgery. For each patient, upper airway model was reconstructed, and the virtual airway model of PPF was designed. The nasal valve area was measured as it was considered to be the narrowest part of the upper airway. The upper airway resistances under different sizes of LPP was predicted through computational fluid dynamics analysis. The minimum size of each lateral pharyngeal port without obviously increase of upper airway resistance was calculated through effect of lateral pharyngeal ports' size on upper airway resistance. Postoperative follow-up was 6-18 months, including speech outcome and respiration outcome. Resting soft palate length (RVL), effective working length of soft palate (EWL) and angle of soft palate elevation (AVL) were measured and compared according to the lateral cephalometric radiograph.
Results: There was a linear relationship between the threshold value and nasal valve (R = 0.62). Among the forty patients, the average size of nasal valve was 47.81 mm2, the average size of the threshold value of LPP was 31.63mm2. The proportion of velopharyngeal closure competence after surgery was 95 %. Compared with the preoperative measurements, there were significantly increase of RVL, EWL and AVL (P < 0.05). There were significantly difference in the nasal obstruction symptom evaluation score in long-term follow-up compared to short-term follow-up (P < 0.05), and no one needed flap revision. There was no significant difference in nasal respiration and nasal resistance before and after surgery (P > 0.05).
Conclusion: With the help of computer fluid dynamics analysis, it is possible to predict the threshold size of lateral pharyngeal port without obviously increasing upper airway resistance and reduce the risk of suffering from airway obstruction for patients undergoing PPF surgery.
期刊介绍：
J Stomatol Oral Maxillofac Surg publishes research papers and techniques - (guest) editorials, original articles, reviews, technical notes, case reports, images, letters to the editor, guidelines - dedicated to enhancing surgical expertise in all fields relevant to oral and maxillofacial surgery: from plastic and reconstructive surgery of the face, oral surgery and medicine, … to dentofacial and maxillofacial orthopedics.
Original articles include clinical or laboratory investigations and clinical or equipment reports. Reviews include narrative reviews, systematic reviews and meta-analyses.
All manuscripts submitted to the journal are subjected to peer review by international experts, and must:
Be written in excellent English, clear and easy to understand, precise and concise;
Bring new, interesting, valid information - and improve clinical care or guide future research;
Be solely the work of the author(s) stated;
Not have been previously published elsewhere and not be under consideration by another journal;
Be in accordance with the journal''s Guide for Authors'' instructions: manuscripts that fail to comply with these rules may be returned to the authors without being reviewed.
Under no circumstances does the journal guarantee publication before the editorial board makes its final decision.
The journal is indexed in the main international databases and is accessible worldwide through the ScienceDirect and ClinicalKey Platforms.
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