Introduction: The treatment of patients with complex facial and neck trauma is one of the most challenging multidisciplinary tasks in surgery. Recent studies on injured soldiers returning from the Iraq war have shown that the pattern of combat injuries has changed significantly. Before the advent of Kevlar body armor, most combat deaths and injuries stemmed from wounds to the chest or skull. Today 21% of soldiers with battle injuries suffer from trauma to the head and neck below the helmet line. The introduction of plating systems and changes in surgical techniques over the last 20 years have made correction of severe malformations in the head and neck possible. Preoperative planning is essential for a successful outcome of these complex procedures. Imaging has evolved from 2-D to 3-D, and from static to animated graphic rendering, and this has greatly facilitated diagnosis of complex traumatic injuries. Simulation technology based on 3D data of an individual patient will have a critical impact on surgical planning and training. Onsite and remotely accessible virtual environments simulating deformable tissues will allow surgeons to plan and simulate operations and retain their skills for infrequent operations.
Specific Aims : The research goal of this proposal is the development and evaluation of a computational environment for the planning of reconstructive surgery. The proposed tool will allow interactive visualization and haptic manipulation of images derived from computed tomography (CT) scans of an individual patient with a head and neck injury. We anticipate that a computational tool will be more precise, faster, and more flexible than conventional techniques that depend on physical models. The computational tool can also be accessed remotely and allowing a surgeon to simulate and plan a surgical case with expert feedback. The research plan consists of the following elements: 1) Develop a visuohaptic virtual environment for interactively exploring CT data, specifying surgical cuts, manipulating bone fragments, and positioning of reconstruction plates 2) Develop an interface for taking and recording physical measurements from 3-D models for surgical planning 3) Enhance the environment to include semi-automation features to further reduce planning time and potentially increase accuracy beyond what is available via conventional techniques 4) Perform a validation study to develop a Telemedicine application for surgery planning Significance: The significance of the proposed surgical planning environment stems from its ability to allow surgeons to simulate, plan, and iterate on complex procedures based on individual patient data in 3-D from a CT scan. The software will allow surgeons to both see and feel the results of their interventions - for example, the quality of the bite or bone alignment of a reconstructed jaw following severe head trauma - before the actual surgery, leading to better planning, fewer errors, shortened surgery time and improved outcomes for the patient. The system will be accessible remotely so that surgeons can use it independent of their location. Potential Impact on Veterans Health Care: A virtual surgical planning system can provide many benefits to VA patient with head and neck trauma and cancer requiring reconstructive surgery. The VA is in an ideal position for telemedicine applications such as a virtual surgery planning system due to a strong communications infrastructure and electronic network that connects all VA medical facilities allowing secure exchange of data. The treatment team can thus use the virtual surgical planning system to provide the best care for the patient, independent of patient or provider location.
Approximately 21% of soldiers with battle injuries suffer from trauma to the head and neck below the helmet line. In addition, complex reconstructive surgery procedures for patients with resected head and neck cancer, the third most common solid tumor within the VA healthcare system, have markedly improved patients'quality of life. Simulation technology based on 3D data of an individual patient will have a critical impact on training and on surgical planning for a successful surgical outcome. Onsite and remotely accessible virtual environments simulating deformable tissues will allow surgeons to plan and simulate operations. The VA is in an ideal position for telemedicine applications such as a virtual surgery planning system due to a strong communications infrastructure, and the establishment of a standards-based electronic network that connects all VA medical facilities allowing secure exchange of data. The treatment team can thus use the virtual surgical planning system to provide the best care for the patient, independent of patient or provider location.
