Infants and children with abnormalities of the upper airway are at risk for hypoxia, respiratory insufficiency and long term morbidity. Multiple levels of airway obstruction encountered in these disorders lead to life threatening difficulties in air exchange, problems with coordination of swallowing, growth, and speech development. In these airway disorders, therapy is typically directed by the clinician's experience and preference, rather than on normalized physiologic or anatomic metrics. Quantitative methods of evaluating and determining optimal management of these upper airway anomalies would be of tremendous benefit for improved clinical care and outcomes. New research tools can now measure computational fluid dynamics. These fluid-structure interaction models allow for the merger of dynamic anatomy with physiologic measures by creating a virtual model of the airway with computed measures of airflow, wall shear stress, pressure distribution, and airway wall shape change. This computational model can be virtually modified to reflect medical intervention, surgical techniques, and normal growth, which can predict changes in airway wall compliance, new airflow patterns, pressure distribution, and other physiologic variables to yield expected clinical results prior to intervention. Improvements in outcomes when computational modeling tools are used in pediatric upper airway intervention planning is enormous, particularly in complicated clinical scenarios. For purposes of model development, we focus on two very specific, commonly encountered, high risk anomalies encountered at our center, Pierre Robin sequence and subglottic stenosis. Normative data regarding growth and development of the upper airway will be studied. We hypothesize that a functional computational model that simulates the mechanical and aerodynamic behavior of the upper airway in children with Pierre Robin sequence and laryngeal lesions (e.g. subglottic stenosis) can be used as an effective diagnostic and treatment planning tool, reducing failures of initial treatment and avoiding potentially unnecessary future complications and interventions.
Specific aims for this proposal are to: (1a) develop a functional computational model of the pediatric upper airway which can be used for diagnosis and to predict treatment outcomes in children <10 years of age with Pierre Robin sequence and subglottic stenosis;data and modeling of normal airways will be obtained to help develop a Pediatric Airway Anatomical Atlas describing the aging airway;an integrated Virtual Pediatric Airway Workbench will also be developed (1b) validate the functional computational model using anatomic and physiologic measures that assess airway patency and airflow limitation in the upper airway in children <10 years of age with Pierre Robin Sequence and subglottic stenosis and (2) apply the computational model to children being evaluated for Pierre Robin Sequence and subglottic stenosis, and determine the ability of the model to accurately predict results of various potential interventions on anatomic and physiologic metrics.
Upper airway problems in young children may lead to life threatening respiratory difficulties, poor growth, aspiration, delay in speech development and long term morbidity. Two common upper airway anomalies are Pierre Robin sequence (small jaw, cleft palate, downward displacement of the tongue) and subglottic stenosis (narrowing of the airway below the vocal cords). Management of these children is typically directed by the clinician's experience and preference, rather than on published protocols or quantitative measures of airway physiology and anatomy. Improved methods of evaluating and determining best management would benefit clinical care and outcomes. Novel research tools that measure structure, airflow and essentially create a virtual model of the airway would significantly improve care of these children. These computational models are now possible and can be modified to reflect medical or surgical intervention as well as normal growth and development. Improved quantitative measurements through computational modeling have enormous potential to significantly improve care in children with complicated upper airways. The researchers in this study hypothesize that a functional computational model may be developed that is similar to the mechanical and aerodynamic behavior of the upper airway in infants with complicated upper airways, specifically children with Pierre Robin Sequence and subglottic stenosis. The researchers also hypothesize that this model could be used as an effective diagnostic/treatment planning tool;thereby, reducing failed treatment and avoiding unnecessary future complications or interventions. Specific aims for this proposal are to: (1a) develop a functional computational model of the pediatric upper airway which can be used for diagnosis and to predict treatment outcomes in children <10 years of age with Pierre Robin sequence and subglottic stenosis; data and modeling of normal airways will also be obtained to develop a Pediatric Airway Anatomical Atlas describing the aging airway and a workbench of the pediatric airway will also be developed allowing the physician to hear airway sounds and virtually interact with the airway (1b) validate the functional computational model using clinical, anatomic and physiologic measures that evaluate airway size and obstruction in the upper airway in children <10 years of age with Pierre Robin Sequence and subglottic stenosis and (2) apply the computational model to infants and children being evaluated for Pierre Robin Sequence and subglottic stenosis, and determine the ability of the model to accurately predict the results of various potential interventions on clinical outcomes. The long term implications for the application of computational modeling for the entire airway, adult and pediatric, and to the broader range of pathologic airway problems has the potential to change the current approach to management.
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