Computational Analysis of the Mature Unilateral Cleft Lip Nasal Deformity on Nasal Patency.
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2019-05-16
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Background:Nasal airway obstruction (NAO) due to nasal anatomic deformities is known to be more common among cleft patients than the general population, yet information is lacking regarding severity and variability of cleft-associated nasal obstruction relative to other conditions causing NAO. This preliminary study compares differences in NAO experienced by unilateral cleft lip nasal deformity (uCLND) subjects with noncleft subjects experiencing NAO. Methods:Computational modeling techniques based on patient-specific computed tomography images were used to quantify the nasal airway anatomy and airflow dynamics in 21 subjects: 5 healthy normal subjects; 8 noncleft NAO subjects; and 8 uCLND subjects. Outcomes reported include Nasal Obstruction Symptom Evaluation (NOSE) scores, cross-sectional area, and nasal resistance. Results:uCLND subjects had significantly larger cross-sectional area differences between the left and right nasal cavities at multiple cross sections compared with normal and NAO subjects. Median and interquartile range (IQR) NOSE scores between NAO and uCLND were 75 (IQR = 22.5) and 67.5 (IQR = 30), respectively. Airflow partition difference between both cavities were: median = 9.4%, IQR = 10.9% (normal); median = 31.9%, IQR = 25.0% (NAO); and median = 29.9%, IQR = 44.1% (uCLND). Median nasal resistance difference between left and right nasal cavities were 0.01 pa.s/ml (IQR = 0.03 pa.s/ml) for normal, 0.09 pa.s/ml (IQR = 0.16 pa.s/ml) for NAO and 0.08 pa.s/ml (IQR = 0.25 pa.s/ml) for uCLND subjects. Conclusions:uCLND subjects demonstrated significant asymmetry between both sides of the nasal cavity. Furthermore, there exists substantial disproportionality in flow partition difference and resistance difference between cleft and noncleft sides among uCLND subjects, suggesting that both sides may be dysfunctional.
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Frank-Ito, Dennis O, David J Carpenter, Tracy Cheng, Yash J Avashia, David A Brown, Adam Glener, Alexander Allori, Jeffrey R Marcus, et al. (2019). Computational Analysis of the Mature Unilateral Cleft Lip Nasal Deformity on Nasal Patency. Plastic and reconstructive surgery. Global open, 7(5). p. e2244. 10.1097/GOX.0000000000002244 Retrieved from https://hdl.handle.net/10161/19250.
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Scholars@Duke
Dennis Onyeka Frank-Ito
My research interests include modeling the effects of human airway anatomy on respiratory airflow patterns, deposition of inhaled gases and particle transport using computational fluid dynamics.
David Andrew Brown
David A. Brown, M.D., Ph.D. is Associate Professor of Surgery and Vice Chief of Research in the Division of Plastic, Maxillofacial, and Oral Surgery at Duke University. Dr. Brown is originally from Colorado and studied engineering at the University of Colorado followed by a Ph.D. in biomedical engineering at UCLA. He subsequently attended medical school at UC Irvine and went on to complete general surgery residency at University of Washington Medical Center followed by plastic surgery residency at Duke University Medical Center. Dr. Brown practices general reconstructive surgery, including the surgical treatment of skin defects resulting from cancer, infection, and trauma. His clinical interests include targeted muscle reinnervation and soft tissue reconstruction of the back. He is an NIH-funded researcher exploring mechanisms of limb and digit regeneration in mammals with the hope of one day applying regeneration-based therapies to human diseases. He is the medical director of the Duke Wound Healing Clinic and co-director of the Duke Regeneration Center. Dr. Brown is a Fellow of the American College of Surgeons and is board-certified by the American Board of Surgery, the American Board of Plastic Surgery, and the American Board of Wound Management.
Alexander C Allori
Pediatric plastic and craniofacial surgeon, taking care of children with cleft lip/palate and other facial differences.
Dedicated to the improvement of multidisciplinary team-based care, especially by way of standardized, prospective outcomes measurement ("If you don't measure it, you can't improve it.")
Passionate about using causal inference methods to improve observational studies.
Jeffrey Robert Marcus
My research parallels our specialized clinical programs at Duke. I am involved in clinical research looking comprehensively at outcomes of cleft care to develop standards for evaluating a team’s overall success. Based on a recent grant from the Centers for Disease Control (CDC), we are also participating with several centers to look specifically at academic, psychosocial, and surgical outcomes for all children with clefts born in North Carolina. We are committed to the technique of nasoalveolar molding for children with clefts and are engaged in analyzing its benefits. In rhinoplasty, we have developed a model for nasal respiratory physiology, and we are looking at the effects of specific surgical procedures on nasal airflow and resistance. Our Craniofacial imaging lab has developed sophisticated software to analyze cranial shape, and we use these techniques to define abnormal conditions and their treatment relative to normal. Lastly, our craniomaxillofacial trauma team continues to look at factors associated with facial trauma in North Carolina in order to implement techniques and processes to deliver optimal care and results.
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