Quantifying Anatomic Deformations During Laryngoscopy
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For a variety of head and neck cancers, specifically those of the oropharynx, larynx, and hypopharynx, minimally invasive trans-oral approaches have been developed to reduce perioperative and long-term morbidity. However, in trans-oral surgical approaches anatomical deformation due to instrumentation, specifically placement of laryngoscopes and retractors, present a significant challenge for surgeons relying on preoperative imaging to resect tumors to negative margins. Quantifying the deformation due to instrumentation is needed in order to develop predictive models of operative deformation. In order to study this deformation, we used a CT/MR-compatible laryngoscopy system in concert with intraoperative CT imaging. 3D models of preoperative and intraoperative anatomy were generated. Mandible and hyoid displacements as well as tongue deformations were quantified for eight patients undergoing diagnostic laryngoscopy. Across patients, we found on average 1.3 cm of displacement for these anatomic structures due to laryngoscope insertion. On average, the maximum displacement for certain tongue regions exceeded 4 cm. The anatomical deformations quantified here can serve as a reference for describing how the upper aerodigestive tract anatomy changes during instrumentation and may be helpful in developing predictive models of intraoperative upper aerodigestive tract deformation.
KeywordsComputed tomography (CT) Trans-oral surgery (TOS) CT/MR-compatible laryngoscopy system
Magnetic resonance imaging
Trans-oral laser microsurgery
Trans-oral robotic surgery
Anatomical coordinate system defined by the Frankfurt plane5 (auriculo-orbital plane), the mid-sagittal plane, and the vertical porion plane
Iterative closest point algorithm
Singular value decomposition
The authors of the paper would like to thank Michael Pearl and Michaela Whitty for their assistance with the study in the operating room, Ethan Murphy for mathematics consultation, Jiyoo Chang for image segmentation work, and Thayer and DHMC staff for providing technical expertise and use of facilities. This study was supported by the Dartmouth SYNERGY Clinical and Translational Science Institute (UL1TR001096) from the National Center for Advancing Translational Sciences of the National Institutes of Health.
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