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Analysis of Upper Airway Flow Dynamics in Robin Sequence Infants Using 4-D Computed Tomography and Computational Fluid Dynamics

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Abstract

Robin Sequence (RS) is a potentially fatal craniofacial condition characterized by undersized jaw, posteriorly displaced tongue, and resultant upper airway obstruction (UAO). Accurate assessment of UAO severity is crucial for management and diagnosis of RS, yet current evaluation modalities have significant limitations and no quantitative measures of airway resistance exist. In this study, we combine 4-dimensional computed tomography and computational fluid dynamics (CFD) to assess, for the first time, UAO severity using fluid dynamic metrics in RS patients. Dramatic intrapopulation differences are found, with the ratio between most and least severe patients in breathing resistance, energy loss, and peak velocity equal to 40:1, 20:1, and 6:1, respectively. Analysis of local airflow dynamics characterized patients as presenting with primary obstructions either at the location of the tongue base, or at the larynx, with tongue base obstructions resulting in a more energetic stenotic jet and greater breathing resistance. Finally, CFD-derived flow metrics are found to correlate with the level of clinical respiratory support. Our results highlight the large intrapopulation variability, both in quantitative metrics of UAO severity (resistance, energy loss, velocity) and in the location and intensity of stenotic jets for RS patients. These results suggest that computed airflow metrics may significantly improve our understanding of UAO and its management in RS.

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Acknowledgments

This research was supported by a National Institute of Health T-32 training Grant (NIH 5T32DC000018-38).

Conflict of interest

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

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Authors and Affiliations

  1. Department of Mechanical Engineering, University of Washington, 4625 Union Bay PL NE, Seattle, WA, 98105, USA

    Michael Barbour & Alberto Aliseda

  2. Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA, USA

    Clare Richardson, Randall Bly & John P. Dahl

  3. Division of Pediatric Otolaryngology, Seattle Children’s Hospital, Seattle, WA, USA

    Clare Richardson, Randall Bly & John P. Dahl

  4. Department of Radiology, Seattle Children’s Hospital, Seattle, WA, USA

    Mike Bindschadler

  5. Center for Clinical and Translational Research, Seattle Children’s Hospital, Seattle, WA, USA

    Seth Friedman

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  1. Michael Barbour
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Correspondence to Michael Barbour.

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Barbour, M., Richardson, C., Bindschadler, M. et al. Analysis of Upper Airway Flow Dynamics in Robin Sequence Infants Using 4-D Computed Tomography and Computational Fluid Dynamics. Ann Biomed Eng 51, 363–376 (2023). https://doi.org/10.1007/s10439-022-03036-6

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  • DOI: https://doi.org/10.1007/s10439-022-03036-6

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