Making Head and Neck Reconstruction Surgery an Engineering Process

Computer modeling and simulation of the human body is rapidly becoming a critical and central tool in a broad range of disciplines, including engineering, education, entertainment, physiology and medicine. Often, these models underpin the goal of transitioning from an artisanal practice to designing and making to an industrial engineering process. One reason for this approach is that designed and simulated models can be thoroughly tested and manufactured by machine to high tolerances, potentially removing much of the guess work when addressing complex human body dynamics and variations. The challenge for researchers is how to create patient-specific models with enough fidelity for in-silico simulation to accurately predict treatment outcomes. To address these challenges, we are developing technology to create dynamic, parametric, multiscale models of human musculoskeletal anatomy that can later be extended to include organ structures and other subsystems. We are working to provide a range, from low-to-high accuracy, of models, including high-resolution bone surfaces and detailed representations of muscle fibre structure and pennation. A significant component of our approach provides 3D finite element (FEM) muscle models coupled with multibody simulation techniques including contact handling and constraints. Our primary modelling effort is for the oral, pharyngeal and laryngeal (OPAL) complex to predict functional outcomes, such as chewing, swallowing and speaking. I report on our progress with our interdisciplinary team of scientific and clinical investigators, and collaborators and iRSM partners, the advances we have made including: an advanced Functional Reference ANatomy Knowledge (FRANK) template of the head and neck that can be registered structurally and functionally to patient-specific data, new techniques for patient-specific registration, liquid bolus simulations in the head and neck models, and a new technique for simulating speech from the biomechanics of the airway. Based on our experiences, I will outline a number of grand challenges that require a community of clinical, scientific and engineering researchers to address before we can transition to patient treatment as an engineered solution.