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Al-Zanoon N, Cummine J, Jeffery CC, Westover L, Aalto D. The effect of simulated radiation induced fibrosis on tongue protrusion. Biomech Model Mechanobiol 2024:10.1007/s10237-024-01860-4. [PMID: 38869655 DOI: 10.1007/s10237-024-01860-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/14/2024] [Indexed: 06/14/2024]
Abstract
Radiation therapy (RT) is an important adjuvant and primary treatment modality for head and neck cancers. A severe side effect of RT is fibrosis or scarring of muscle tissues of the oral cavity including the tongue. Previous studies have demonstrated that increased radiation doses to the oral cavity structures have led to decrements in function, hypothesized to result from changes in muscle tissue properties that affect the tongue's function. To understand the complex relationship between tongue muscle fibrosis and tongue function, the current study used a virtual biomechanical model of the tongue. Fibrosis parameters including density (high, low), area (large, small) and location (946 node centres) were systematically varied in the model to test its impact on a target tongue tip motion (protrusion). The impact of fibrosis lesion parameters on three directional components of the tip (anterior-inferior, lateral-medial, and superior-inferior) were analyzed using multi linear regression models. Increases in density and area of fibrosis significantly predicted tongue protrusion movements compared to baseline. In the anterior-posterior direction, reductions in the tongue protrusion were observed. In the inferior-superior direction, the tongue height remained above baseline for the majority of cases. In the lateral-medial direction, ipsilateral deviations were observed. The location of fibrosis modulated these three main effects by either amplifying the observed effect or minimizing it. The findings support the hypothesis that changes in muscle tissue properties because of fibrosis impact tongue function. Increases in density and area of fibrosis impact key muscles in the target motion. The range of modulating effects of the lesion location (i.e., either amplifying or minimizing certain impact patterns) highlights the intricacy of tongue anatomy/soft tissue biomechanics and may suggest that lesions in any location will compromise the tongue's movement.
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Affiliation(s)
- Noor Al-Zanoon
- Department of Communication Sciences and Disorders, University of Alberta, Rehabilitation Medicine, Edmonton, AB, Canada.
| | - Jacqueline Cummine
- Department of Communication Sciences and Disorders, University of Alberta, Rehabilitation Medicine, Edmonton, AB, Canada
| | - Caroline C Jeffery
- Department of Communication Sciences and Disorders, University of Alberta, Rehabilitation Medicine, Edmonton, AB, Canada
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Lindsey Westover
- Department of Biomedical Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB, Canada
- Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB, Canada
| | - Daniel Aalto
- Department of Communication Sciences and Disorders, University of Alberta, Rehabilitation Medicine, Edmonton, AB, Canada
- Institute for Reconstructive Sciences in Medicine (iRSM), Misericordia Community Hospital, Edmonton, AB, Canada
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Kappert KDR, Voskuilen L, Smeele LE, Balm AJM, Jasperse B, Nederveen AJ, van der Heijden F. Personalized biomechanical tongue models based on diffusion-weighted MRI and validated using optical tracking of range of motion. Biomech Model Mechanobiol 2021; 20:1101-1113. [PMID: 33682028 PMCID: PMC8154835 DOI: 10.1007/s10237-021-01435-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 02/11/2021] [Indexed: 12/13/2022]
Abstract
For advanced tongue cancer, the choice between surgery and organ-sparing treatment is often dependent on the expected loss of tongue functionality after treatment. Biomechanical models might assist in this choice by simulating the post-treatment function loss. However, this function loss varies between patients and should, therefore, be predicted for each patient individually. In the present study, the goal was to better predict the postoperative range of motion (ROM) of the tongue by personalizing biomechanical models using diffusion-weighted MRI and constrained spherical deconvolution reconstructions of tongue muscle architecture. Diffusion-weighted MRI scans of ten healthy volunteers were obtained to reconstruct their tongue musculature, which were subsequently registered to a previously described population average or atlas. Using the displacement fields obtained from the registration, the segmented muscle fiber tracks from the atlas were morphed back to create personalized muscle fiber tracks. Finite element models were created from the fiber tracks of the atlas and those of the individual tongues. Via inverse simulation of a protruding, downward, left and right movement, the ROM of the tongue was predicted. This prediction was compared to the ROM measured with a 3D camera. It was demonstrated that biomechanical models with personalized muscles bundles are better in approaching the measured ROM than a generic model. However, to achieve this result a correction factor was needed to compensate for the small magnitude of motion of the model. Future versions of these models may have the potential to improve the estimation of function loss after treatment for advanced tongue cancer.
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Affiliation(s)
- K D R Kappert
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. .,Department of Robotics and Mechatronics, Faculty of EEMCS, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
| | - L Voskuilen
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Academic Centre for Dentistry Amsterdam and Amsterdam UMC, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| | - L E Smeele
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A J M Balm
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Robotics and Mechatronics, Faculty of EEMCS, Technical Medical Centre, University of Twente, Enschede, The Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - B Jasperse
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - A J Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - F van der Heijden
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Robotics and Mechatronics, Faculty of EEMCS, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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Calka M, Perrier P, Ohayon J, Grivot-Boichon C, Rochette M, Payan Y. Machine-Learning based model order reduction of a biomechanical model of the human tongue. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 198:105786. [PMID: 33059060 DOI: 10.1016/j.cmpb.2020.105786] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 09/30/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVES This paper presents the results of a Machine-Learning based Model Order Reduction (MOR) method applied to a complex 3D Finite Element (FE) biomechanical model of the human tongue, in order to create a Digital Twin Model (DTM) that enables real-time simulations. The DTM is designed for future inclusion in a computer assisted protocol for tongue surgery planning. METHODS The proposed method uses an "a posteriori" MOR that allows, from a limited number of simulations with the FE model, to predict in real time mechanical responses of the human tongue to muscle activations. RESULTS The MOR method is evaluated for simulations associated with separate single tongue muscle activations. It is shown to be able to account with a sub-millimetric spatial accuracy for the non-linear dynamical behavior of the tongue model observed in these simulations. CONCLUSION Further evaluations of the MOR method will include tongue movements induced by multiple muscle activations. At this stage our MOR method offers promising perspectives for the use of the tongue model in a clinical context to predict the impact of tongue surgery on tongue mobility. As a long term application, this DTM of the tongue could be used to predict the functional consequences of the surgery in terms of speech production and swallowing.
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Affiliation(s)
- Maxime Calka
- Univ. Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble F-38000, France; Univ. Grenoble Alpes, CNRS, Grenoble INP, GIPSA-lab, Grenoble F-38000, France; ANSYS, Villeurbanne F-69100, France.
| | - Pascal Perrier
- Univ. Grenoble Alpes, CNRS, Grenoble INP, GIPSA-lab, Grenoble F-38000, France
| | - Jacques Ohayon
- Univ. Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble F-38000, France; Savoie Mont-Blanc University, Polytech Annecy-Chambéry, Le Bourget du Lac 73376, France
| | | | | | - Yohan Payan
- Univ. Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble F-38000, France
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Kappert KDR, Connesson N, Elahi SA, Boonstra S, Balm AJM, van der Heijden F, Payan Y. In-vivo tongue stiffness measured by aspiration: Resting vs general anesthesia. J Biomech 2020; 114:110147. [PMID: 33276256 DOI: 10.1016/j.jbiomech.2020.110147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 11/16/2020] [Accepted: 11/21/2020] [Indexed: 11/29/2022]
Abstract
Tongue cancer treatment often results in impaired speech, swallowing, or mastication. Simulating the effect of treatments can help the patient and the treating physician to understand the effects and impact of the intervention. To simulate deformations of the tongue, identifying accurate mechanical properties of tissue is essential. However, not many succeeded in characterizing in-vivo tongue stiffness. Those who did, measured the tongue At Rest (AR), in which muscle tone subsides even if muscles are not willingly activated. We expected to find an absolute rest state in participants 'under General Anesthesia' (GA). We elaborated on previous work by measuring the mechanical behavior of the in-vivo tongue under aspiration using an improved volume-based method. Using this technique, 5 to 7 measurements were performed on 10 participants both AR and under GA. The obtained Pressure-Shape curves were first analyzed using the initial slope and its variations. Hereafter, an inverse Finite Element Analysis (FEA) was applied to identify the mechanical parameters using the Yeoh, Gent, and Ogden hyperelastic models. The measurements AR provided a mean Young's Modulus of 1638 Pa (min 1035 - max 2019) using the Yeoh constitutive model, which is in line with previous ex-vivo measurements. However, while hoping to find a rest state under GA, the tongue unexpectedly appeared to be approximately 2 to 2.5 times stiffer under GA than AR. Explanations for this were sought by examining drugs administered during GA, blood flow, perfusion, and upper airway reflexes, but neither of these explanations could be confirmed.
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Affiliation(s)
- K D R Kappert
- Head & Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands; Robotics and Mechatronics, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
| | - N Connesson
- TIMC-IMAG Laboratory, University Grenoble Alpes & CNRS, Grenoble, France
| | - S A Elahi
- Human Movement Science Department, Mechanical Engineering Department, KU Leuven, Leuven, Belgium
| | - S Boonstra
- Head & Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands; Robotics and Mechatronics, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - A J M Balm
- Head & Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands; Robotics and Mechatronics, Technical Medical Centre, University of Twente, Enschede, The Netherlands; Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - F van der Heijden
- Head & Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands; Robotics and Mechatronics, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Y Payan
- TIMC-IMAG Laboratory, University Grenoble Alpes & CNRS, Grenoble, France
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Kappert KDR, van Dijk S, Wellenstein D, van Alphen MJA, van Son RJJH, Smeele LE, Balm AJM. Five Specific Tongue Movements in a Healthy Population. Dysphagia 2020; 36:736-742. [PMID: 33040201 PMCID: PMC8289788 DOI: 10.1007/s00455-020-10195-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 09/28/2020] [Indexed: 11/29/2022]
Abstract
The importance of tongue mobility on speech, oral food transport, and swallowing is well recognized. However, whether the individual tongue mobility influences postoperative function in oral cancer treatment remains to be elucidated. This study assesses the ability to perform five tongue movements as rolling, twisting (two sides), folding, and the 'cloverleaf' in a healthy population. Because a tumor in oral cancer patients often restricts the mobility of the tongue, it might be helpful to know if it is possible to recall any of those movements without demonstrating it. Two observers asked 387 Dutch healthy adults if they could perform one of the five specific tongue movements and were subsequently asked to demonstrate the five movements. The distribution in the Dutch population is: rolling: 83.7%, cloverleaf: 14.7%, folding: 27.5%, twisting left: 36.1% and twisting right: 35.6%. The percentage of people that can fold their tongue is almost ten times higher (3% versus 27.5%) than in previous research, and it was found that the ability to roll the tongue is not a prerequisite for folding of the tongue. A relationship between gender or right-handedness and the ability to perform certain tongue movements could not be found. Of the participants, 9.9% and 13.1% incorrectly assumed that they could demonstrate tongue rolling and cloverleaf. Tongue folding and twisting (left or right) were incorrectly assumed in 36.9%, 24.1%, and 25.4% of the cases. Rolling and cloverleaf are preferred for future prediction models because these movements are easy to recall without demonstrating.
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Affiliation(s)
- Kilian D R Kappert
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. .,Robotics and Mechatronics, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
| | - Simone van Dijk
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - David Wellenstein
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Maarten J A van Alphen
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Rob J J H van Son
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Amsterdam Center for Language and Communication, Universtiy of Amsterdam, Amsterdam, The Netherlands
| | - Ludi E Smeele
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Alfons J M Balm
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
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Kappert KDR, van Alphen MJA, Smeele LE, Balm AJM, van der Heijden F. Quantification of tongue mobility impairment using optical tracking in patients after receiving primary surgery or chemoradiation. PLoS One 2019; 14:e0221593. [PMID: 31454385 PMCID: PMC6711543 DOI: 10.1371/journal.pone.0221593] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 08/10/2019] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Tongue mobility has shown to be a clinically interesting parameter on functional results after tongue cancer treatment which can be objectified by measuring the Range Of Motion (ROM). Reliable measurements of ROM would enable us to quantify the severity of functional impairments and use these for shared decision making in treatment choices, rehabilitation of speech and swallowing disturbances after treatment. METHOD Nineteen healthy participants, eighteen post-chemotherapy patients and seventeen post-surgery patients were asked to perform standardized tongue maneuvers in front of a 3D camera system, which were subsequently tracked and corrected for head and jaw motion. Indicators, such as the left-right tongue range and the deflection angle with the horizontal axis were extracted from the tongue trajectory to serve as a quantitative measure for the impaired tongue mobility. RESULTS The range and deflection angle showed an excellent intra- and interrater reliability (ICC 0.9) The repeatability experiment showed an average standard deviation of 2.5 mm to 3.5 mm for every movement, except the upward movement. The post-surgery patient group showed a smaller tongue range and higher deflection angle overall than the healthy participants. Post-chemoradiation patients showed less difference in tongue ROM compared with healthy participants. Only a few patients showed asymmetrical movement after treatment, which could not always be explained by T-stage or the side of treatment alone. CONCLUSION We introduced a reliable and reproducible method for measuring the ROM and to quantify for motion impairments, that was able to show differences in tongue ROM between healthy subjects and patients after chemoradiation or surgery. Future research should focus on measuring patients with oral cancer pre- and post-treatment in combination with the collection of detailed information about the individual tongue anatomy, so that the full ROM trajectory can be used to identify changes over time and to quantify functional impairment.
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Affiliation(s)
- K. D. R. Kappert
- Head & Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
- * E-mail:
| | - M. J. A. van Alphen
- Head & Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - L. E. Smeele
- Head & Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A. J. M. Balm
- Head & Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
- Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - F. van der Heijden
- Head & Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
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