To what extent can mastication functionality be restored following mandibular reconstruction surgery? A computer modeling approach.

STATEMENT OF PROBLEM: Advanced cases of head and neck cancer involving the mandible often require surgical removal of diseased sections and subsequent replacement with donor bone. During the procedure, the surgeon must make decisions regarding which bones or tissues to resect. This requires balancing tradeoffs related to issues such as surgical access and post-operative function; however, the latter is often difficult to predict, especially given that long-term functionality also depends on the impact of post-operative rehabilitation programs. PURPOSE: To assist in surgical decision-making, we present an approach for estimating the effects of reconstruction on key aspects of post-operative mandible function. MATERIAL AND METHODS: We develop dynamic biomechanical models of the reconstructed mandible considering different defect types and validate them using literature data. We use these models to estimate the degree of functionality that might be achieved following post-operative rehabilitation. RESULTS: We find significant potential for restoring mandibular functionality, even in cases involving large defects. This entails an average trajectory error below 2 mm, bite force comparable to a healthy individual, improved condyle mobility, and a muscle activation change capped at a maximum of 20%. CONCLUSION: These results suggest significant potential for adaptability in the masticatory system and improved post-operative rehabilitation, leading to greater restoration of jaw function.

Computational models and their applications in biomechanical analysis of mandibular reconstruction surgery.

Advanced head and neck cancers involving the mandible often require surgical removal of the diseased parts and replacement with donor bone or prosthesis to recreate the form and function of the premorbid mandible. The degree to which this reconstruction successfully replicates key geometric features of the original bone critically affects the cosmetic and functional outcomes of speaking, chewing, and breathing. With advancements in computational power, biomechanical modeling has emerged as a prevalent tool for predicting the functional outcomes of the masticatory system and evaluating the effectiveness of reconstruction procedures in patients undergoing mandibular reconstruction surgery. These models offer cost-effective and patient-specific treatment tailored to the needs of individuals. To underscore the significance of biomechanical modeling, we conducted a review of 66 studies that utilized computational models in the biomechanical analysis of mandibular reconstruction surgery. The majority of these studies employed finite element method (FEM) in their approach; therefore, a detailed investigation of FEM has also been provided. Additionally, we categorized these studies based on the main components analyzed, including bone flaps, plates/screws, and prostheses, as well as their design and material composition.

Simulation-based biomechanical assessment of unpowered exoskeletons for running.

Due to the complexity and high degrees of freedom, the detailed assessment of human biomechanics is necessary for the design and optimization of an effective exoskeleton. In this paper, we present full kinematics, dynamics, and biomechanics assessment of unpowered exoskeleton augmentation for human running gait. To do so, the considered case study is the assistive torque profile of I-RUN. Our approach is using some extensive data-driven OpenSim simulation results employing a generic lower limb model with 92-muscles and 29-DOF. In the simulation, it is observed that exoskeleton augmentation leads to [Formula: see text] metabolic rate reduction for the stiffness coefficient of [Formula: see text]. Moreover, this optimum stiffness coefficient minimizes the biological hip moment by [Formula: see text]. The optimum stiffness coefficient ([Formula: see text]) also reduces the average force of four major hip muscles, i.e., Psoas, Gluteus Maximus, Rectus Femoris, and Semimembranosus. The effect of assistive torque profile on the muscles' fatigue is also studied. Interestingly, it is observed that at [Formula: see text], both all 92 lower limb muscles' fatigue and two hip major mono-articular muscles' fatigue have the maximum reduction. This result re-confirm our hypothesis that "reducing the forces of two antagonistic mono-articular muscles is sufficient for involved muscles' total fatigue reduction." Finally, the relation between the amount of metabolic rate reduction and kinematics of hip joint is examined carefully where for the first time, we present a reliable kinematic index for prediction of the metabolic rate reduction by I-RUN augmentation. This index not only explains individual differences in metabolic rate reduction but also provides a quantitative measure for training the subjects to maximize their benefits from I-RUN.