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Gehret PM, Dumas AA, Jacobs IN, Gottardi R. A Pilot Study of Decellularized Cartilage for Laryngotracheal Reconstruction in a Neonatal Pig Model. Laryngoscope 2024; 134:807-814. [PMID: 37658705 PMCID: PMC11046979 DOI: 10.1002/lary.31017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 06/30/2023] [Accepted: 08/03/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE Severe subglottic stenosis develops as a response to intubation in 1% of the >200,000 neonatal intensive care unit infants per year and may require laryngotracheal reconstruction (LTR) with autologous hyaline cartilage. Although effective, LTR is limited by comorbidities, severity of stenosis, and graft integration. In children, there is a significant incidence of restenosis requiring revision surgery. Tissue engineering has been proposed to develop alterative grafting options to improve outcomes and eliminate donor-site morbidity. Our objective is to engineer a decellularized, channel-laden xenogeneic cartilage graft, that we deployed in a proof-of-concept, neonatal porcine LTR model. METHODS Meniscal porcine cartilage was freeze-thawed and washed with pepsin/elastase to decellularize and create microchannels. A 6 × 10-mm decellularized cartilage graft was then implanted in 4 infant pigs in an anterior cricoid split. Airway patency and host response were monitored endoscopically until sacrifice at 12 weeks, when the construct phenotype, cricoid expansion, mechanics, and histomorphometry were evaluated. RESULTS The selective digestion of meniscal components yielded decellularized cartilage with cell-size channels. After LTR with decellularized meniscus, neonatal pigs were monitored via periodic endoscopy observing re-epithelization, integration, and neocartilage formation. At 12 weeks, the graft appeared integrated and exhibited airway expansion of 4 mm in micro-CT and endoscopy. Micro-CT revealed a larger lumen compared with age-matched controls. Finally, histology showed significant neocartilage formation. CONCLUSION Our neonatal porcine LTR model with a decellularized cartilage graft is a novel approach to tissue engineered pediatric LTR. This pilot study sets the stage for "off-the-shelf" graft procurement and future optimization of MEND for LTR. LEVEL OF EVIDENCE NA Laryngoscope, 134:807-814, 2024.
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Affiliation(s)
- Paul M Gehret
- Department of Surgery, Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Alexandra A Dumas
- Department of Surgery, Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Ian N Jacobs
- Department of Surgery, Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
- Department of Otorhinolaryngology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Riccardo Gottardi
- Department of Surgery, Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Department of Otorhinolaryngology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Department of Orthopaedic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Ri.MED Foundation, Palermo, Italy
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2
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Open paediatric laryngotracheal reconstruction: a five-year experience at a tertiary referral centre. J Laryngol Otol 2023; 137:192-199. [PMID: 35057879 DOI: 10.1017/s0022215121004217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Laryngotracheal reconstruction with costal cartilage graft is a cornerstone procedure in treatment of multiple paediatric airway pathologies. The current study aimed to report on the experience of laryngotracheal reconstruction and document post-operative outcomes and complications. METHOD Records of laryngotracheal reconstruction procedures performed between 2016 and 2020 were retrospectively reviewed. Primary indication, clinical data, decannulation rate, voice assessment, need for revision surgery and possible complications were analysed. RESULTS A total of 41 patients were treated with laryngotracheal reconstruction. Subglottic stenosis formed the largest percentage of cases followed by congenital glottic web (20 and 14 patients, respectively). Three patients (7.3 per cent) underwent single stage surgery, and the remaining cases had a double stage procedure. Revision laryngotracheal reconstruction was needed in a single case, and 38 out of 39 tracheostomised patients were successfully decannulated. CONCLUSION Favourable outcomes were reported with costal cartilage laryngotracheal reconstruction as a definitive treatment for a large range of paediatric airway problems.
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3
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Xu C, Ma Y, Huang H, Ruan Z, Li Y. A Review of Woven Tracheal Stents: Materials, Structures, and Application. J Funct Biomater 2022; 13:jfb13030096. [PMID: 35893464 PMCID: PMC9326637 DOI: 10.3390/jfb13030096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/30/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022] Open
Abstract
The repair and reconstruction of tracheal defects is a challenging clinical problem. Due to the wide choice of materials and structures, weaving technology has shown unique advantages in simulating the multilayer structure of the trachea and providing reliable performance. Currently, most woven stent-based stents focus only on the effect of materials on stent performance while ignoring the direct effect of woven process parameters on stent performance, and the advantages of weaving technology in tissue regeneration have not been fully exploited. Therefore, this review will introduce the effects of stent materials and fabric construction on the performance of tracheal stents, focusing on the effects of weaving process parameters on stent performance. We will summarize the problems faced by woven stents and possible directions of development in the hope of broadening the technical field of artificial trachea preparation.
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Affiliation(s)
- Chen Xu
- College of Textiles, Donghua University, Shanghai 201620, China; (C.X.); (Y.M.)
| | - Yanxue Ma
- College of Textiles, Donghua University, Shanghai 201620, China; (C.X.); (Y.M.)
| | - Haihua Huang
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai 200080, China;
| | - Zheng Ruan
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai 200080, China;
- Correspondence: (Z.R.); (Y.L.)
| | - Yuling Li
- College of Textiles, Donghua University, Shanghai 201620, China; (C.X.); (Y.M.)
- Correspondence: (Z.R.); (Y.L.)
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4
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Niermeyer WL, Rodman C, Li MM, Chiang T. Tissue engineering applications in otolaryngology-The state of translation. Laryngoscope Investig Otolaryngol 2020; 5:630-648. [PMID: 32864434 PMCID: PMC7444782 DOI: 10.1002/lio2.416] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/06/2020] [Accepted: 05/11/2020] [Indexed: 12/14/2022] Open
Abstract
While tissue engineering holds significant potential to address current limitations in reconstructive surgery of the head and neck, few constructs have made their way into routine clinical use. In this review, we aim to appraise the state of head and neck tissue engineering over the past five years, with a specific focus on otologic, nasal, craniofacial bone, and laryngotracheal applications. A comprehensive scoping search of the PubMed database was performed and over 2000 article hits were returned with 290 articles included in the final review. These publications have addressed the hallmark characteristics of tissue engineering (cellular source, scaffold, and growth signaling) for head and neck anatomical sites. While there have been promising reports of effective tissue engineered interventions in small groups of human patients, the majority of research remains constrained to in vitro and in vivo studies aimed at furthering the understanding of the biological processes involved in tissue engineering. Further, differences in functional and cosmetic properties of the ear, nose, airway, and craniofacial bone affect the emphasis of investigation at each site. While otolaryngologists currently play a role in tissue engineering translational research, continued multidisciplinary efforts will likely be required to push the state of translation towards tissue-engineered constructs available for routine clinical use. LEVEL OF EVIDENCE NA.
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Affiliation(s)
| | - Cole Rodman
- The Ohio State University College of MedicineColumbusOhioUSA
| | - Michael M. Li
- Department of Otolaryngology—Head and Neck SurgeryThe Ohio State University Wexner Medical CenterColumbusOhioUSA
| | - Tendy Chiang
- Department of OtolaryngologyNationwide Children's HospitalColumbusOhioUSA
- Department of Otolaryngology—Head and Neck SurgeryThe Ohio State University Wexner Medical CenterColumbusOhioUSA
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5
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Abstract
Airway and other head and neck disorders affect hundreds of thousands of patients each year and most require surgical intervention. Among these, congenital deformity that affects newborns is particularly serious and can be life-threatening. In these cases, reconstructive surgery is resolutive but bears significant limitations, including the donor site morbidity and limited available tissue. In this context, tissue engineering represents a promising alternative approach for the surgical treatment of otolaryngologic disorders. In particular, 3D printing coupled with advanced imaging technologies offers the unique opportunity to reproduce the complex anatomy of native ear, nose, and throat, with its import in terms of functionality as well as aesthetics and the associated patient well-being. In this review, we provide a general overview of the main ear, nose and throat disorders and focus on the most recent scientific literature on 3D printing and bioprinting for their treatment.
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Affiliation(s)
- Roberto Di Gesù
- Fondazione Ri.MED, Palermo, Italy.,Department of Pediatrics, Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Abhinav P Acharya
- Department of Chemical Engineering, Arizona State University, Tempe, AZ, USA
| | - Ian Jacobs
- Department of Surgery, Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Riccardo Gottardi
- Fondazione Ri.MED, Palermo, Italy.,Department of Pediatrics, Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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6
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Abstract
The larynx sometimes requires repair and reconstruction due to cancer resection, trauma, stenosis, or developmental disruptions. Bioengineering has provided some scaffolding materials and initial attempts at tissue engineering, especially of the trachea, have been made. The critical issues of providing protection, maintaining a patent airway, and controlling swallowing and phonation, require that the regenerated laryngotracheal cartilages must have mechanical and material properties that closely mimic native tissue. These properties are determined by the cellular and proteomic characteristics of these tissues. However, little is known of these properties for these specific cartilages. This review considers what is known and what issues need to be addressed.
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Affiliation(s)
- Christine M. Pauken
- Head and Neck Regeneration Program, Mayo Clinic Center for Regenerative Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Richard Heyes
- Head and Neck Regeneration Program, Mayo Clinic Center for Regenerative Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - David G. Lott
- Head and Neck Regeneration Program, Mayo Clinic Center for Regenerative Medicine, Mayo Clinic, Phoenix, AZ, USA,David G. Lott, Head and Neck Regeneration Program, Mayo Clinic Center for Regenerative Medicine, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA.
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7
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Ito K, Toma-Hirano M, Yasui T. Successful Posterior Canal Wall Reconstruction with Tissue-Engineered Cartilage. OTO Open 2019; 3:2473974X19825628. [PMID: 31236535 PMCID: PMC6572918 DOI: 10.1177/2473974x19825628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 11/14/2018] [Accepted: 12/21/2018] [Indexed: 11/24/2022] Open
Abstract
Difficulties are associated with reconstruction of middle ear bony structures in surgery for destructive lesions, including cholesteatoma. Although autologous cartilage appears to be the optimal choice because of its resistance to infection, the harvesting of sufficient volumes may be challenging. Therefore, regenerative medicine techniques to obtain sufficient material for reconstruction are awaited. We herein present a case of middle ear surgery for cholesteatoma with a sufficient volume of stick-shaped tissue-engineered cartilage produced from a piece of autologous auricular cartilage and autologous serum, with sufficient firmness to reconstruct bony structures. During surgery, sections of tissue-engineered cartilage were placed side by side to reconstruct the posterior canal wall. The postoperative course was uneventful. This is the first-in-human report of reconstructing middle ear bony structures with tissue-engineered cartilage. The results suggest a promising future for the satisfactory reconstruction of middle ear structures with minimal morbidity at the donor site.
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Affiliation(s)
- Ken Ito
- Department of Otolaryngology, Faculty of
Medicine, Teikyo University, Tokyo, Japan
| | - Makiko Toma-Hirano
- Department of Otolaryngology, Faculty of
Medicine, Teikyo University, Tokyo, Japan
| | - Takuya Yasui
- Department of Otolaryngology, Faculty of
Medicine, Teikyo University, Tokyo, Japan
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8
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Milner TD, Okhovat S, Clement WA, Wynne DM, Kunanandam T. A systematic review of simulated laryngotracheal reconstruction animal models. Laryngoscope 2018; 129:235-243. [PMID: 30325036 DOI: 10.1002/lary.27288] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Review of the literature to identify practical, high-fidelity, commercially available animal models for simulation training and surgical skills maintenance in laryngotracheal reconstruction (LTR). METHODS A systematic review of PubMed and Embase databases was conducted independently by two authors, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Search terms included "laryngotracheal reconstruction," "laryngotracheoplasty," "pig and larynx," "sheep and larynx," and "rabbit and larynx." Articles were then assessed, identifying model cost and availability, model validation, feasibility as a training tool, and verisimilitude to pediatric LTR. RESULTS In total, 79 articles were considered suitable for inclusion in the study, incorporating both in vitro and in vivo models. Models utilized included rabbit (n = 69), pig (n = 7), sheep (n = 1), and goat (n = 2). The rabbit model was similar in size to the neonate, but differences in laryngeal anatomy and cartilage texture made graft insertion difficult. The anatomy of the pig, sheep, and goat larynges more closely resembled the pediatric patient, allowing improved grafting, but corresponded more in size to that of an older child. Commercial availability of the pig and sheep was considered greatest, and was reflected in cost. None of the animal models identified in the literature have been validated as a simulation tool. CONCLUSIONS The rabbit, sheep and pig models seemed to demonstrate the greatest potential for use as advanced pediatric airway surgery simulation models, with the rabbit model being most utilized in the literature. However, as yet there have been no models formally validated as a simulation training tool. Laryngoscope, 129:235-243, 2019.
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Affiliation(s)
- Thomas D Milner
- Department of Otolaryngology-Head and Neck Surgery, Royal Hospital for Children, Glasgow, United Kingdom
| | - Saleh Okhovat
- Department of Otolaryngology-Head and Neck Surgery, Royal Hospital for Children, Glasgow, United Kingdom
| | - William A Clement
- Department of Otolaryngology-Head and Neck Surgery, Royal Hospital for Children, Glasgow, United Kingdom
| | - David M Wynne
- Department of Otolaryngology-Head and Neck Surgery, Royal Hospital for Children, Glasgow, United Kingdom
| | - Thushitha Kunanandam
- Department of Otolaryngology-Head and Neck Surgery, Royal Hospital for Children, Glasgow, United Kingdom
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9
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Balakrishnan K, Sidell DR, Bauman NM, Bellia-Munzon GF, Boesch RP, Bromwich M, Cofer SA, Daines C, de Alarcon A, Garabedian N, Hart CK, Ida JB, Leboulanger N, Manning PB, Mehta DK, Monnier P, Myer CM, Prager JD, Preciado D, Propst EJ, Rahbar R, Russell J, Rutter MJ, Thierry B, Thompson DM, Torre M, Varela P, Vijayasekaran S, White DR, Wineland AM, Wood RE, Wootten CT, Zur K, Cotton RT. Outcome measures for pediatric laryngotracheal reconstruction: International consensus statement. Laryngoscope 2018; 129:244-255. [DOI: 10.1002/lary.27445] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/29/2018] [Accepted: 06/21/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Karthik Balakrishnan
- Department of Otorhinolaryngology and Mayo Clinic Children's Center; Rochester Minnesota
| | - Douglas R. Sidell
- Department of Otolaryngology-Head and Neck Surgery; Stanford University; Palo Alto California
| | - Nancy M. Bauman
- Division of Otolaryngology, Children's National Health System; Washington DC
| | - Gaston F. Bellia-Munzon
- Department of Pediatric Surgery; General Hospital of Children Pedro de Elizalde; Buenos Aires Argentina
| | - R. Paul Boesch
- Department of Pediatric and Adolescent Medicine and Mayo Clinic Children's Center; Mayo Clinic; Rochester Minnesota
| | | | - Shelagh A. Cofer
- Department of Otorhinolaryngology and Mayo Clinic Children's Center; Rochester Minnesota
| | - Cori Daines
- Department of Pediatrics; University of Arizona Health Sciences; Tucson Arizona
| | - Alessandro de Alarcon
- Division of Pediatric Otolaryngology and Aerodigestive and Esophageal Center; Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine; Cincinnati Ohio
| | - Nöel Garabedian
- Department of Otorhinolaryngology; Hôpital Universitaire Necker-Enfants Malades; Paris France
| | - Catherine K. Hart
- Division of Pediatric Otolaryngology and Aerodigestive and Esophageal Center; Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine; Cincinnati Ohio
| | - Jonathan B. Ida
- Department of Otolaryngology, Head and Neck Surgery; Northwestern University Feinberg School of Medicine; Chicago Illinois
| | - Nicolas Leboulanger
- Department of Otorhinolaryngology; Hôpital Universitaire Necker-Enfants Malades; Paris France
| | - Peter B. Manning
- Section of Pediatric Cardiothoracic Surgery; St. Louis Children's Hospital and Washington University School of Medicine; St. Louis Missouri
| | - Deepak K. Mehta
- Department of Pediatric Otolaryngology; Texas Children's Hospital; Houston Texas
| | - Philippe Monnier
- Department of Otolaryngology, Head and Neck Surgery; University Hospital of Lausanne (CHUV); Lausanne Switzerland
| | - Charles M. Myer
- Division of Pediatric Otolaryngology and Aerodigestive and Esophageal Center; Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine; Cincinnati Ohio
| | - Jeremy D. Prager
- Department of Otolaryngology; University of Colorado; Aurora Colorado
| | - Diego Preciado
- Division of Otolaryngology, Children's National Health System; Washington DC
| | - Evan J. Propst
- Department of Otolaryngology-Head & Neck Surgery, Hospital for Sick Children; University of Toronto; Toronto Ontario Canada
| | - Reza Rahbar
- Department of Otolaryngology; Boston Children's Hospital, Harvard Medical School; Boston Massachusetts
| | - John Russell
- Department of Paediatric Otolaryngology; Our Lady's Hospital for Sick Children; Dublin Ireland
| | - Michael J. Rutter
- Division of Pediatric Otolaryngology and Aerodigestive and Esophageal Center; Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine; Cincinnati Ohio
| | - Briac Thierry
- Department of Otorhinolaryngology; Hôpital Universitaire Necker-Enfants Malades; Paris France
| | - Dana M. Thompson
- Department of Otolaryngology, Head and Neck Surgery; Northwestern University Feinberg School of Medicine; Chicago Illinois
| | - Michele Torre
- Airway Team and Surgical Department; Instituto Giannina Gaslini; Genoa Italy
| | - Patricio Varela
- Pediatric Surgery Department; University of Chile, Clinical Las Condes Medical Center; Santiago Chile
| | - Shyan Vijayasekaran
- Department of Otolaryngology, Head and Neck Surgery; Princess Margaret Hospital for Children; Perth Australia
| | - David R. White
- Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston South Carolina
| | - Andre M. Wineland
- University of Arkansas School for Medical Sciences; Department of Otolaryngology-Head & Neck Surgery, Arkansas Children's Hospital; Little Rock Arkansas
| | - Robert E. Wood
- Division of Pulmonary Medicine, Cincinnati Children's Hospital; Cincinnati Ohio
| | | | - Karen Zur
- Center for Pediatric Airway Disorders, Children's Hospital of Philadelphia, Perelman School of Medicine; University of Pennsylvania; Philadelphia Pennsylvania U.S.A
| | - Robin T. Cotton
- Division of Pediatric Otolaryngology and Aerodigestive and Esophageal Center; Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine; Cincinnati Ohio
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10
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Beyond dilation: current concepts in endoscopic airway stenting and reconstruction. Curr Opin Otolaryngol Head Neck Surg 2018; 24:516-521. [PMID: 27636982 DOI: 10.1097/moo.0000000000000310] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW To discuss current modalities of endoscopic airway management beyond balloon dilation therapy. RECENT FINDINGS Advances continue to be made through technology and bioengineering with exciting potential in the pediatric airway. Smaller robots and instrumentation allow increased endoscopic surgical success. Biodegradable stents and bioengineered grafts are on the horizon for use in airway surgery. Dysphonia following airway reconstruction is of increasing recognition with new endoscopic treatments being performed. Supraglottoplasty is further recognized as a treatment for obstructive sleep apnea for laryngomalacia diagnosed on sleep endoscopy. Interarytenoid injection may be beneficial in the normal larynx for aspiration and dysphagia as well as diagnosing and treating type I laryngeal clefts. SUMMARY Endoscopic airway surgery continues to be a popular and effective method of treating the pediatric airway. Technological advances such as in robotics may have an increasing role in the future of endoscopic airway surgery in children. Bioengineered airway adjuncts including biodegradable airway stents look to be promising in the future treatment of airway stenosis.
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11
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13-93B3 Bioactive Glass: a New Scaffold for Transplantation of Stem Cell-Derived Chondrocytes. J Craniofac Surg 2018; 29:233-236. [DOI: 10.1097/scs.0000000000004037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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12
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Abstract
PURPOSE OF REVIEW Tissue engineering is a rapidly expanding field in medicine and involves regeneration and restoration of many organs, including larynx and the airways. Currently, this is not included in routine practice; however, a number of clinical trials in humans are ongoing or starting. This review will cover publications during the past 2 years and the focus is on larynx and trachea. RECENT FINDINGS Recent reports concern the development and investigations of cell therapies, including biological factors such as growth factors which promote healing of damage and increased vascular support of the tissue. A separate section concerns studies of stromal cells and stem cells in tissue engineering. Cell therapies and treatment with biological active factors are often combined with the development of scaffolds to support or reconstruct the soft tissue in the larynx or the cartilages in trachea or larynx. New techniques for scaffold construction, such as 3D printing, are developed. The trend in the recent publications is to combine these methods. SUMMARY Recent advances in tissue engineering of the larynx and trachea include the development of cell therapies or treatment with biological active factors often in combination with scaffolds.
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Lange P, Shah H, Birchall M, Sibbons P, Ansari T. Characterization of a biologically derived rabbit tracheal scaffold. J Biomed Mater Res B Appl Biomater 2016; 105:2126-2135. [PMID: 27417155 DOI: 10.1002/jbm.b.33741] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 05/06/2016] [Accepted: 06/20/2016] [Indexed: 12/12/2022]
Abstract
There is a clinical need to provide replacement tracheal tissue for the pediatric population affected by congenital defects, as current surgical solutions are not universally applicable. A potential solution is to use tissue engineered scaffold as the framework for regenerating autologous tissue. Rabbit trachea were used and different detergents (Triton x-100 and sodium deoxycholate) and enzymes (DNAse/RNAse) investigated to create a decellularization protocol. Each reagent was initially tested individually and the outcome used to design a combined protocol. At each stage the resultant scaffold was assessed histologically, molecularly for acellularity and matrix preservation. Immunogenicity of the final scaffold was assessed by implantation into a rat model for 4 weeks. Both enzymes and detergents were required to produce a completely acellular (DNA content 42.78 ng/mg) scaffold with preserved collagen and elastin however, GAG content were reduced (8.78 ± 1.35 vs. 5.5 ± 4.8). Following in vivo implantation the scaffold elicited minimal immune response and showed significant cellular infiltration and vasculogenesis. The luminal aspect of the implanted scaffold showed infiltration of host derived cells, which were positive for pan cytokeratin. It is possible to create biologically derived biocompatible scaffolds to address specific pediatric clinical problems. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 2126-2135, 2017.
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Affiliation(s)
- P Lange
- Department of Surgical Research, NPIMR, Watford Rd, Harrow, HA1 3UJ, UK.,UCL Ear Institute, Royal National Throat Nose and Ear Hospital, London, WC1 8DA, UK
| | - H Shah
- Department of Surgical Research, NPIMR, Watford Rd, Harrow, HA1 3UJ, UK
| | - M Birchall
- UCL Ear Institute, Royal National Throat Nose and Ear Hospital, London, WC1 8DA, UK
| | - P Sibbons
- Department of Surgical Research, NPIMR, Watford Rd, Harrow, HA1 3UJ, UK
| | - T Ansari
- Department of Surgical Research, NPIMR, Watford Rd, Harrow, HA1 3UJ, UK
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14
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Heterogeneity of Scaffold Biomaterials in Tissue Engineering. MATERIALS 2016; 9:ma9050332. [PMID: 28773457 PMCID: PMC5503070 DOI: 10.3390/ma9050332] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 04/23/2016] [Accepted: 04/26/2016] [Indexed: 12/20/2022]
Abstract
Tissue engineering (TE) offers a potential solution for the shortage of transplantable organs and the need for novel methods of tissue repair. Methods of TE have advanced significantly in recent years, but there are challenges to using engineered tissues and organs including but not limited to: biocompatibility, immunogenicity, biodegradation, and toxicity. Analysis of biomaterials used as scaffolds may, however, elucidate how TE can be enhanced. Ideally, biomaterials should closely mimic the characteristics of desired organ, their function and their in vivo environments. A review of biomaterials used in TE highlighted natural polymers, synthetic polymers, and decellularized organs as sources of scaffolding. Studies of discarded organs supported that decellularization offers a remedy to reducing waste of donor organs, but does not yet provide an effective solution to organ demand because it has shown varied success in vivo depending on organ complexity and physiological requirements. Review of polymer-based scaffolds revealed that a composite scaffold formed by copolymerization is more effective than single polymer scaffolds because it allows copolymers to offset disadvantages a single polymer may possess. Selection of biomaterials for use in TE is essential for transplant success. There is not, however, a singular biomaterial that is universally optimal.
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