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Barnett E, Heaton JT, Petrillo RH, Purnell P, Burns JA. Minimizing Thermal Damage During Thulium Laser-Assisted Partial Arytenoidectomy: Pulsed Versus Continuous Cutting in an Ex-Vivo Calf Model. Ann Otol Rhinol Laryngol 2023; 132:1355-1360. [PMID: 36824026 DOI: 10.1177/00034894231157648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
OBJECTIVES The 2 µm-wavelength thulium laser is an effective cutter during partial arytenoidectomy, but thermal trauma can damage adjacent laryngeal tissue. Pulsing laser energy may reduce trauma when compared to continuous-wave cutting. This study measured temperature changes, thermal trauma, and time to complete partial arytenoidectomy, with and without pulsing, in an ex-vivo calf model. METHODS Tissue temperature and time to complete a trans-cartilaginous cut were measured during partial arytenoidectomy on ex-vivo calf vocal folds (N = 24) using a thulium laser in continuous-wave (CW, N = 12) and pulsed-wave (PW, N = 12) modes. Energy was 5 W for CW and PW cuts; pulse-widths were 250, 500, and 750 ms. Thermal damage was analyzed histologically by measuring the depth of lactate dehydrogenase (LDH) inactivation perpendicular to the laser-cut edge at the vocal process. Paired t-tests compared CW and PW modes. RESULTS Change in temperature was lower using CW (6.5°C) compared to PW modes (250 ms = 18°; 500 ms = 16°; 750 = 19°; P < .05). Trans-cartilaginous cuts were completed faster using CW (37 seconds) compared to PW (250 ms = 136 seconds; 500 ms = 61 seconds; 750 = 44 seconds; P < .05), and both modes delivered the same total Joules. The average depth of LDH depletion (thermal damage) was similar for all cuts. CONCLUSIONS 1. Thulium laser cuts in continuous-mode unexpectedly produced less tissue heating yet created similar thermal damage than pulsed-mode cuts during simulated partial arytenoidectomy. 2. Trans-cartilaginous cuts were completed significantly faster in continuous-mode as compared to pulsed-mode cutting. 3. Pulsing the thulium laser does not minimize thermal damage compared to continuous wave cutting during thulium laser-assisted partial arytenoidectomy.
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Affiliation(s)
| | - James T Heaton
- Harvard Medical School, Boston, MA, USA
- Department of Surgery - Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation - Massachusetts General Hospital, Boston, MA, USA
| | - Robert H Petrillo
- Harvard Medical School, Boston, MA, USA
- Department of Surgery - Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation - Massachusetts General Hospital, Boston, MA, USA
| | - Philip Purnell
- Harvard Medical School, Boston, MA, USA
- Department of Surgery - Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation - Massachusetts General Hospital, Boston, MA, USA
| | - James A Burns
- Harvard Medical School, Boston, MA, USA
- Department of Surgery - Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation - Massachusetts General Hospital, Boston, MA, USA
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Kishimoto AO, Kishimoto Y, Shi X, Hutchinson EB, Zhang H, Shi Y, Oliveira G, Li L, Welham NV, Rowland IJ. High-resolution magnetic resonance and mass spectrometry imaging of the human larynx. J Anat 2021; 239:545-556. [PMID: 34032275 DOI: 10.1111/joa.13451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/21/2021] [Indexed: 12/16/2022] Open
Abstract
High-resolution, noninvasive and nondestructive imaging of the subepithelial structures of the larynx would enhance microanatomic tissue assessment and clinical decision making; similarly, in situ molecular profiling of laryngeal tissue would enhance biomarker discovery and pathology readout. Towards these goals, we assessed the capabilities of high-resolution magnetic resonance imaging (MRI) and matrix-assisted laser desorption/ionisation-mass spectrometry (MALDI-MS) imaging of rarely reported paediatric and adult cadaveric larynges that contained pathologies. The donors were a 13-month-old male, a 10-year-old female with an infraglottic mucus retention cyst and a 74-year-old female with advanced polypoid degeneration and a mucus retention cyst. MR and molecular imaging data were corroborated using whole-organ histology. Our MR protocols imaged the larynges at 45-117 μm2 in-plane resolution and capably resolved microanatomic structures that have not been previously reported radiographically-such as the vocal fold superficial lamina propria, vocal ligament and macula flavae; age-related tissue features-such as intramuscular fat deposition and cartilage ossification; and the lesions. Diffusion tensor imaging characterised differences in water diffusivity, primary tissue fibre orientation, and fractional anisotropy between the intrinsic laryngeal muscles, mucosae and lesions. MALDI-MS imaging revealed peptide signatures and putative protein assignments for the polypoid degeneration lesion and the N-glycan constituents of one mucus retention cyst. These imaging approaches have immediate application in experimental research and, with ongoing technology development, potential for future clinical application.
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Affiliation(s)
| | - Yo Kishimoto
- Department of Otolaryngology - Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Xudong Shi
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Hua Zhang
- Division of Pharmaceutical Sciences, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Yatao Shi
- Division of Pharmaceutical Sciences, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Gisele Oliveira
- Graduate Program in Speech-Language Pathology, Touro College, Brooklyn, NY, USA
| | - Lingjun Li
- Division of Pharmaceutical Sciences, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA.,Department of Chemistry, University of Wisconsin-Madison, Madison, WI, USA
| | - Nathan V Welham
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | - Ian J Rowland
- Department of Entomology, University of Wisconsin-Madison, Madison, WI, USA
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Kishimoto AO, Kishimoto Y, Young DL, Zhang J, Rowland IJ, Welham NV. High- and ultrahigh-field magnetic resonance imaging of naïve, injured and scarred vocal fold mucosae in rats. Dis Model Mech 2016; 9:1397-1403. [PMID: 27638667 PMCID: PMC5117232 DOI: 10.1242/dmm.026526] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/10/2016] [Indexed: 12/16/2022] Open
Abstract
Subepithelial changes to the vocal fold mucosa, such as fibrosis, are difficult to identify using visual assessment of the tissue surface. Moreover, without suspicion of neoplasm, mucosal biopsy is not a viable clinical option, as it carries its own risk of iatrogenic injury and scar formation. Given these challenges, we assessed the ability of high- (4.7 T) and ultrahigh-field (9.4 T) magnetic resonance imaging to resolve key vocal fold subepithelial tissue structures in the rat, an important and widely used preclinical model in vocal fold biology. We conducted serial in vivo and ex vivo imaging, evaluated an array of acquisition sequences and contrast agents, and successfully resolved key anatomic features of naïve, acutely injured, and chronically scarred vocal fold mucosae on the ex vivo scans. Naïve lamina propria was hyperintense on T1-weighted imaging with gadobenate dimeglumine contrast enhancement, whereas chronic scar was characterized by reduced lamina propria T1 signal intensity and mucosal volume. Acutely injured mucosa was hypointense on T2-weighted imaging; lesion volume steadily increased, peaked at 5 days post-injury, and then decreased – consistent with the physiology of acute, followed by subacute, hemorrhage and associated changes in the magnetic state of hemoglobin and its degradation products. Intravenous administration of superparamagnetic iron oxide conferred no T2 contrast enhancement during the acute injury period. These findings confirm that magnetic resonance imaging can resolve anatomic substructures within naïve vocal fold mucosa, qualitative and quantitative features of acute injury, and the presence of chronic scar. Summary: Magnetic resonance imaging is shown to allow the nondestructive assessment of acute injury and scar formation in vocal fold mucosa, as demonstrated ex vivo using a preclinical rat model.
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Affiliation(s)
- Ayami Ohno Kishimoto
- Department of Surgery, Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | - Yo Kishimoto
- Department of Surgery, Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | - David L Young
- Department of Surgery, Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | - Jinjin Zhang
- Department of Radiology and Center for Magnetic Resonance Research, University of Minnesota-Twin Cities, Minneapolis, MN 55455, USA
| | - Ian J Rowland
- Department of Entomology, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Nathan V Welham
- Department of Surgery, Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
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Current Opinion in Otolaryngology & Head & Neck Surgery. Current world literature. Curr Opin Otolaryngol Head Neck Surg 2009; 17:494-8. [PMID: 19907224 DOI: 10.1097/moo.0b013e32833385d7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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