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Rodrigues IDFS, Guerreiro Cardoso PF, Nepomuceno da Silva NA, Correia AT, Minamoto H, Bibas BJ, Xavier Costa NDS, Mancini MW, Dolhnikoff M, Pego-Fernandes PM. Comparison between contact diode laser with 980 nm and 1470 nm wavelengths for posterior laryngofissure in pigs. Sci Rep 2024; 14:11457. [PMID: 38769365 PMCID: PMC11106238 DOI: 10.1038/s41598-024-62333-3] [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] [Received: 01/20/2024] [Accepted: 05/15/2024] [Indexed: 05/22/2024] Open
Abstract
To compare two different wavelengths of the surgical contact diode laser (CDL) for producing a posterior laryngofissure in in-vivo pigs. Anesthetized pigs underwent a tracheostomy and an anterior laryngofissure through a cervicotomy. They were randomly selected for the CDL wavelength and Power, according to the peak of Power set at device (980nm wavelength: Ppeak power of 10 W, 15 W, and 20 W, or 1470 nm wavelength: Ppeak 3 W, 5 W, 7 W, 10 W). At the end of the experiment, the laryngotracheal specimen was extracted and sent for histology and morphometry measurements (incision size, depth, area, and lateral thermal damage). Hemodynamic data and arterial blood gases were recorded during the incisions. Statistical analysis of the comparisons between the parameters and groups had a level of significance of p < 0.05. Twenty-six pigs were divided into CDL 980 nm (n = 11) and 1470 nm (n = 15). There was a greater incision area at the thyroid level in the 980 nm CDL and a wider incision at the trachea level, with a larger distance between mucosa borders. There were no significant differences in the area of lateral thermal damage between the two groups and neither difference among the power levels tested. Both wavelengths tested showed similar results in the various combinations of power levels without significant differences in the lateral thermal damage. The posterior laryngofissure incision can be performed by either of the wavelengths at low and medium power levels without great difference on lateral thermal damage.
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Affiliation(s)
- Isaac de Faria Soares Rodrigues
- Thoracic Surgery Research Laboratory (LIM-61), Division of Thoracic Surgery, Faculdade de Medicina, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Paulo Francisco Guerreiro Cardoso
- Thoracic Surgery Research Laboratory (LIM-61), Division of Thoracic Surgery, Faculdade de Medicina, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Natalia Aparecida Nepomuceno da Silva
- Thoracic Surgery Research Laboratory (LIM-61), Division of Thoracic Surgery, Faculdade de Medicina, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Aristides Tadeu Correia
- Thoracic Surgery Research Laboratory (LIM-61), Division of Thoracic Surgery, Faculdade de Medicina, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Helio Minamoto
- Thoracic Surgery Research Laboratory (LIM-61), Division of Thoracic Surgery, Faculdade de Medicina, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Benoit Jacques Bibas
- Thoracic Surgery Research Laboratory (LIM-61), Division of Thoracic Surgery, Faculdade de Medicina, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | - Marilia Wellichan Mancini
- Department of Biophotonics, Institute of Research and Education in the Health Area (NUPEN), Sao Carlos, SP, Brazil
| | - Marisa Dolhnikoff
- Departament of Pathology, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Paulo Manuel Pego-Fernandes
- Thoracic Surgery Research Laboratory (LIM-61), Division of Thoracic Surgery, Faculdade de Medicina, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Andrus L, Camli B, Mau T, Ben-Yakar A. Ultrafast Laser Microlaryngeal Surgery for In Vivo Subepithelial Void Creation in Canine Vocal Folds. Laryngoscope 2023; 133:3042-3048. [PMID: 37096749 PMCID: PMC10754041 DOI: 10.1002/lary.30713] [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: 12/19/2022] [Revised: 03/20/2023] [Accepted: 04/09/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND/OBJECTIVES Tightly-focused ultrafast laser pulses (pulse widths of 100 fs-10 ps) provide high peak intensities to produce a spatially confined tissue ablation effect. The creation of sub-epithelial voids within scarred vocal folds (VFs) via ultrafast laser ablation may help to localize injectable biomaterials to treat VF scarring. Here, we demonstrate the feasibility of this technique in an animal model using a custom-designed endolaryngeal laser surgery probe. METHODS Unilateral VF mucosal injuries were created in two canines. Four months later, ultrashort laser pulses (5 ps pulses at 500 kHz) were delivered via the custom laser probe to create sub-epithelial voids of ~3 × 3-mm2 in both healthy and scarred VFs. PEG-rhodamine was injected into these voids. Ex vivo optical imaging and histology were used to assess void morphology and biomaterial localization. RESULTS Large sub-epithelial voids were observed in both healthy and scarred VFs immediately following in vivo laser treatment. Two-photon imaging and histology confirmed ~3-mm wide subsurface voids in healthy and scarred VFs of canine #2. Biomaterial localization within a void created in the scarred VF of canine #2 was confirmed with fluorescence imaging but was not visualized during follow-up two-photon imaging. As an alternative, the biomaterial was injected into the excised VF and could be observed to localize within the void. CONCLUSIONS We demonstrated sub-epithelial void formation and the ability to inject biomaterials into voids in a chronic VF scarring model. This proof-of-concept study provides preliminary evidence towards the clinical feasibility of such an approach to treating VF scarring using injectable biomaterials. LEVEL OF EVIDENCES N/A Laryngoscope, 133:3042-3048, 2023.
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Affiliation(s)
- Liam Andrus
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas, 78712, United States
| | - Berk Camli
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, Texas, 78712, United States
| | - Ted Mau
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, 75390, United States
| | - Adela Ben-Yakar
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas, 78712, United States
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, Texas, 78712, United States
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Qi J, Tatla T, Nissanka-Jayasuriya E, Yuan AY, Stoyanov D, Elson DS. Surgical polarimetric endoscopy for the detection of laryngeal cancer. Nat Biomed Eng 2023; 7:971-985. [PMID: 37012312 PMCID: PMC10427430 DOI: 10.1038/s41551-023-01018-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 02/23/2023] [Indexed: 04/05/2023]
Abstract
The standard-of-care for the detection of laryngeal pathologies involves distinguishing suspicious lesions from surrounding healthy tissue via contrasts in colour and texture captured by white-light endoscopy. However, the technique is insufficiently sensitive and thus leads to unsatisfactory rates of false negatives. Here we show that laryngeal lesions can be better detected in real time by taking advantage of differences in the light-polarization properties of cancer and healthy tissues. By measuring differences in polarized-light retardance and depolarization, the technique, which we named 'surgical polarimetric endoscopy' (SPE), generates about one-order-of-magnitude greater contrast than white-light endoscopy, and hence allows for the better discrimination of cancerous lesions, as we show with patients diagnosed with squamous cell carcinoma. Polarimetric imaging of excised and stained slices of laryngeal tissue indicated that changes in the retardance of polarized light can be largely attributed to architectural features of the tissue. We also assessed SPE to aid routine transoral laser surgery for the removal of a cancerous lesion, indicating that SPE can complement white-light endoscopy for the detection of laryngeal cancer.
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Affiliation(s)
- Ji Qi
- Research Center for Humanoid Sensing, Zhejiang Lab, Hangzhou, China.
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK.
- Department of Computer Science, University College London, London, UK.
- Centre For Medical Image Computing, University College London, London, UK.
- Hamlyn Centre for Robotic Surgery, Imperial College London, London, UK.
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | - Taranjit Tatla
- Hamlyn Centre for Robotic Surgery, Imperial College London, London, UK
- Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | | | - Alan Yilun Yuan
- Department of Electrical and Electronic Engineering, Imperial College London, London, UK
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK.
- Department of Computer Science, University College London, London, UK.
- Centre For Medical Image Computing, University College London, London, UK.
| | - Daniel S Elson
- Hamlyn Centre for Robotic Surgery, Imperial College London, London, UK.
- Department of Surgery and Cancer, Imperial College London, London, UK.
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Andrus L, Jeon H, Pawlowski M, Debord B, Gerome F, Benabid F, Mau T, Tkaczyk T, Ben-Yakar A. Ultrafast laser surgery probe for sub-surface ablation to enable biomaterial injection in vocal folds. Sci Rep 2022; 12:20554. [PMID: 36446830 PMCID: PMC9708667 DOI: 10.1038/s41598-022-24446-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/15/2022] [Indexed: 11/30/2022] Open
Abstract
Creation of sub-epithelial voids within scarred vocal folds via ultrafast laser ablation may help in localization of injectable therapeutic biomaterials towards an improved treatment for vocal fold scarring. Several ultrafast laser surgery probes have been developed for precise ablation of surface tissues; however, these probes lack the tight beam focusing required for sub-surface ablation in highly scattering tissues such as vocal folds. Here, we present a miniaturized ultrafast laser surgery probe designed to perform sub-epithelial ablation in vocal folds. The requirement of high numerical aperture for sub-surface ablation, in addition to the small form factor and side-firing architecture required for clinical use, made for a challenging optical design. An Inhibited Coupling guiding Kagome hollow core photonic crystal fiber delivered micro-Joule level ultrashort pulses from a high repetition rate fiber laser towards a custom-built miniaturized objective, producing a 1/e2 focal beam radius of 1.12 ± 0.10 μm and covering a 46 × 46 μm2 scan area. The probe could deliver up to 3.8 μJ pulses to the tissue surface at 40% transmission efficiency through the entire system, providing significantly higher fluences at the focal plane than were required for sub-epithelial ablation. To assess surgical performance, we performed ablation studies on freshly excised porcine hemi-larynges and found that large area sub-epithelial voids could be created within vocal folds by mechanically translating the probe tip across the tissue surface using external stages. Finally, injection of a model biomaterial into a 1 × 2 mm2 void created 114 ± 30 μm beneath the vocal fold epithelium surface indicated improved localization when compared to direct injection into the tissue without a void, suggesting that our probe may be useful for pre-clinical evaluation of injectable therapeutic biomaterials for vocal fold scarring therapy. With future developments, the surgical system presented here may enable treatment of vocal fold scarring in a clinical setting.
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Affiliation(s)
- Liam Andrus
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, 78712, USA
| | - Hamin Jeon
- Department of Bioengineering, Rice University, Houston, TX, 77005, USA
| | - Michal Pawlowski
- Department of Bioengineering, Rice University, Houston, TX, 77005, USA
| | - Benoit Debord
- GPPMM Group, XLIM, CNRS-University of Limoges, Limoges, France
| | - Frederic Gerome
- GPPMM Group, XLIM, CNRS-University of Limoges, Limoges, France
| | - Fetah Benabid
- GPPMM Group, XLIM, CNRS-University of Limoges, Limoges, France
| | - Ted Mau
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Tomasz Tkaczyk
- Department of Bioengineering, Rice University, Houston, TX, 77005, USA
| | - Adela Ben-Yakar
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, 78712, USA.
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, 78712, USA.
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Sharma GK, Chen LY, Chou L, Badger C, Hong E, Rangarajan S, Chang TH, Armstrong WB, Verma SP, Chen Z, Ramalingam R, Wong BJF. Surface kinematic and depth-resolved analysis of human vocal folds in vivo during phonation using optical coherence tomography. JOURNAL OF BIOMEDICAL OPTICS 2021; 26:JBO-210125R. [PMID: 34414705 PMCID: PMC8374544 DOI: 10.1117/1.jbo.26.8.086005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/26/2021] [Indexed: 05/30/2023]
Abstract
SIGNIFICANCE The human vocal fold (VF) oscillates in multiple vectors and consists of distinct layers with varying viscoelastic properties that contribute to the mucosal wave. Office-based and operative laryngeal endoscopy are limited to diagnostic evaluation of the VF epithelial surface only and are restricted to axial-plane characterization of the horizontal mucosal wave. As such, understanding of the biomechanics of human VF motion remains limited. AIM Optical coherence tomography (OCT) is a micrometer-resolution, high-speed endoscopic imaging modality which acquires cross-sectional images of tissue. Our study aimed to leverage OCT technology and develop quantitative methods for analyzing the anatomy and kinematics of in vivo VF motion in the coronal plane. APPROACH A custom handheld laryngeal stage was used to capture OCT images with 800 A-lines at 250 Hz. Automated image postprocessing and analytical methods were developed. RESULTS Novel kinematic analysis of in vivo, long-range OCT imaging of the vibrating VF in awake human subjects is reported. Cross-sectional, coronal-plane panoramic videos of the larynx during phonation are presented with three-dimensional videokymographic and space-time velocity analysis of VF motion. CONCLUSIONS Long-range OCT with automated computational methods allows for cross-sectional dynamic laryngeal imaging and has the potential to broaden our understanding of human VF biomechanics and sound production.
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Affiliation(s)
- Giriraj K. Sharma
- University of California, Irvine Medical Center, Department of Otolaryngology–Head and Neck Surgery, Irvine, California, United States
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
| | - Lily Y. Chen
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
| | - Lidek Chou
- OCT Medical Imaging, Inc., Irvine, California, United States
| | - Christopher Badger
- University of California, Irvine, School of Medicine, Irvine, California, United States
| | - Ellen Hong
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
| | | | | | - William B. Armstrong
- University of California, Irvine Medical Center, Department of Otolaryngology–Head and Neck Surgery, Irvine, California, United States
| | - Sunil P. Verma
- University of California, Irvine Medical Center, Department of Otolaryngology–Head and Neck Surgery, Irvine, California, United States
| | - Zhongping Chen
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
- University of California, Irvine, Department of Biomedical Engineering, Irvine, California, United States
| | - Ram Ramalingam
- OCT Medical Imaging, Inc., Irvine, California, United States
| | - Brian J.-F. Wong
- University of California, Irvine Medical Center, Department of Otolaryngology–Head and Neck Surgery, Irvine, California, United States
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
- University of California, Irvine, Department of Biomedical Engineering, Irvine, California, United States
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Wittig L, Betz C, Eggert D. Optical coherence tomography for tissue classification of the larynx in an outpatient setting‐a translational challenge on the verge of a resolution? TRANSLATIONAL BIOPHOTONICS 2020. [DOI: 10.1002/tbio.202000013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Lukas Wittig
- Universitätsklinikum Hamburg‐Eppendorf, Otorhinolaryngology, Head and Neck Surgery Hamburg Germany
| | - Christian Betz
- Universitätsklinikum Hamburg‐Eppendorf, Otorhinolaryngology, Head and Neck Surgery Hamburg Germany
| | - Dennis Eggert
- Universitätsklinikum Hamburg‐Eppendorf, Otorhinolaryngology, Head and Neck Surgery Hamburg Germany
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Ning X, Yang K, Shi W, Xu C. Comparison of hypertrophic scarring on a red Duroc pig and a Guangxi Mini Bama pig. Scars Burn Heal 2020; 6:2059513120930903. [PMID: 32637158 PMCID: PMC7318807 DOI: 10.1177/2059513120930903] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Pigs are the most promising models for the study of wound healing and hypertrophic scarring because they are anatomically and physiologically similar to human beings. The Red Duroc pig and Mini Bama pig are two swine models that have attracted a lot of attention. The aim of the present study was to examine and compare the scarring process in a red Duroc pig and a Mini Bama pig, providing knowledge for researchers and clinicians to enable them to choose the most suitable pig model for studies.
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Affiliation(s)
- Xiaoyu Ning
- School of Chemical and Biomedical Engineering Nanyang Technological University, Singapore
| | - Kai Yang
- SG Med International Pte Ltd., Singapore
| | - Wei Shi
- Key Laboratory of Flexible Electronics & Institute of Advanced Materials, Jiangsu National Synergetic Innovation Center for Advanced Materials Nanjing Tech University, Nanjing, Jiangsu, China
| | - Chenjie Xu
- School of Chemical and Biomedical Engineering Nanyang Technological University, Singapore
- Department of Biomedical Engineering City University of Hong Kong, Kowloon, Hong Kong
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Jerjes W, Hamdoon Z, Yousif AA, Al-Rawi NH, Hopper C. Epithelial tissue thickness improves optical coherence tomography's ability in detecting oral cancer. Photodiagnosis Photodyn Ther 2019; 28:69-74. [PMID: 31454715 DOI: 10.1016/j.pdpdt.2019.08.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/17/2019] [Accepted: 08/23/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND OCT is a non-invasive imaging technique that enables the measurement of epithelial thickness and architectural changes, which can help in the diagnosis of pre-cancerous and cancerous lesions. The purpose of the study was to assess whether epithelial tissue thickness improves optical coherence tomography's ability in detecting oral cancer. PATIENTS AND METHODS Surgically resected oral margins from 60 patients diagnosed with oral squamous cell carcinoma were subjected to OCT. Three OCT measurements (immediate, 1 h and 24 h post-resection) were conducted per resected tissue specimen to look at the effect of saline and formalin on the specimen and its effect on the reproducibility of the OCT. OCT was, then, used to measure the epithelial tissue thickness in cancer-free and cancer-involved margins in eight oral anatomical locations. This data was, then, combined with architectural changes data to calculate the sensitivity and specificity. RESULTS An overall of 189 cancer-free margins and 51 cancer-involved margins had their epithelial thickness measured using OCT and compared to histopathology. With regards to the validity of the OCT and histopathological measurements, epithelial thickness showed good correlation between different readings at all oral sites. With regards to the reproducibility of the OCT measurements, the mean epithelial thickness for all measurements at first (immediate) and second (1 h post-resection - saline preserved) measurements was not significantly different. Underestimation of the epithelial depth in cancer-free margins was 20 μm, while in the cancer-involved margins was 10 μm. Combining data from architectural changes and epithelial thickness, a sensitivity of 92% and a specificity of 94% was achieved. CONCLUSION Oral epithelium measurements using OCT were valid compared to those made with gold standard pathology. Measurements made using OCT was also reproducible with minor underestimation. Epithelial thickness, combined with architectural changes, led to high accuracy in differentiating between cancer-free and cancer-involved margins.
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Affiliation(s)
- Waseem Jerjes
- University College London Medical School, London, UK; North End Medical Centre, London, UK.
| | - Zaid Hamdoon
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates; Unit of OMFS, UCL Eastman Dental Institute, London, UK
| | - Aamr A Yousif
- College of Pharmacy, University of Duhok, Duhok, Iraq
| | - Natheer H Al-Rawi
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Colin Hopper
- University College London Medical School, London, UK; Unit of OMFS, UCL Eastman Dental Institute, London, UK
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Gora MJ, Suter MJ, Tearney GJ, Li X. Endoscopic optical coherence tomography: technologies and clinical applications [Invited]. BIOMEDICAL OPTICS EXPRESS 2017; 8:2405-2444. [PMID: 28663882 PMCID: PMC5480489 DOI: 10.1364/boe.8.002405] [Citation(s) in RCA: 142] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/20/2017] [Accepted: 03/27/2017] [Indexed: 05/07/2023]
Abstract
In this paper, we review the current state of technology development and clinical applications of endoscopic optical coherence tomography (OCT). Key design and engineering considerations are discussed for most OCT endoscopes, including side-viewing and forward-viewing probes, along with different scanning mechanisms (proximal-scanning versus distal-scanning). Multi-modal endoscopes that integrate OCT with other imaging modalities are also discussed. The review of clinical applications of endoscopic OCT focuses heavily on diagnosis of diseases and guidance of interventions. Representative applications in several organ systems are presented, such as in the cardiovascular, digestive, respiratory, and reproductive systems. A brief outlook of the field of endoscopic OCT is also discussed.
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Affiliation(s)
- Michalina J Gora
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
- ICube Laboratory, CNRS, Strasbourg University, 1 Place de l'Hopital, Strasbourg 67091, France
| | - Melissa J Suter
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
- Department of Medicine, Division of Pulmonary and Critical Care, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Guillermo J Tearney
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
- Department of Pathology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Xingde Li
- Department of Biomedical Engineering, Department of Electrical and Computer Engineering, and Department of Oncology, Johns Hopkins University, 720 Rutland Avenue, Traylor 710, Baltimore, MD 21205, USA
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10
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Ajose-Popoola O, Su E, Hamamoto A, Wang A, Jing JC, Nguyen TD, Chen JJ, Osann KE, Chen Z, Ahuja GS, Wong BJF. Diagnosis of subglottic stenosis in a rabbit model using long-range optical coherence tomography. Laryngoscope 2016; 127:64-69. [PMID: 27559721 DOI: 10.1002/lary.26241] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 07/13/2016] [Accepted: 07/15/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVES/HYPOTHESIS Current imaging modalities lack the necessary resolution to diagnose subglottic stenosis. The aim of this study was to use optical coherence tomography (OCT) to evaluate nascent subglottic mucosal injury and characterize mucosal thickness and structural changes using texture analysis in a simulated intubation rabbit model. STUDY DESIGN Prospective animal study in rabbits. METHODS Three-centimeter-long sections of endotracheal tubes (ETT) were endoscopically placed in the subglottis and proximal trachea of New Zealand White rabbits (n = 10) and secured via suture. OCT imaging and conventional endoscopic video was performed just prior to ETT segment placement (day 0), immediately after tube removal (day 7), and 1 week later (day 14). OCT images were analyzed for airway wall thickness and textural properties. RESULTS Endoscopy and histology of intubated rabbits showed a range of normal to edematous tissue, which correlated with OCT images. The mean airway mucosal wall thickness measured using OCT was 336.4 μm (day 0), 391.3 μm (day 7), and 420.4 μm (day 14), with significant differences between day 0 and day 14 (P = .002). Significance was found for correlation and homogeneity texture features across all time points (P < .05). CONCLUSIONS OCT is a minimally invasive endoscopic imaging modality capable of monitoring progression of subglottic mucosal injury. This study is the first to evaluate mucosal injury during simulated intubation using serial OCT imaging and texture analysis. OCT and texture analysis have the potential for early detection of subglottic mucosal injury, which could lead to better management of the neonatal airway and limit the progression to stenosis. LEVEL OF EVIDENCE NA Laryngoscope, 127:64-69, 2017.
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Affiliation(s)
- Olubunmi Ajose-Popoola
- Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Irvine, California, U.S.A
| | - Erica Su
- Beckman Laser Institute, University of California-Irvine, Irvine, California, U.S.A
| | - Ashley Hamamoto
- Beckman Laser Institute, University of California-Irvine, Irvine, California, U.S.A
| | - Alex Wang
- Beckman Laser Institute, University of California-Irvine, Irvine, California, U.S.A
| | - Joseph C Jing
- Beckman Laser Institute, University of California-Irvine, Irvine, California, U.S.A.,Department of Biomedical Engineering, University of California-Irvine, Irvine, California, U.S.A
| | - Tony D Nguyen
- Beckman Laser Institute, University of California-Irvine, Irvine, California, U.S.A.,School of Medicine, University of California-Irvine, Irvine, California, U.S.A
| | - Jason J Chen
- Beckman Laser Institute, University of California-Irvine, Irvine, California, U.S.A
| | - Kathryn E Osann
- School of Medicine, University of California-Irvine, Irvine, California, U.S.A
| | - Zhongping Chen
- Beckman Laser Institute, University of California-Irvine, Irvine, California, U.S.A.,Department of Biomedical Engineering, University of California-Irvine, Irvine, California, U.S.A
| | - Gurpreet S Ahuja
- Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Irvine, California, U.S.A.,CHOC Children's Hospital of Orange County, Orange, California, U.S.A
| | - Brian J F Wong
- Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Irvine, California, U.S.A.,Beckman Laser Institute, University of California-Irvine, Irvine, California, U.S.A.,Department of Biomedical Engineering, University of California-Irvine, Irvine, California, U.S.A
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11
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Sharma GK, Chin Loy A, Su E, Jing J, Chen Z, Wong BJF, Verma S. Quantitative Evaluation of Adult Subglottic Stenosis Using Intraoperative Long-range Optical Coherence Tomography. Ann Otol Rhinol Laryngol 2016; 125:815-22. [PMID: 27354215 DOI: 10.1177/0003489416655353] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To determine the feasibility of long-range optical coherence tomography (LR-OCT) as a tool to intraoperatively image and measure the subglottis and trachea during suspension microlaryngoscopy before and after endoscopic treatment of subglottic stenosis (SGS). METHODS Long-range optical coherence tomography of the adult subglottis and trachea was performed during suspension microlaryngoscopy before and after endoscopic treatment for SGS. The anteroposterior and transverse diameters, cross-sectional area (CSA), distance from the vocal cords, and length of the SGS were measured using a MATLAB software. Pre-intervention and postintervention airway dimensions were compared. Three-dimensional volumetric airway reconstructions were generated using medical image processing software (MIMICS). RESULTS Intraoperative LR-OCT imaging was performed in 3 patients undergoing endoscopic management of SGS. Statistically significant differences in mean anteroposterior diameter (P < .01), transverse diameter (P < .001), and CSA (P < .001) were noted between pre-intervention and postintervention data. Three-dimensional airway models were viewed in cross-sectional format and via virtual "fly through" bronchoscopy. CONCLUSIONS This is the first report of intraoperative LR-OCT of the subglottic and tracheal airway before and after surgical management of SGS in humans. Long-range optical coherence tomography offers a practical means to measure the dimensions of SGS and acquire objective data on the response to endoscopic treatment of SGS.
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Affiliation(s)
- Giriraj K Sharma
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Anthony Chin Loy
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Erica Su
- Beckman Laser Institute, University of California, Irvine, California, USA
| | - Joe Jing
- Beckman Laser Institute, University of California, Irvine, California, USA Department of Biomedical Engineering, University of California, Irvine, California, USA
| | - Zhongping Chen
- Beckman Laser Institute, University of California, Irvine, California, USA Department of Biomedical Engineering, University of California, Irvine, California, USA
| | - Brian J-F Wong
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Sunil Verma
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA University Voice and Swallowing Center, University of California, Irvine, California, USA
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12
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Sharma GK, Ahuja GS, Wiedmann M, Osann KE, Su E, Heidari AE, Jing JC, Qu Y, Lazarow F, Wang A, Chou L, Uy CC, Dhar V, Cleary JP, Pham N, Huoh K, Chen Z, Wong BJF. Long-Range Optical Coherence Tomography of the Neonatal Upper Airway for Early Diagnosis of Intubation-related Subglottic Injury. Am J Respir Crit Care Med 2016. [PMID: 26214043 DOI: 10.1164/rccm.201501-0053oc] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Subglottic edema and acquired subglottic stenosis are potentially airway-compromising sequelae in neonates following endotracheal intubation. At present, no imaging modality is capable of in vivo diagnosis of subepithelial airway wall pathology as signs of intubation-related injury. OBJECTIVES To use Fourier domain long-range optical coherence tomography (LR-OCT) to acquire micrometer-resolution images of the airway wall of intubated neonates in a neonatal intensive care unit setting and to analyze images for histopathology and airway wall thickness. METHODS LR-OCT of the neonatal laryngotracheal airway was performed a total of 94 times on 72 subjects (age, 1-175 d; total intubation, 1-104 d). LR-OCT images of the airway wall were analyzed in MATLAB. Medical records were reviewed retrospectively for extubation outcome. MEASUREMENTS AND MAIN RESULTS Backward stepwise regression analysis demonstrated a statistically significant association between log(duration of intubation) and both laryngeal (P < 0.001; multiple r(2) = 0.44) and subglottic (P < 0.001; multiple r(2) = 0.55) airway wall thickness. Subjects with positive histopathology on LR-OCT images had a higher likelihood of extubation failure (odds ratio, 5.9; P = 0.007). Longer intubation time was found to be significantly associated with extubation failure. CONCLUSIONS LR-OCT allows for high-resolution evaluation and measurement of the airway wall in intubated neonates. Our data demonstrate a positive correlation between laryngeal and subglottic wall thickness and duration of intubation, suggestive of progressive soft tissue injury. LR-OCT may ultimately aid in the early diagnosis of postintubation subglottic injury and help reduce the incidences of failed extubation caused by subglottic edema or acquired subglottic stenosis in neonates. Clinical trial registered with www.clinicaltrials.gov (NCT 00544427).
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Affiliation(s)
- Giriraj K Sharma
- 1 Department of Otolaryngology-Head and Neck Surgery.,2 Beckman Laser Institute
| | - Gurpreet S Ahuja
- 1 Department of Otolaryngology-Head and Neck Surgery.,3 Division of Otolaryngology and
| | | | | | | | | | - Joseph C Jing
- 2 Beckman Laser Institute.,5 Department of Biomedical Engineering, and
| | - Yueqiao Qu
- 5 Department of Biomedical Engineering, and
| | | | | | | | - Cherry C Uy
- 6 Division of Neonatology, University of California Irvine, Irvine, California; and
| | - Vijay Dhar
- 7 Division of Neonatology, CHOC Children's Hospital of Orange County, Orange, California
| | - John P Cleary
- 6 Division of Neonatology, University of California Irvine, Irvine, California; and.,7 Division of Neonatology, CHOC Children's Hospital of Orange County, Orange, California
| | - Nguyen Pham
- 1 Department of Otolaryngology-Head and Neck Surgery.,3 Division of Otolaryngology and
| | - Kevin Huoh
- 1 Department of Otolaryngology-Head and Neck Surgery.,3 Division of Otolaryngology and
| | - Zhongping Chen
- 2 Beckman Laser Institute.,5 Department of Biomedical Engineering, and
| | - Brian J-F Wong
- 1 Department of Otolaryngology-Head and Neck Surgery.,2 Beckman Laser Institute.,5 Department of Biomedical Engineering, and
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13
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Jungheim M, Donner S, Bleeker S, Ripken T, Krueger A, Ptok M. Effect of saline inhalation on vocal fold epithelial morphology evaluated by optical coherence tomography. Laryngoscope 2016; 126:E332-6. [PMID: 26972688 DOI: 10.1002/lary.25891] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 12/09/2016] [Accepted: 12/31/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Examination of tissue structures by optical coherence tomography (OCT) has been shown to be useful on mucous membranes of the vocal folds, but so far its application to the human larynx has been limited because it is technically cumbersome and usually needs to be performed with sedation. Here a newly developed, noninvasive combined laryngoscopy and OCT procedure is described and its suitability for ambulatory OCT studies evaluated. Because inhalation therapies utilizing saline solutions are commonly used as a treatment option for disorders of the airways, and vocal fold epithelium is most likely to be affected due to its superficial positioning, epithelial thickness was chosen as a relevant test parameter and evaluated before and after saline inhalation. METHODS Seven vocally healthy participants performed a 10-minute inhalation of saline solution and underwent a combined laryngoscopy and OCT before and after the inhalation therapy. Endoscopy was performed using a newly developed combined laryngoscopy and OCT device. The OCT images were used to estimate the epithelial thickness of the vocal folds. RESULTS Epithelial thickness measured in all participants before treatment was comparable in size reported in previous studies. Statistical differences before and after inhalation were not detected. CONCLUSION The newly developed combined laryngoscopy and OCT procedure enables rapid investigation of the vocal fold epithelium. Inhalation of saline solution did not appear to affect the thickness of the epithelium of the vocal folds in vocally healthy subjects, as evaluated by OCT. LEVEL OF EVIDENCE N/A. Laryngoscope, 126:E332-E336, 2016.
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Affiliation(s)
- Michael Jungheim
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hannover, Germany.
| | - Sabine Donner
- Biomedical Optics Department, Laser Zentrum Hannover e.V, Hannover, Germany
| | - Sebastian Bleeker
- Biomedical Optics Department, Laser Zentrum Hannover e.V, Hannover, Germany
| | - Tammo Ripken
- Biomedical Optics Department, Laser Zentrum Hannover e.V, Hannover, Germany
| | - Alexander Krueger
- Biomedical Optics Department, Laser Zentrum Hannover e.V, Hannover, Germany
| | - Martin Ptok
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hannover, Germany
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In vivo cross-sectional imaging of the phonating larynx using long-range Doppler optical coherence tomography. Sci Rep 2016; 6:22792. [PMID: 26960250 PMCID: PMC4785353 DOI: 10.1038/srep22792] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 01/28/2016] [Indexed: 12/04/2022] Open
Abstract
Diagnosis and treatment of vocal fold lesions has been a long-evolving science for the otolaryngologist. Contemporary practice requires biopsy of a glottal lesion in the operating room under general anesthesia for diagnosis. Current in-office technology is limited to visualizing the surface of the vocal folds with fiber-optic or rigid endoscopy and using stroboscopic or high-speed video to infer information about submucosal processes. Previous efforts using optical coherence tomography (OCT) have been limited by small working distances and imaging ranges. Here we report the first full field, high-speed, and long-range OCT images of awake patients’ vocal folds as well as cross-sectional video and Doppler analysis of their vocal fold motions during phonation. These vertical-cavity surface-emitting laser source (VCSEL) OCT images offer depth resolved, high-resolution, high-speed, and panoramic images of both the true and false vocal folds. This technology has the potential to revolutionize in-office imaging of the larynx.
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15
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Garcia JA, Benboujja F, Beaudette K, Guo R, Boudoux C, Hartnick CJ. Using attenuation coefficients from optical coherence tomography as markers of vocal fold maturation. Laryngoscope 2015; 126:E218-23. [PMID: 26525926 DOI: 10.1002/lary.25765] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Optical coherence tomography (OCT) is a promising technology to noninvasively assess vocal fold microanatomy. The goal of this study was to develop a methodology using OCT to identify quantifiable markers of vocal fold development. STUDY DESIGN In vivo study. METHODS A two-step process was developed to reproducibly image the midmembranous vocal fold edge of 10 patients younger than 2 years and 10 patients between 11 and 16 years of age using OCT. An image analysis algorithm was implemented to extract OCT-derived A-lines for each patient. These A-lines were divided into three zones according to apparent changes in slope. Relative attenuation coefficients, or tissue- and system-dependent parameters that describe the rate at which optical signal decays, were calculated for each zone. RESULTS Young patients had distinct relative attenuation coefficients in zone 1 (P < .0001), whereas zones 2 and 3 were indistinct (P = .1129). Older patients had distinct relative attenuation coefficients in zones 1, 2, and 3 (P < .0370). Between age groups, relative attenuation coefficients were different in zones 2 and 3 (P < .0001, P = .0315, respectively) and indistinct in zone 1 (P = .1438). CONCLUSIONS Relative attenuation coefficients can be used as markers of vocal fold development. Differences in relative attenuation coefficients likely represent changes in extracellular matrix structure within the lamina propria and may become useful for guiding treatment of voice disorders in the pediatric population. LEVEL OF EVIDENCE NA Laryngoscope, 126:E218-E223, 2016.
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Affiliation(s)
- Jordan A Garcia
- Department of Otolaryngology , Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Fouzi Benboujja
- Engineering Physics Department, Polytechnique Montreal, Montreal, Quebec, Canada
| | - Kathy Beaudette
- Engineering Physics Department, Polytechnique Montreal, Montreal, Quebec, Canada
| | - Rong Guo
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Caroline Boudoux
- Engineering Physics Department, Polytechnique Montreal, Montreal, Quebec, Canada
| | - Christopher J Hartnick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
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16
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Lemieux BT, Chen JJ, Jing J, Chen Z, Wong BJF. Measurement of ciliary beat frequency using Doppler optical coherence tomography. Int Forum Allergy Rhinol 2015; 5:1048-54. [PMID: 26136399 PMCID: PMC4698234 DOI: 10.1002/alr.21582] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 05/26/2015] [Indexed: 11/05/2022]
Abstract
BACKGROUND Measuring ciliary beat frequency (CBF) is a technical challenge and difficult to perform in vivo. Doppler optical coherence tomography (D-OCT) is a mesoscopic noncontact imaging modality that provides high-resolution tomographic images and detects micromotion simultaneously in living tissues. In this work we used D-OCT to measure CBF in ex vivo tissue as the first step toward translating this technology to clinical use. METHODS Fresh ex vivo samples of rabbit tracheal mucosa were imaged using both D-OCT and phase-contrast microscopy (n = 5). The D-OCT system was designed and built to specification in our lab (1310-nm swept source vertical-cavity surface-emitting laser [VCSEL], 6-μm axial resolution). The samples were placed in culture and incubated at 37°C. A fast Fourier transform was performed on the D-OCT signal recorded on the surface of the samples to gauge CBF. High-speed digital video of the epithelium recorded via phase-contrast microscopy was analyzed to confirm the CBF measurements. RESULTS The D-OCT system detected Doppler signal at the epithelial layer of ex vivo rabbit tracheal samples suggestive of ciliary motion. CBF was measured at 9.36 ± 1.22 Hz using D-OCT and 9.08 ± 0.48 Hz using phase-contrast microscopy. No significant differences were found between the 2 methods (p > 0.05). CONCLUSION D-OCT allows for the quantitative measurement of CBF without the need to resolve individual cilia. Furthermore, D-OCT technology can be incorporated into endoscopic platforms that allow clinicians to readily measure CBF in the office and provide a direct measurement of mucosal health.
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Affiliation(s)
- Bryan T Lemieux
- Beckman Laser Institute, University of California-Irvine, Irvine, CA
| | - Jason J Chen
- Beckman Laser Institute, University of California-Irvine, Irvine, CA
| | - Joseph Jing
- Beckman Laser Institute, University of California-Irvine, Irvine, CA
- Department of Biomedical Engineering, University of California-Irvine, Irvine, CA
| | - Zhongping Chen
- Beckman Laser Institute, University of California-Irvine, Irvine, CA
- Department of Biomedical Engineering, University of California-Irvine, Irvine, CA
| | - Brian J F Wong
- Beckman Laser Institute, University of California-Irvine, Irvine, CA
- Department of Biomedical Engineering, University of California-Irvine, Irvine, CA
- Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Irvine, CA
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17
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Donner S, Bleeker S, Ripken T, Ptok M, Jungheim M, Krueger A. Automated working distance adjustment enables optical coherence tomography of the human larynx in awake patients. J Med Imaging (Bellingham) 2015; 2:026003. [PMID: 26158116 DOI: 10.1117/1.jmi.2.2.026003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 05/20/2015] [Indexed: 11/14/2022] Open
Abstract
Optical coherence tomography (OCT) provides structural information of laryngeal tissue which is comparable to histopathological analysis of biopsies taken under general anesthesia. In awake patients, movements impede clinically useful OCT acquisition. Therefore, an automatic compensation of movements was implemented into a swept source OCT-laryngoscope. Video and OCT beam path were combined in one tube of 10-mm diameter. Segmented OCT images served as distance sensor and a feedback control adjusted the working distance between 33 and 70 mm by synchronously translating the reference mirror and focusing lens. With this motion compensation, the tissue was properly visible in up to 88% of the acquisition time. During quiet respiration, OCT contrasted epithelium and lamina propria. Mean epithelial thickness was measured to be 109 and [Formula: see text] in female and male, respectively. Furthermore, OCT of mucosal wave movements during phonation enabled estimation of the oscillation frequency and amplitude. Regarding clinical issues, the OCT-laryngoscope with automated working distance adjustment may support the estimation of the depth extent of epithelial lesions and contribute to establish an indication for a biopsy. Moreover, OCT of the vibrating vocal folds provides functional information, possibly giving further insight into mucosal behavior during the vibratory cycle.
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Affiliation(s)
- Sabine Donner
- Laser Zentrum Hannover e.V. , Biomedical Optics Department, Hollerithallee 8, 30419 Hannover, Germany
| | - Sebastian Bleeker
- Laser Zentrum Hannover e.V. , Biomedical Optics Department, Hollerithallee 8, 30419 Hannover, Germany
| | - Tammo Ripken
- Laser Zentrum Hannover e.V. , Biomedical Optics Department, Hollerithallee 8, 30419 Hannover, Germany
| | - Martin Ptok
- Hannover Medical School , Clinic for Phoniatry and Paediatric Audiology, Carl-Neuberg-Street 1, 30625 Hannover, Germany
| | - Michael Jungheim
- Hannover Medical School , Clinic for Phoniatry and Paediatric Audiology, Carl-Neuberg-Street 1, 30625 Hannover, Germany
| | - Alexander Krueger
- Laser Zentrum Hannover e.V. , Biomedical Optics Department, Hollerithallee 8, 30419 Hannover, Germany
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18
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Volgger V, Sharma GK, Jing JC, Peaks YSA, Loy AC, Lazarow F, Wang A, Qu Y, Su E, Chen Z, Ahuja GS, Wong BJF. Long-range Fourier domain optical coherence tomography of the pediatric subglottis. Int J Pediatr Otorhinolaryngol 2015; 79:119-26. [PMID: 25532671 PMCID: PMC4297587 DOI: 10.1016/j.ijporl.2014.11.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 11/08/2014] [Accepted: 11/14/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Acquired subglottic stenosis (SGS) most commonly results from prolonged endotracheal intubation and is a diagnostic challenge in the intubated child. At present, no imaging modality allows for in vivo characterization of subglottic microanatomy to identify early signs of acquired SGS while the child remains intubated. Fourier domain optical coherence tomography (FD-OCT) is a minimally invasive, light-based imaging modality which provides high resolution, three dimensional (3D) cross-sectional images of biological tissue. We used long-range FD-OCT to image the subglottis in intubated pediatric patients undergoing minor head and neck surgical procedures in the operating room. METHODS A long-range FD-OCT system and rotary optical probes (1.2mm and 0.7mm outer diameters) were constructed. Forty-six pediatric patients (ages 2-16 years) undergoing minor upper airway surgery (e.g., tonsillectomy and adenoidectomy) were selected for intraoperative, trans-endotracheal tube FD-OCT of the subglottis. Images were analyzed for anatomical landmarks and subepithelial histology. Volumetric image sets were rendered into virtual 3D airway models in Mimics software. RESULTS FD-OCT was performed on 46 patients (ages 2-16 years) with no complications. Gross airway contour was visible on all 46 data sets. Twenty (43%) high-quality data sets clearly demonstrated airway anatomy (e.g., tracheal rings, cricoid and vocal folds) and layered microanatomy of the mucosa (e.g., epithelium, basement membrane and lamina propria). The remaining 26 data sets were discarded due to artifact, high signal-to-noise ratio or missing data. 3D airway models were allowed for user-controlled manipulation and multiplanar airway slicing (e.g., sagittal, coronal) for visualization of OCT data at multiple anatomic levels simultaneously. CONCLUSIONS Long-range FD-OCT produces high-resolution, 3D volumetric images of the pediatric subglottis. This technology offers a safe and practical means for in vivo evaluation of lower airway microanatomy in intubated pediatric patients. Ultimately, FD-OCT may be applied to serial monitoring of the neonatal subglottis in long-term intubated infants at risk for acquired SGS.
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Affiliation(s)
- Veronika Volgger
- Department of Otorhinolaryngology-Head and Neck Surgery, Ludwig Maximilian University Munich, 80539 München, Germany
| | - Giriraj K Sharma
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, CA 92868, USA
| | - Joseph C Jing
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA 92612, USA
| | - Ya-Sin A Peaks
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, CA 92868, USA
| | - Anthony Chin Loy
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, CA 92868, USA
| | - Frances Lazarow
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, CA 92868, USA
| | - Alex Wang
- Beckman Laser Institute, University of California Irvine, Irvine, CA 92612, USA
| | - Yueqiao Qu
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA 92612, USA
| | - Erica Su
- Beckman Laser Institute, University of California Irvine, Irvine, CA 92612, USA
| | - Zhongping Chen
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA 92612, USA; Beckman Laser Institute, University of California Irvine, Irvine, CA 92612, USA
| | - Gurpreet S Ahuja
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, CA 92868, USA; CHOC Children's Hospital of Orange County, Orange, CA 92868, USA
| | - Brian J-F Wong
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, CA 92868, USA; Beckman Laser Institute, University of California Irvine, Irvine, CA 92612, USA.
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20
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Ferhanoglu O, Yildirim M, Subramanian K, Ben-Yakar A. A 5-mm piezo-scanning fiber device for high speed ultrafast laser microsurgery. BIOMEDICAL OPTICS EXPRESS 2014; 5:2023-36. [PMID: 25071946 PMCID: PMC4102346 DOI: 10.1364/boe.5.002023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 05/23/2014] [Accepted: 05/26/2014] [Indexed: 05/05/2023]
Abstract
Towards developing precise microsurgery tools for the clinic, we previously developed image-guided miniaturized devices using low repetition rate amplified ultrafast lasers for surgery. To improve the speed of tissue removal while reducing device diameter, here we present a new 5-mm diameter device that delivers high-repetition rate laser pulses for high speed ultrafast laser microsurgery. The device consists of an air-core photonic bandgap fiber (PBF) for the delivery of high energy pulses, a piezoelectric tube actuator for fiber scanning, and two aspheric lenses for focusing the light. Its inline optical architecture provides easy alignment and substantial size reduction to 5 mm diameter as compared to our previous MEMS-scanning devices while realizing improved intensity squared (two-photon) lateral and axial resolutions of 1.16 μm and 11.46 μm, respectively. Our study also sheds light on the maximum pulse energies that can be delivered through the air-core PBF and identifies cladding damage at the input facet of the fiber as the limiting factor. We have achieved a maximum energy delivery larger than 700 nJ at 92% coupling efficiency. An in depth analysis reveals how this value is greatly affected by possible slight misalignments of the beam during coupling and the measured small beam pointing fluctuations. In the absence of these imperfections, self-phase modulation becomes the limiting factor for the maximum energy delivery, setting the theoretical upper bound to near 2 μJ for a 1-m long, 7-μm, air-core PBF. Finally, the use of a 300 kHz repetition rate fiber laser enabled rapid ablation of 150 µm x 150 µm area within only 50 ms. Such ablation speeds can now allow the surgeons to translate the surgery device as fast as ~4 mm/s to continuously remove a thin layer of a 150 µm wide tissue. Thanks to a high optical transmission efficiency of the in-line optical architecture of the device and improved resolution, we could successfully perform ablation of scarred cheek pouch tissue, drilling through a thin slice. With further development, this device can serve as a precise and high speed ultrafast laser scalpel in the clinic.
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Shalom DF, Ledford KJ, Qadir A, Lind LR, Winkler HA. Visualization of synthetic mesh utilizing optical coherence tomography. Int Urogynecol J 2013; 24:1909-14. [PMID: 23640004 DOI: 10.1007/s00192-013-2106-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 03/26/2013] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Owing to the recent upsurge in adverse events reported after mesh-augmented pelvic organ prolapse (POP) repairs, our aim was to determine whether the location and depth of synthetic mesh can be measured postoperatively within the vaginal tissue microstructure using optical coherence tomography (OCT). METHODS Seventeen patients with prior mesh-augmented repairs were recruited for participation. Patients were included if they had undergone an abdominal sacral colpopexy (ASC) or vaginal repair with mesh. Exclusion criteria were a postoperative period of <6 months, or the finding of mesh exposure on examination. OCT was used to image the vaginal wall at various POP-Q sites. If mesh was visualized, its location and depth was calculated and recorded. RESULTS Ten patients underwent ASC and 7 patients had 8 transvaginal mesh repairs. Mesh was visualized in 16 of the 17 patients using OCT. In all ASC patients, mesh was imaged centrally at the posterior apex. In patients with transvaginal mesh in the anterior and/or posterior compartments, the mesh was visualized directly anterior and/or posterior to the apex respectively. Mean depth of the mesh in the ASC, anterior, and posterior groups was 60.9, 146.7, and 125.7 μm respectively. Mesh was visualized within the vaginal epithelial layer in all 16 patients despite the route of placement. CONCLUSION In this pilot study we found that OCT can be used to visualize polypropylene mesh within the vaginal wall following mesh-augmented prolapse repair. Regardless of abdominal versus vaginal placement, the mesh was identified within the vaginal epithelial layer.
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Affiliation(s)
- Dara F Shalom
- Division of Female Pelvic Medicine and Reconstructive Surgery, North Shore University Hospital/Long Island Jewish, Manhasset, NY, USA,
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Maturo S, Benboujja F, Boudoux C, Hartnick C. Quantitative distinction of unique vocal fold subepithelial architectures using optical coherence tomography. Ann Otol Rhinol Laryngol 2013. [PMID: 23193909 DOI: 10.1177/000348941212101109] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The primary objective of this study was to quantitatively analyze ex vivo porcine, fetal human, and adult human vocal folds by use of optical coherence tomography (OCT). A secondary objective was to quantitatively discriminate among 1-, 2-, and 3-layer lamina propria structures. METHODS We performed an analysis of the vocal folds of 10 adult pig, 3 adult human, and 2 fetal human vocal fold specimens using OCT and histologic techniques. We present a quantitative comparison of the OCT results and histologic findings. RESULTS We found that OCT allowed for the visualization of the subepithelial vocal fold architecture of all imaged tissue, and that it revealed distinct characteristic signal intensities for each type of specimen. CONCLUSIONS Optical coherence tomography was developed for in vivo imaging of biological microstructures. This study demonstrates the ability of OCT to differentiate between the vocal fold architectures of 3 histologically distinct types of vocal folds. Future studies aim to develop a quantitative optical imaging algorithm that can be used to facilitate an in vivo longitudinal clinical investigation of the changes that occur in this layered structure over time and maturation.
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Affiliation(s)
- Stephen Maturo
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02114, USA
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Volgger V, Stepp H, Ihrler S, Kraft M, Leunig A, Patel PM, Susarla M, Jackson K, Betz CS. Evaluation of optical coherence tomography to discriminate lesions of the upper aerodigestive tract. Head Neck 2012; 35:1558-66. [DOI: 10.1002/hed.23189] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2012] [Indexed: 11/07/2022] Open
Affiliation(s)
- Veronika Volgger
- Department of Otorhinolaryngology; Head & Neck Surgery; Klinikum der Universität München; Munich Germany
- Laser-Forschungslabor; LIFE Center; Klinikum der Universität München; Munich Germany
| | - Herbert Stepp
- Laser-Forschungslabor; LIFE Center; Klinikum der Universität München; Munich Germany
| | - Stephan Ihrler
- Labor für Dermatohistologie und Oralpathologie; Munich Germany
| | - Marcel Kraft
- Department of Otorhinolaryngology; Kantonsspital Baselland; Liestal Switzerland
| | - Andreas Leunig
- Department of Otorhinolaryngology; Head & Neck Surgery; Klinikum der Universität München; Munich Germany
| | - Parag M. Patel
- Department of Otolaryngology; Head & Neck Surgery; Princess Alexandra Hospital; Woolloongabba Queensland Australia
| | - Malavika Susarla
- Department of Otolaryngology; Head & Neck Surgery; Princess Alexandra Hospital; Woolloongabba Queensland Australia
| | - Kathleen Jackson
- Department of Otolaryngology; Head & Neck Surgery; Princess Alexandra Hospital; Woolloongabba Queensland Australia
| | - Christian S. Betz
- Department of Otorhinolaryngology; Head & Neck Surgery; Klinikum der Universität München; Munich Germany
- Laser-Forschungslabor; LIFE Center; Klinikum der Universität München; Munich Germany
- Department of Otolaryngology; Head & Neck Surgery; Princess Alexandra Hospital; Woolloongabba Queensland Australia
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24
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Burns JA, Kim KH, deBoer JF, Anderson RR, Zeitels SM. Polarization-sensitive optical coherence tomography imaging of benign and malignant laryngeal lesions: an in vivo study. Otolaryngol Head Neck Surg 2011; 145:91-9. [PMID: 21493273 DOI: 10.1177/0194599811403078] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Optical coherence tomography (OCT), an imaging technology that provides cross-sectional subsurface tissue structure images using back-scattered light, is a promising noninvasive imaging modality for in vivo assessment of vocal fold layered microstructure. Polarization-sensitive OCT (PS-OCT) augments conventional OCT by detecting changes in the polarization state of reflected light. This study imaged various benign and malignant laryngeal pathologies in patients undergoing direct laryngoscopy under general anesthesia to determine whether PS-OCT would provide useful additional information about vocal fold microstructure and glottic surface pathology. STUDY DESIGN. Prospective clinical trial. SETTING Tertiary care center. SUBJECTS AND METHODS Twenty-three patients who were undergoing microlaryngoscopy under general anesthesia for benign (n = 18) and alignant (n = 5) glottic disease were imaged bilaterally with OCT and PS-OCT (n = 46 vocal folds). Intraoperative microphotography guided placement of the imaging probe. Normal-appearing glottic tissue was also imaged if present. When clinically indicated, biopsy or complete removal of the lesion established histologic confirmation. RESULTS PS-OCT provided high-quality, vertical, cross-sectional images up to 1.2-mm deep that complemented microlaryngoscopy and conventional OCT for vocal fold pathologies. Scar tissue was visualized by PS-OCT, characterized by a birefringence pattern more intense than that of normal glottic tissue. Cancer typically showed disruption or absence of both layered structure and birefringence. CONCLUSION Combining PS-OCT with OCT during human vocal cord imaging provides useful information in characterizing vocal cord lesions, articularly scar tissue.
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Affiliation(s)
- James A Burns
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA.
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25
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Ovári A, Pau HW, Just T. [Optical coherence tomography in otolaryngology]. Orv Hetil 2011; 152:1125-32. [PMID: 21712174 DOI: 10.1556/oh.2011.29164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Optical coherence tomography is an imaging technique based on coherence interferometry. It is used in many medical fields due to its non-invasive imaging capabilities with micrometer resolution. The aim of the authors was to review the applicability of the optical coherence tomography in otolaryngology. Literature data and their own studies show that optical coherence tomography is a reliable method for identifying and targeted biopsy of inflammated, pre-malignant or cancer tissue in human laryngeal and pharyngeal mucosa. Another emerging field for optical coherence tomography is diagnosis of middle ear diseases, especially stapes ankylosis and cholesteatoma.
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Affiliation(s)
- Attila Ovári
- Universität Rostock Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner" Rostock
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26
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Hirshoren N, Varon D, Weinberger JM, Gross M. Airway obstruction and hemophilia-A: epiglottis hematoma. Laryngoscope 2010; 120:1428-9. [PMID: 20583237 DOI: 10.1002/lary.20969] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Acute upper airway obstruction is a potentially life-threatening event. Hemophilia-A is a coagulopathy with high risk for spontaneous bleeding. Here we describe for the first time a spontaneous epiglottic internal hemorrhage leading to upper airway narrowing in a hemophilia-A patient. The patient was admitted to the intensive care unit for airway observation and treatment with factor VIII supplementation. In the first 48 hours there was rapid respiratory improvement. The epiglottic swelling resolved on the 5th day. In this patient no oral intubation or surgical management was needed.
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Affiliation(s)
- Nir Hirshoren
- Department of Otolaryngology/Head and Neck Surgery, Hadassah Hebrew-University Medical Center, Jerusalem, Israel.
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27
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Current World Literature. Curr Opin Otolaryngol Head Neck Surg 2010; 18:191-4. [DOI: 10.1097/moo.0b013e32833ad4c9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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