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Int J Pediatr Otorhinolaryngol. 2015 Jan;79(1):63-70. doi: 10.1016/j.ijporl.2014.11.009. Epub 2014 Nov 15.

Intraoperative long range optical coherence tomography as a novel method of imaging the pediatric upper airway before and after adenotonsillectomy.

Author information

1
Beckman Laser Institute, University of California-Irvine, Irvine, CA, USA.
2
Children's Hospital of Orange County, Orange, CA, USA; Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Irvine, CA, USA.
3
Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Irvine, CA, USA.
4
Beckman Laser Institute, University of California-Irvine, Irvine, CA, USA; Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Irvine, CA, USA. Electronic address: bjwong@uci.edu.

Abstract

BACKGROUND/OBJECTIVES:

While upper airway obstruction is a common problem in the pediatric population, the first-line treatment, adenotonsillectomy, fails in up to 20% of patients. The decision to proceed to surgery is often made without quantitative anatomic guidance. We evaluated the use of a novel technique, long-range optical coherence tomography (LR-OCT), to image the upper airway of children under general anesthesia immediately before and after tonsillectomy and/or adenoidectomy. We investigated the feasibility of LR-OCT to identify both normal anatomy and sites of airway narrowing and to quantitatively compare airway lumen size in the oropharyngeal and nasopharyngeal regions pre- and post-operatively.

METHODS:

46 children were imaged intraoperatively with a custom-designed LR-OCT system, both before and after adenotonsillectomy. These axial LR-OCT images were both rendered into 3D airway models for qualitative analysis and manually segmented for quantitative comparison of cross-sectional area.

RESULTS:

LR-OCT images demonstrated normal anatomic structures (base of tongue, epiglottis) as well as regions of airway narrowing. Volumetric rendering of pre- and post-operative images clearly showed regions of airway collapse and post-surgical improvement in airway patency. Quantitative analysis of cross-sectional images showed an average change of 70.52mm(2) (standard deviation 47.87mm(2)) in the oropharynx after tonsillectomy and 105.58mm(2) (standard deviation 60.62mm(2)) in the nasopharynx after adenoidectomy.

CONCLUSIONS:

LR-OCT is an emerging technology that rapidly generates 3D images of the pediatric upper airway in a feasible manner. This is the first step toward development of an office-based system to image awake pediatric subjects and thus better identify loci of airway obstruction prior to surgery.

KEYWORDS:

Adenoidectomy; Long range optical coherence tomography; Tonsillectomy

PMID:
25479699
PMCID:
PMC4313623
DOI:
10.1016/j.ijporl.2014.11.009
[Indexed for MEDLINE]
Free PMC Article

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