Quantitative Evaluation of Adult Subglottic Stenosis Using Intraoperative Long-range Optical Coherence Tomography.

Giriraj K. Sharma,Anthony Chin Loy,Sunil Verma,Brian J-F. Wong,Zhongping Chen,Erica Su,Joe Jing

doi:10.1177/0003489416655353

Abstract

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). 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). 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. 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.

Highlights

Subglottic stenosis (SGS) occurs as a consequence of trauma, prolonged endotracheal intubation, infectious and chronic inflammatory diseases,[1,2] or for idiopathic[3] reasons and remains a therapeutic challenge for otolaryngologists
The long-range optical coherence tomography (LR-Optical coherence tomography (OCT)) was performed during suspension microlaryngoscopy on 3 adult female subjects before and after endoscopic treatment for SGS
All 3 subjects were imaged without OCT-related adverse events or technical complications

Summary

Introduction

Subglottic stenosis (SGS) occurs as a consequence of trauma, prolonged endotracheal intubation, infectious and chronic inflammatory diseases,[1,2] or for idiopathic[3] reasons and remains a therapeutic challenge for otolaryngologists. Evaluation of the airway and characterization of stenosis is a critical aspect of SGS management. Serial airway evaluation of patients with SGS is important to gauge treatment efficacy and the rate of disease recurrence. There are limited options to practically and accurately measure the cross-sectional dimensions of SGS and quantify the efficacy of treatment. The most widely used objective measure of SGS in clinical practice is the Cotton-Myer grading system.[4] This SGS classification scheme requires interchanging of endotracheal tubes to yield a crude estimate of the percentage of airway stenosis and does not accurately measure nonconcentric stenosis. Diagnostic imaging options for evaluation and measurement of SGS include computed tomography (CT) and magnetic resonance (MR) imaging. Thin-cut CT may be used to measure airway dimensions in the transverse and cranio-caudal

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