Abstract
Electromechanical reshaping (EMR) of cartilage is a promising noninvasive technique with potential for broad application in reconstructive surgery. EMR involves applying direct current electrical fields to localized stress regions and initiating a series of oxidation-reduction reactions, thus effecting a shape change. Previous EMR studies have focused on macroscopic structural measurements of the shape change effect or monitoring of electrical current flow. Only limited investigation of structural changes in the tissue at the histologic level have been performed, and not in real time. This study is the first to use optical coherence tomography (OCT) to examine structural changes in cartilage during EMR. Two platinum needle electrodes were inserted into fixed rectangular rabbit nasal septal cartilage specimens. The spectral domain OCT probe was then positioned above the section of cartilage in which the anode needle was inserted. A constant voltage of 6V was applied for 3 minutes, and images were obtained (8 frames/second). OCT was also performed in specimens undergoing dehydration under ambient conditions and during pH changes produced by the addition of HCl, as both processes accompany EMR. The OCT data identified distinct findings among the three conditions, suggesting that EMR causes a much greater degree of reshaping on a molecular level than dehydration or a change in pH alone. OCT provides a means to gauge structural changes in the tissue matrix during EMR. The application of OCT to image the EMR process will add to our understanding of the mechanisms of action involved and potentially facilitate optimization of this process.
Highlights
Cartilage reshaping is a key element in facial reconstructive surgery
While the purpose of Electromechanical reshaping (EMR) is to effect shape change, the cartilage was not mechanically bent into a jig as performed in previous EMR experiments, as the main objective of the study is to visually examine structural changes at a histological level
In the optical coherence tomography (OCT)-EMR video, a significant degree of reshaping, cell migration and bubble formation are observed in concentric rings radiating out from the anode
Summary
Cartilage reshaping is a key element in facial reconstructive surgery. Cartilage tissue is used to provide structural support for soft tissues in the head, neck, and upper airway, as well as support for joint movement.[1] Surgical techniques have been developed to reshape cartilage to replace damaged or missing cartilage due to trauma, surgical defects, or congenital malformations. Conventional techniques include sculpting, morselizing, or suturing grafts from native cartilage.[2] these techniques are complex and invasive, and results often depend on the skill of the surgeon. Current procedures come with risks such as warping of cartilage over time and graft rejection. Alternative procedures such as thermal-dependent laser and radiofrequency cartilage reshaping have been proposed.[3,4]
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