Cartilage Reshaping Research Articles

Laser Reshaping of Cartilage

Laser Reshaping of Cartilage

Laser-mediated cartilage reshaping with feedback-controlled cryogen spray cooling: biophysical properties and viability.

Recent studies have indicated that chondrocyte viability decreases with prolonged or repeated laser irradiation. To optimize laser-mediated cartilage reshaping, the heating process must be finely controlled. In this study, we use high-power Nd:YAG laser irradiation (lambda = 1.32 microm) combined with cryogen spray cooling (CSC) in an attempt to reshape porcine septal cartilage while enhancing chondrocyte viability. Chondrocyte viability was determined after high-power (50 W/cm2) Nd:YAG-mediated cartilage reshaping with and without cryogen spray cooling (CSC) and correlated with dynamic measurements of tissue optical and thermal properties. After 1.5 to 2.0 seconds of laser exposure, characteristic changes in diffuse reflectance (indicating the onset of accelerated stress relaxation) was observed in both laser only and laser with CSC specimens. After 2 seconds of laser exposure, specimens in both groups retained the curved shape for up to 14 days. After one laser exposure, chondrocyte viability was 94.35 +/- 6.1% with CSC and 68.77 +/- 20.1% (P < 0.05) without CSC. After two laser exposures, a similar trend was observed with CSC (70.18 +/- 16.44%) opposed to without CSC (28 +/- 45%; P < 0.05). CSC during high-power laser irradiation allows rapid heating while minimizing extreme front surface temperature elevations and axial thermal gradients. Laser irradiation with CSC can be used to effectively reshape cartilage tissue with the additional advantage of increasing chondrocyte viability.

Feedback-controlled laser-mediated cartilage reshaping.

To demonstrate feedback-controlled laser-mediated cartilage reshaping using dynamic measurements of tissue optical properties and radiometric surface temperatures. Flat cartilage specimens were reshaped into curved configurations using a feedback-controlled laser device. Fresh porcine nasal septum, stripped of perichondrium and cut into uniform strips (25 x 10 x 1.5-2.1 mm) with a custom guillotine microtome. Cartilage specimens secured in a cylindrical reshaping jig (2.5 cm in diameter) and irradiated with an Nd:YAG laser (lambda = 1.32 microns, 25 W/cm2, 50-Hz pulse repetition rate). During laser irradiation, radiometric surface temperature was measured along with changes in forward-scattered light from a diode probe laser (lambda = 650 nm, 5 mW), using a lock-in detection technique. Sequential irradiation of the specimen outer surface was made (3 laser passes). Characteristic changes in tissue temperature and light-scattering signals were used to terminate laser irradiation. Effective reshaping was accomplished for both thin (1.5-mm) and thick (2.1-mm) specimens. Following reshaping, specimens were stored in saline solution at 4 degrees C for 21 days. No return to the original flat configuration was noted during this period. The prototype device effectively reshapes flat native porcine cartilage into curve configurations. The use of optical and thermal signals provides effective feedback control for optimizing the reshaping process.

Heating and structural alterations in cartilage under laser radiation

The authors have developed a theoretical model to calculate the temperature field and the spatial distribution of modified cartilage following laser irradiation. The model incorporates both thermal and mass transfer in a tissue with bulk absorption of laser radiation, water evaporation from the surfaces of a slab, and temperature dependence of the diffusion coefficient. The authors propose that water undergoes a bound-to-free phase transition in cartilage heated to about 70/spl deg/C and the mobility of proteoglycan units in the cartilage matrix increases. Movement of the proteoglycan units takes place only when the temperature exceeds 70/spl deg/C and results in tissue denaturation. Using their model, the authors show: (1) the maximal temperature is reached not on the surface irradiated but rather at some distance below; (2) surface temperature reaches its asymptotic value quicker than the maximal temperature; and (3) the depth of the denatured tissue volume strongly depends on laser fluency, wavelength, exposure time, and cartilage thickness. The model allows for the prediction and control of temperature and depth of structural alterations during the course of laser reshaping and treatment of cartilage.

Characterization of temperature-dependent biophysical properties during laser mediated cartilage reshaping

Laser radiation can be used to reshape cartilage tissue into new morphologic configurations. When a critical temperature is attained, mechanically deformed cartilage becomes malleable and may be reshaped into new geometric configurations that harden as the tissue cools. This temperature dependent process results in mechanical stress relaxation and is characteristic of a phase transformation. The principal advantages of using laser radiation for the generation of thermal energy in tissue are precise control of both the space-time temperature distribution and time-dependent thermal denaturation kinetics. We illustrate the utility of laser mediated cartilage reshaping in ex vivo porcine model of reconstructive nasal and laryngeal surgery, and attempt to determine the temperature range in which accelerated stress relaxation occurs during laser mediated cartilage reshaping. Optimization of the reshaping process requires identification of the temperature dependence of this phase transformation and its relationship to observed changes in cartilage optical (diffuse scattering), mechanical (internal stress), and thermodynamic properties (heat capacity). Light scattering, infrared radiometry, and modulated differential scanning calorimetry were used to measure temperature-dependent changes in the biophysical properties of cartilage tissue during fast (laser mediated) and slow heating (conventional calorimetric beating). Our studies using MDSC and laser probe techniques have identified changes in tissue thermodynamic and optical properties suggestive of a phase transformation occurring near 60/spl deg/C. Clinically, reshaped cartilage tissue can be used to recreate the underlying cartilaginous framework of structures in the head and neck such as the ear, larynx, trachea, and nose.

Stress Relaxation of Porcine Septal Cartilage During Nd:YAG (λ=1.32 μm) Laser Irradiation: Mechanical, Optical, and Thermal Responses

Laser-assisted cartilage reshaping is mediated by thermally induced stress relaxation, and may be used to alter cartilage morphology for reconstructive surgical procedures in the upper airway and face without carving, morselizing, or suturing. Internal stress σ(t), integrated backscattered light intensity I(t) from a He-Ne probe laser (λ=632.8 nm), and radiometric surface temperature Sc(t) were measured during the reshaping of porcine nasal septal cartilage using a pulsed Nd:YAG laser (λ=1.32 μm). Internal stress and integrated backscattered light intensity were observed to increase, plateau, and then decrease in similar ways during laser irradiation. The plateau region occurred when the cartilage front surface temperature approached 65 °C. I(t) was utilized in a feedback control procedure to reshape cartilage specimens from a flat to a curved geometry. Immediately following laser irradiation, the tissues were rehydrated in normal saline for 15 min while wrapped around a small dowel. A stable shape change was retained for 21 days while the specimens were stored in normal saline at 5 °C. The backscattered light intensity signal mirrors underlying changes in internal stress, and further rate of change or slope of I(t) is nearly zero when the surface temperature reaches about 65 °C. Measurements of I(t) (or, equivalently, the fractional change in integrated backscattered light intensity ΔI(t)/I0) may be used to control the process of laser-assisted cartilage reshaping and minimize nonspecific thermal injury due to uncontrolled heating. © 1998 Society of Photo-Optical Instrumentation Engineers.

The infradome graft: a new technique to improve dome reshaping in rhinoplasty.

As the open approach rhinoplasty has gained popularity, newer techniques for aggressive reshaping of the alar cartilage have become available. The most effective way to increase alar dome definition is the dome plication technique described by Daniel, which places a horizontal mattress suture, applied with incremental tension, between the medial and lateral crura. The disadvantage of this technique is that it can produce either overtightening or distortion of the cartilage, with excessive pinching of the nasal tip. Also, as it relies on a single nylon suture to fight against the cartilage's shape memory, it has the potential for relapse. The present article describes a new technique to overcome these problems. It consists of placing two parallel strips prepared from the resected alar cartilage excess under the domes. These grafted cartilages block the plication suture, thus avoiding the risk of excessive pinching of the domes and ensuring symmetry and stability. Using this technique, I have consistently obtained a nasal tip that is well defined over the nasal dorsum line in my patients.

Measurement of radiometric surface temperature and integrated backscattered light intensity during feedback-controlled laser-assisted cartilage reshaping

Cartilage undergoes characteristic mechanical stress relaxation following laser irradiation below the ablation threshold. Porcine auricular cartilage (1–2 mm thickness) was irradiated with a Nd:YAG laser (λ=1.32 μm) at two power levels (W/cm2). Surface temperature (S c (t) (°C)) (monitored using a single element HgCdTe infrared detector, 10-14 μm spectral range), and integrated back scattered light intensityI(t) were measured during laser irradiation. A HeNe laser beam (λ=632.8 nm) was incident on the back surface of the cartilage specimen and fractional integrated backscattered light intensity was measured using an integrating sphere anda silicon photodiode. Laser irradiation (5.83 W/cm2, 50 Hz pulse repetition rate (PRR)) continued until surface temperature reached approximately 70°C, during which cartilage mechanical stress relaxation was observed. Integrated back scattered light intensity reached a plateau at about 70°C). At higher laser power (39.45 W/cm2, 50 Hz PRR), a feedback-controlled cryogen spray was used to maintain surface temperature below 50°C. A similar plateau response was noted in integrated backscattered light intensity. This signal may be used to optimise the process of stress relaxation in laser cartilage reshaping. Several clinical applications involving reconstructive surgery are proposed.

The effect of holmium laser radiation on stress, temperature and structure of cartilage

It is difficult to permanently alter the shape of cartilage in a controlled way. In otolaryngology and plastic surgery several procedures are done to alter the shape of cartilage, for example the correction of a deviated nasal septum and surgery for bat ears. The aim of this paper is to study the main parameters which are necessary for the phenomenon of reshaping of cartilage under non-destructive laser radiation. We have measured temperature and stress in cartilage when it is being reshaped with a holmium laser, It has been shown that laser-induced stress relaxation in cartilage takes place when the tissue temperature exceeds 70°C. We have determined the conditions which allow the shape of cartilage to be altered without producing any pronounced alteration to matrix structure or chondrocytes.

Thermal and diffusion processes in laser-induced stress relaxation and reshaping of cartilage

The thermodynamic characteristics of the ‘bound-to-free’ phase transformation of water are studied by means of differential microcalorimetry and FTIR spectroscopy. This phase transition controls the stress relaxation and reshaping of cartilage which we have observed previously under moderate laser heating. It is shown that the FTIR spectrum of bound water in cartilage differs from that of free water in cartilage, and that both show differences to the FTIR spectrum of pure water. The proportion of bound water in cartilage is found to be of the order 4%. We have examined water liberation and absorption kinetics and found them to be controlled by diffusion through the tissue and also by the bound-to-free water transformation. The theoretical modelling and experimental data allowed calculation of diffusion coefficients and the activation energy for water transfer. The latter was found to be close to the heat of phase transformation of water. We have established that the drying and wetting processes in cartilage are reversible (fully or in a part, depending on the temperature of preliminary drying) and can be described by identical solutions of the diffusion problem, with coefficients of water diffusion being the same. The mechanism of water diffusion in cartilaginous tissue is also discussed.

Surgery of the nasal tip.

One of the most challenging aspects of cosmetic rhinoplasty is nasal tip refinement. In efforts to control tip rotation, projection and architecture, surgeons face constant tradeoffs between tip position and dorsal reduction. Open structure rhinoplasty allows direct visualization of bony-cartilaginous deformities, preservation of nasal structural integrity and precise nasal tip alteration. The open rhinoplasty technique involves, control of tip projection and rotation, reshaping of nasal tip cartilage, minimal resection of the nasal dorsum and lower lateral cartilage and preservation or reinforcement of major tip supports. The advantage of open structure rhinoplasty includes preservation of inherent nasal supporting elements and precise nasal reshaping which are essential for aesthetically pleasing and predictable postoperative results.

Endoscopic Laser-Assisted Reshaping of Collapsed Tracheal Cartilage a Laboratory Study

Repair of anterior tracheal wall collapse is a common and troublesome problem encountered by the head and neck surgeon. The standard treatment calls for an open procedure with or without stenting, depending on the extent of the damage. To avoid the morbidity of the open procedure, a new concept of endoscopic cartilage reshaping was investigated in a laboratory animal study. It involved the application of 1.44-micron pulsed neodymium:yttrium-aluminum-garnet (Nd:YAG) laser at relatively low power to restructure without devitalizing cartilage. An in vivo study was done in six dogs to determine appropriate laser dosimetry in a model of tracheal wall collapse created by a tracheotomy. The deformed cartilage was treated endoscopically with a noncontact 1.44-micron Nd:YAG laser, at 2 to 4 W of power with a repetition rate of 20 Hz, in three animals. As a control, three animals had endoscopic cartilage incisions followed by stent placement. Six weeks postoperatively, both groups had an adequate airway lined by healthy mucosa. In the animals with stenting, however, there was stenosis formation due to scarring at both ends of the stent, with significant inflammatory response in the local area. This study shows that it is possible to use low-power laser energy to reshape cartilage without destroying its viability, and to restore the tracheal wall to a normal contour without ablation or vaporization. The reshaped cartilage will tend to retain its shape with functional elastic force, as seen in in vitro studies. These preliminary results are encouraging, and it seems reasonable to consider using the technique in selected clinical cases as an alternative to conventional open surgery.