Dmitry Protsenko - Academia.edu (original) (raw)

Papers by Dmitry Protsenko

Tissue optical properties are necessary parameters for prescribing light dosimetry in photomedici... more Tissue optical properties are necessary parameters for prescribing light dosimetry in photomedicine. In many diagnostic or therapeutic applications where optical fiber probes are used, pressure is often applied to the tissue to reduce index mismatch and increase light transmittance. In this study, we have measured in vitro optical properties as a function of pressure with a visible-IR spectrophotometer. A spectral

Lasers in Surgery and Medicine

Thermal Treatment of Tissue: Energy Delivery and Assessment IV, 2007

Successful application of laser cartilage reshaping (LCR) for the in-situ treatment of structural... more Successful application of laser cartilage reshaping (LCR) for the in-situ treatment of structural deformities in the nasal septum, external ear and trachea requires a better understanding of the evolution of cartilage mechanical properties with temperature. We develop a method of Radio Frequency (RF) heating for reliable evaluation of mechanical changes in septal cartilage undergoing heating and used obtained data to

The Laryngoscope, Jan 17, 2015

The trachea is a composite cartilaginous structure particularly prone to various forms of convexi... more The trachea is a composite cartilaginous structure particularly prone to various forms of convexities. Electromechanical reshaping (EMR) is an emerging technique used to reshape cartilaginous tissues by applying electric current in tandem with imposed mechanical deformation to achieve shape change. In this study, EMR was used to reshape tracheal cartilage rings to demonstrate the feasibility of this technology as a potentially minimally invasive procedure to alter tracheal structure. Controlled laboratory study using ex vivo porcine tracheae. The natural concavity of each porcine tracheal ring was reversed around a cork mandrel. Two pairs of electrodes were inserted along the long axis of the tracheal ring and placed 1.5 millimeters from the midline. Current was applied over a range of voltages (3 volts [V], 4V, and 5V) for either 2 or 3 minutes. The degree of EMR-induced reshaping was quantified from photographs using digital techniques. Confocal imaging with fluorescent live and d...

Urology, 1996

Objectives. Currently, various side-emitting optical fibers with different tip geometry are used ... more Objectives. Currently, various side-emitting optical fibers with different tip geometry are used transurethrally to deliver laser radiation for treatment of benign prostatic hyperplasia (BPH). Since fiber tip design could profoundly affect the size and profile of the emitted laser beam, and consequently the tissue response and the extent of tissue coagulation, we evaluated commercially available fibers in regard to their optical characteristics and their ability to coagulate tissue in a controlled experimental setting.

Photonic Therapeutics and Diagnostics VII, 2011

Electromechanical reshaping of cartilage is a novel modality that has significant clinical applic... more Electromechanical reshaping of cartilage is a novel modality that has significant clinical applications in otolaryngology and plastic surgery. Although EMR dosimetry has been extensively studied, little is known about the mechanisms of EMR, of which local tissue pH changes is believed to play a role. In this study, rabbit nasal septal cartilage is subject to a number of experiments aimed at elucidating pH-related changes using phenol red. The lateral extent and magnitude of pH change as well as factors that impact pH change are studied. Increasing voltage and application appear to increase the area and intensity of color change. With parameters known to produce thermal tissue injury, a transitional zone likely representing a confluence of acid-base products is noted in the region around the bend axis. Furthermore, rehydration and pH indicator application time do not appear to play a role in the quality of pH change. These simple experiments may provide insight into the role of pH changes in EMR that may allow correlation of dosimetry to tissue damage, further optimizing the clinical potential of EMR.

Lasers in Surgery: Advanced Characterization, Therapeutics, and Systems XIV, 2004

Stenotic, collapsed, and flow-restricted tracheal airways may result from blunt trauma, chronic i... more Stenotic, collapsed, and flow-restricted tracheal airways may result from blunt trauma, chronic infection, and the prolonged endotracheal intubation. This pilot investigation characterizes the degree of shape change produced by Ho:YAG laser (λ=2.12 μm) irradiation of rabbit and ...

JAMA Facial Plastic Surgery, 2013

Objective: To report the first successful study to date of in vivo electromechanical reshaping of... more Objective: To report the first successful study to date of in vivo electromechanical reshaping of ear cartilage in a rabbit model. Methods: Ears of New Zealand white rabbits were reshaped using percutaneous needle electrode electromechanical reshaping (5 V for 4 minutes) and were then bolstered for 4 weeks. Ten ears were treated, with 2 undergoing sham procedures and serving as controls. The treatment was performed using a platinum array of electrodes consisting of 4 parallel rows of needles inserted across the region of flexures in the ear. After 4 weeks, the animals were killed, and the ears were photographed and sectioned for conventional light microscopy and confocal microscopy (live-dead fluorescent assays).

JAMA Facial Plastic Surgery, 2014

IMPORTANCE Electromechanical reshaping (EMR) is a low-cost, needle-based, and simple means to sha... more IMPORTANCE Electromechanical reshaping (EMR) is a low-cost, needle-based, and simple means to shape cartilage tissue without the use of scalpels, sutures, or heat that can potentially be used in an outpatient setting to perform otoplasty. OBJECTIVES To demonstrate that EMR can alter the shape of intact pinnae in an in vivo animal model and to show that the amount of shape change and the limited cell injury are proportional to the dosimetry.

Optical Tomography and Spectroscopy of Tissue: Theory, Instrumentation, Model, and Human Studies II, 1997

ABSTRACT Tissue optical properties are necessary parameters for prescribing light dosimetry in ph... more ABSTRACT Tissue optical properties are necessary parameters for prescribing light dosimetry in photomedicine. In many diagnostic or therapeutic applications where optical fiber probes are used, pressure is often applied to the tissue to reduce index mismatch and increase light transmittance. In this study, we have measured in vitro optical properties as a function of pressure with a visible-IR spectrophotometer. A spectral range of 400 - 1800 nm with a spectral resolution of 5 nm was used for all measurements. Skin specimens of two Hispanic donors and three caucasian donors were obtained from the tissue bank. Each specimen, sandwiched between microscope slides, was compressed by a spring-loaded apparatus. Then diffuse reflectance and transmittance of each sample were measured at no load and at approximately 0.1 and 1 kgf/cm2. Under compression, tissue thicknesses were reduced up to 78%. Generally, reflectance decreased while the overall transmittance increased under compression. The absorption and reduced scattering coefficients were calculated using the inverse adding doubling method. Compared with the no-load controls, there was an increase in the absorption and scattering coefficients among most of the compressed specimens.

The Laryngoscope, 2014

Objectives/Hypothesis: Electromechanical reshaping (EMR) involves reshaping cartilage by mechanic... more Objectives/Hypothesis: Electromechanical reshaping (EMR) involves reshaping cartilage by mechanical deformation and delivering electric current to the area around the bend axis, causing local stress relaxation and permanent shape change. The mechanism of EMR is currently unclear, although preliminary studies suggest that voltage and application time are directly related to the concentration and diffusion of acid-base products within the treated tissue with little heat generation. This study aims to characterize local tissue pH changes following EMR and to demonstrate that local tissue pH changes are correlated with tissue damage and shape change.

The Laryngoscope, 2011

Objective/Hypothesis-Needle electrode-based electromechanical reshaping (EMR) is a novel, ultra-l... more Objective/Hypothesis-Needle electrode-based electromechanical reshaping (EMR) is a novel, ultra-low cost nascent surgical technology to reshape cartilage with low morbidity. EMR uses direct current (DC) to induce mechanical relaxation in cartilage that is first deformed into a required geometry, which in turn leads to permanent shape change. The objective of this study was to determine the effect of EMR voltage and time on the shape change of costal cartilage grafts.

The Laryngoscope, 2010

Objectives: This study describes the process of tissue electroforming and how shape changes in ca... more Objectives: This study describes the process of tissue electroforming and how shape changes in cartilage can be produced by the application of direct current (DC). The dependence of shape change on voltage and application time is explored. Study Design: Basic investigation using ex vivo porcine septal cartilage grafts and electromechanical cartilage deformation focused on development of a new surgical technique. Methods: Uniform flat porcine nasal septal cartilage specimens were mechanically deformed between two semicircular aluminum electrodes. DC current was applied to establish charge separation and electrical streaming potential. Voltage (0 -3.5 V) and application time (0 -5 minutes) were varied. Shape change was measured, and shape retention was calculated using analytic representation. The effect of the direction of applied current on shape change was evaluated by switching the polarities of electrodes and using parameters of 0 to 5.5 V and 5 minutes. Temperature during reshaping was monitored with a thermocouple, and surface features were evaluated using light microscopy. Results: Reshaped specimen demonstrated mechanical stability similar to native cartilage tissue. Shape retention strongly correlated with increasing voltage and application time. Only a small current (<0.1 A) through the tissue was measured. Temperature change was less than 2°C during electroforming, suggesting that electroforming likely results from some nonthermal mechanisms. Surface features indicated that electrodeposition may occur depending on electrode material and magnitude of the applied voltage. Conclusions: These find-ings demonstrate that cartilage can be reshaped through the process we have described as "electroforming" by generating intrinsic differences in charge separation with negligible heat production.

The Laryngoscope, 2014

Although minor and major tip support mechanisms have been described in detail, no quantitative mo... more Although minor and major tip support mechanisms have been described in detail, no quantitative models exist to provide support for the relative contributions of the structural properties of the major alar cartilage, the fibrous attachments to surrounding structures, and the rigid support structures in an objective manner. The finite element method was used to compute the stress distribution in the nose during simple tip compression, and then identify the specific anatomic structures that resist deformation and thus contribute to tip support. Additionally, the impact of caudal septal resection on nasal tip support was examined. The computer models consisted of three tissue components with anatomically correct geometries for skin and bone derived from computed tomographic data. Septum, upper lateral cartilages, and major alar cartilages were fitted within the model using three-dimensional computer-aided design software. Five-millimeter nasal tip compression was performed on the models with caudal septal resection (3 and 5 mm) and without resection to simulate palpation, then the resulting spatial distribution of stress and displacement was calculated. The von Mises stress in the normal model was primarily concentrated along the medial crural angle. As caudal septum length was reduced, stress was redistributed to adjacent soft tissue and bone, resulting in less force acting on the septum. In all models, displacement was greatest near the intermediate crura. These models are the first step in the comprehensive mechanical analysis of nasal tip dynamics. Our model supports the concept of the caudal septum and major alar cartilage providing the majority of critical load-bearing support.

The Laryngoscope, 2013

Objectives/Hypothesis: Determine the effective electromechanical reshaping (EMR) parameters for s... more Objectives/Hypothesis: Determine the effective electromechanical reshaping (EMR) parameters for shape change and cell viability in the ex vivo rabbit costal cartilage model.

The Laryngoscope, 2013

This study attempts to characterize the biomechanical properties of a PDS-cartilage composite gra... more This study attempts to characterize the biomechanical properties of a PDS-cartilage composite graft for use in septorhinoplasty. Experimental Study. This study used a PDS analog, porcine cartilage cut to 1 × 5 × 20 mm, and a mechanical testing platform to measure flexure of a composite graft. Samples were assessed in four groups based on variations in suture pattern and orientation. The platform measured the force required to deflect the sample 2 mm in single cantilever beam geometry before and after the polymer was affixed to the specimen. Elastic Moduli were calculated before and after application of the polydioxanone polymer. The average modulus of the cartilage alone was 17 ± 0.9 MPa. The modulus of the composite cartilage-polymer graft with 2 suture fixation was 21.2 ± 1.5 MPa. The 3-suture configuration produced an increase to 25.8 ± 2.23 MPa. The four-suture configuration produced 23.1 ± 3.19 MPa. The five-suture configuration produced 25.7 ± 2.6 MPa. The modulus of the analog alone was 170 ± 30 MPa. The modulus of the 0.5 mm PDS was 692 ± 37.4 MPa. The modulus of the 0.15 mm perforated PDS was 447 ± 34.8 MPa. The study found that suturing a polymer plate to cartilage resulted in enhanced stiffness of the composite. Under the conditions of the study, there was no significant difference in elastic moduli between suture configurations, making the two-suture linear configuration optimal in the one-plane cantilever deflection model.

Lasers in Surgery and Medicine, 2008

Laser cartilage reshaping (LCR) is a promising method for the in situ treatment of structural def... more Laser cartilage reshaping (LCR) is a promising method for the in situ treatment of structural deformities in the nasal septum, external ear and trachea. Laser heating leads to changes in cartilage mechanical properties and produces relaxation of internal stress allowing formation of a new stable shape. While some animal and preliminary human studies have demonstrated clinical feasibility of LCR, application of the method outside specialized centers requires a better understanding of the evolution of cartilage mechanical properties with temperature. The purpose of this study was to (1) develop a method for reliable evaluation of mechanical changes in the porcine septal cartilage undergoing stress relaxation during laser heating and (2) model the mechanical changes in cartilage at steady state following laser heating. Rectangular cartilage specimens harvested from porcine septum were heated uniformly by a radio-frequency (RF) electric field (500 kHz) for 8 and 12 seconds to maximum temperatures from 50 to 90 degrees C. Cylindrical samples were fashioned from the heated specimens and their equilibrium elastic modulus was measured in a step unconfined compression experiment. Functional dependencies of the elastic modulus and maximum temperature were interpolated from the measurements. Profiles of the elastic modulus produced after 8 and 12 seconds of laser irradiation (Nd:YAG, lambda = 1.34 microm, spot diameter 4.8 mm, laser power 8 W) were calculated from interpolation functions and surface temperature histories measured with a thermal camera. The calculated elastic modulus profiles were incorporated into a numerical model of uniaxial unconfined compression of laser irradiated cylindrical samples. The reaction force to a 0.1 compressive strain was calculated and compared with the reaction force obtained in analogous mechanical measurements experiment. RF heating of rectangular cartilage sample produces a spatially uniform temperature field (temperature variations &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 4 degrees C) in a central region of the sample which is also large enough for reliable mechanical testing. Output power adjustment of the RF generator allows production of temperature histories that are very similar to those produced by laser heating at temperatures above 60 degrees C. This allows creation of RF cartilage samples with mechanical properties similar to laser irradiated cartilage, however with a spatially uniform temperature field. Cartilage equilibrium elastic modulus as a function of peak temperature were obtained from the mechanical testing of RF heated samples. In the temperature interval from 60 to 80 degrees C, the equilibrium modulus decreased from 0.08+/- 0.01 MPa to 0.016+/-0.007 MPa, respectively. The results of the numerical simulation of uniaxial compression of laser heated samples demonstrate good correlation with experimentally obtained reaction force. The thermal history and corresponding thermally induced modification of mechanical properties of laser irradiated septal cartilage can be mimicked by heating tissue samples with RF electric current with the added advantage of a uniform temperature profile. The spatial distribution of the mechanical properties obtained in septal cartilage after laser irradiation could be computed from mechanical testing of RF heated samples and used for numerical simulation of LCR procedure. Generalization of this methodology to incorporate orthogonal mechanical properties may aid in optimizing clinical laser cartilage reshaping procedures.

Lasers in Surgery and Medicine, 2012

Thermally mediated modalities of cartilage reshaping utilize localized heating of cartilage combi... more Thermally mediated modalities of cartilage reshaping utilize localized heating of cartilage combined with mechanical deformation to achieve new geometries. We sought to determine the steady state elastic modulus of thermally modified cartilage without deformation, as this provides a constraint in mechanical models of the shape change process. The main objective of this study was to characterize the steady state elastic modulus of porcine septal cartilage after uniform heating with radiofrequency (RF) to peak temperatures of 50 ± 5, 65 ± 5, and 85 ± 5°C. The cartilage was divided into three equally sized regions, designated as anterior, middle and posterior. Each region was then sectioned into two specimens with the proximal component serving as a paired control. The data confirm that there is high baseline variability in control steady state elastic moduli between animals. Also, the control values confirm a decreasing steady state elastic modulus from anterior to posterior. There is no statistical significance (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05) found between the elastic moduli of control and treated samples. Although shape change and retention have been fairly well characterized, little is known about the specific relation between steady state elastic modulus of cartilage and maximum treatment temperature. We determined that the difference of steady state elastic modulus between control and treated porcine septal samples was not statistically significant after uniform heating with RF to peak temperatures of 50 ± 5, 65 ± 5, and 85 ± 5°C. Ultimately, the results of this study do not pertain to the regions of heated cartilage that are shaped to hold a new form; however, it does show that the regions that are not mechanically deformed do return to the original pre-treatment elastic modulus. This is still useful information that may be used in finite element models to predict changes in internal stress distributions of cartilage after laser reshaping.

Lasers in Surgery and Medicine, 2008

Background and Objectives: Trauma, emergent tracheostomy, and prolonged intubation are common cau... more Background and Objectives: Trauma, emergent tracheostomy, and prolonged intubation are common causes of severe deformation and narrowing of the trachea. Laser technology may be used to reshape tracheal cartilage using minimally invasive methods. The objectives of this study were to determine: (1) the dependence of tracheal cartilage shape change on temperature and laser dosimetry using heated saline bath immersion and laser irradiation, respectively, (2) the effect of temperature on the mechanical behavior of cartilage, and (3) tissue viability as a function of laser dosimetry. Materials and Methods: Ex vivo rabbit trachea cartilage specimens were bent and secured around a cylinder (6 mm), and then immersed in a saline bath (45 and 728C) for 5-100 seconds. In separate experiments, tracheal specimens were irradiated with a diode laser (l ¼ 1.45 mm, 220-400 J/ cm 2 ). Mechanical analysis was then used to determine the elastic modulus in tension after irradiation. Fluorescent viability assays combined with laser scanning confocal microscopy (LSCM) were employed to image and identify thermal injury regions. Results: Shape change transition zones, between 62 and 668C in the saline heating bath and above power densities of 350 J/cm 2 (peak temperatures 65 AE 108C) for laser irradiation were identified. Above these zones, the elastic moduli were higher (8.2 AE 4 MPa) than at lower temperatures (4.5 AE 3 MPa). LSCM identified significant loss of viable chondrocytes within the laser-irradiation zones. Conclusion: Our results indicate a change in mechanical properties occurs with laser irradiation and further demonstrates that significant thermal damage is concurrent with clinically relevant shape change in the elastic cartilage tissues of the rabbit trachea using the present laser and dosimetry parameters.

Tissue optical properties are necessary parameters for prescribing light dosimetry in photomedici... more Tissue optical properties are necessary parameters for prescribing light dosimetry in photomedicine. In many diagnostic or therapeutic applications where optical fiber probes are used, pressure is often applied to the tissue to reduce index mismatch and increase light transmittance. In this study, we have measured in vitro optical properties as a function of pressure with a visible-IR spectrophotometer. A spectral

Lasers in Surgery and Medicine

Thermal Treatment of Tissue: Energy Delivery and Assessment IV, 2007

Successful application of laser cartilage reshaping (LCR) for the in-situ treatment of structural... more Successful application of laser cartilage reshaping (LCR) for the in-situ treatment of structural deformities in the nasal septum, external ear and trachea requires a better understanding of the evolution of cartilage mechanical properties with temperature. We develop a method of Radio Frequency (RF) heating for reliable evaluation of mechanical changes in septal cartilage undergoing heating and used obtained data to

The Laryngoscope, Jan 17, 2015

The trachea is a composite cartilaginous structure particularly prone to various forms of convexi... more The trachea is a composite cartilaginous structure particularly prone to various forms of convexities. Electromechanical reshaping (EMR) is an emerging technique used to reshape cartilaginous tissues by applying electric current in tandem with imposed mechanical deformation to achieve shape change. In this study, EMR was used to reshape tracheal cartilage rings to demonstrate the feasibility of this technology as a potentially minimally invasive procedure to alter tracheal structure. Controlled laboratory study using ex vivo porcine tracheae. The natural concavity of each porcine tracheal ring was reversed around a cork mandrel. Two pairs of electrodes were inserted along the long axis of the tracheal ring and placed 1.5 millimeters from the midline. Current was applied over a range of voltages (3 volts [V], 4V, and 5V) for either 2 or 3 minutes. The degree of EMR-induced reshaping was quantified from photographs using digital techniques. Confocal imaging with fluorescent live and d...

Urology, 1996

Objectives. Currently, various side-emitting optical fibers with different tip geometry are used ... more Objectives. Currently, various side-emitting optical fibers with different tip geometry are used transurethrally to deliver laser radiation for treatment of benign prostatic hyperplasia (BPH). Since fiber tip design could profoundly affect the size and profile of the emitted laser beam, and consequently the tissue response and the extent of tissue coagulation, we evaluated commercially available fibers in regard to their optical characteristics and their ability to coagulate tissue in a controlled experimental setting.

Photonic Therapeutics and Diagnostics VII, 2011

Electromechanical reshaping of cartilage is a novel modality that has significant clinical applic... more Electromechanical reshaping of cartilage is a novel modality that has significant clinical applications in otolaryngology and plastic surgery. Although EMR dosimetry has been extensively studied, little is known about the mechanisms of EMR, of which local tissue pH changes is believed to play a role. In this study, rabbit nasal septal cartilage is subject to a number of experiments aimed at elucidating pH-related changes using phenol red. The lateral extent and magnitude of pH change as well as factors that impact pH change are studied. Increasing voltage and application appear to increase the area and intensity of color change. With parameters known to produce thermal tissue injury, a transitional zone likely representing a confluence of acid-base products is noted in the region around the bend axis. Furthermore, rehydration and pH indicator application time do not appear to play a role in the quality of pH change. These simple experiments may provide insight into the role of pH changes in EMR that may allow correlation of dosimetry to tissue damage, further optimizing the clinical potential of EMR.

Lasers in Surgery: Advanced Characterization, Therapeutics, and Systems XIV, 2004

Stenotic, collapsed, and flow-restricted tracheal airways may result from blunt trauma, chronic i... more Stenotic, collapsed, and flow-restricted tracheal airways may result from blunt trauma, chronic infection, and the prolonged endotracheal intubation. This pilot investigation characterizes the degree of shape change produced by Ho:YAG laser (λ=2.12 μm) irradiation of rabbit and ...

JAMA Facial Plastic Surgery, 2013

Objective: To report the first successful study to date of in vivo electromechanical reshaping of... more Objective: To report the first successful study to date of in vivo electromechanical reshaping of ear cartilage in a rabbit model. Methods: Ears of New Zealand white rabbits were reshaped using percutaneous needle electrode electromechanical reshaping (5 V for 4 minutes) and were then bolstered for 4 weeks. Ten ears were treated, with 2 undergoing sham procedures and serving as controls. The treatment was performed using a platinum array of electrodes consisting of 4 parallel rows of needles inserted across the region of flexures in the ear. After 4 weeks, the animals were killed, and the ears were photographed and sectioned for conventional light microscopy and confocal microscopy (live-dead fluorescent assays).

JAMA Facial Plastic Surgery, 2014

IMPORTANCE Electromechanical reshaping (EMR) is a low-cost, needle-based, and simple means to sha... more IMPORTANCE Electromechanical reshaping (EMR) is a low-cost, needle-based, and simple means to shape cartilage tissue without the use of scalpels, sutures, or heat that can potentially be used in an outpatient setting to perform otoplasty. OBJECTIVES To demonstrate that EMR can alter the shape of intact pinnae in an in vivo animal model and to show that the amount of shape change and the limited cell injury are proportional to the dosimetry.

Optical Tomography and Spectroscopy of Tissue: Theory, Instrumentation, Model, and Human Studies II, 1997

ABSTRACT Tissue optical properties are necessary parameters for prescribing light dosimetry in ph... more ABSTRACT Tissue optical properties are necessary parameters for prescribing light dosimetry in photomedicine. In many diagnostic or therapeutic applications where optical fiber probes are used, pressure is often applied to the tissue to reduce index mismatch and increase light transmittance. In this study, we have measured in vitro optical properties as a function of pressure with a visible-IR spectrophotometer. A spectral range of 400 - 1800 nm with a spectral resolution of 5 nm was used for all measurements. Skin specimens of two Hispanic donors and three caucasian donors were obtained from the tissue bank. Each specimen, sandwiched between microscope slides, was compressed by a spring-loaded apparatus. Then diffuse reflectance and transmittance of each sample were measured at no load and at approximately 0.1 and 1 kgf/cm2. Under compression, tissue thicknesses were reduced up to 78%. Generally, reflectance decreased while the overall transmittance increased under compression. The absorption and reduced scattering coefficients were calculated using the inverse adding doubling method. Compared with the no-load controls, there was an increase in the absorption and scattering coefficients among most of the compressed specimens.

The Laryngoscope, 2014

Objectives/Hypothesis: Electromechanical reshaping (EMR) involves reshaping cartilage by mechanic... more Objectives/Hypothesis: Electromechanical reshaping (EMR) involves reshaping cartilage by mechanical deformation and delivering electric current to the area around the bend axis, causing local stress relaxation and permanent shape change. The mechanism of EMR is currently unclear, although preliminary studies suggest that voltage and application time are directly related to the concentration and diffusion of acid-base products within the treated tissue with little heat generation. This study aims to characterize local tissue pH changes following EMR and to demonstrate that local tissue pH changes are correlated with tissue damage and shape change.

The Laryngoscope, 2011

Objective/Hypothesis-Needle electrode-based electromechanical reshaping (EMR) is a novel, ultra-l... more Objective/Hypothesis-Needle electrode-based electromechanical reshaping (EMR) is a novel, ultra-low cost nascent surgical technology to reshape cartilage with low morbidity. EMR uses direct current (DC) to induce mechanical relaxation in cartilage that is first deformed into a required geometry, which in turn leads to permanent shape change. The objective of this study was to determine the effect of EMR voltage and time on the shape change of costal cartilage grafts.

The Laryngoscope, 2010

Objectives: This study describes the process of tissue electroforming and how shape changes in ca... more Objectives: This study describes the process of tissue electroforming and how shape changes in cartilage can be produced by the application of direct current (DC). The dependence of shape change on voltage and application time is explored. Study Design: Basic investigation using ex vivo porcine septal cartilage grafts and electromechanical cartilage deformation focused on development of a new surgical technique. Methods: Uniform flat porcine nasal septal cartilage specimens were mechanically deformed between two semicircular aluminum electrodes. DC current was applied to establish charge separation and electrical streaming potential. Voltage (0 -3.5 V) and application time (0 -5 minutes) were varied. Shape change was measured, and shape retention was calculated using analytic representation. The effect of the direction of applied current on shape change was evaluated by switching the polarities of electrodes and using parameters of 0 to 5.5 V and 5 minutes. Temperature during reshaping was monitored with a thermocouple, and surface features were evaluated using light microscopy. Results: Reshaped specimen demonstrated mechanical stability similar to native cartilage tissue. Shape retention strongly correlated with increasing voltage and application time. Only a small current (<0.1 A) through the tissue was measured. Temperature change was less than 2°C during electroforming, suggesting that electroforming likely results from some nonthermal mechanisms. Surface features indicated that electrodeposition may occur depending on electrode material and magnitude of the applied voltage. Conclusions: These find-ings demonstrate that cartilage can be reshaped through the process we have described as "electroforming" by generating intrinsic differences in charge separation with negligible heat production.

The Laryngoscope, 2014

Although minor and major tip support mechanisms have been described in detail, no quantitative mo... more Although minor and major tip support mechanisms have been described in detail, no quantitative models exist to provide support for the relative contributions of the structural properties of the major alar cartilage, the fibrous attachments to surrounding structures, and the rigid support structures in an objective manner. The finite element method was used to compute the stress distribution in the nose during simple tip compression, and then identify the specific anatomic structures that resist deformation and thus contribute to tip support. Additionally, the impact of caudal septal resection on nasal tip support was examined. The computer models consisted of three tissue components with anatomically correct geometries for skin and bone derived from computed tomographic data. Septum, upper lateral cartilages, and major alar cartilages were fitted within the model using three-dimensional computer-aided design software. Five-millimeter nasal tip compression was performed on the models with caudal septal resection (3 and 5 mm) and without resection to simulate palpation, then the resulting spatial distribution of stress and displacement was calculated. The von Mises stress in the normal model was primarily concentrated along the medial crural angle. As caudal septum length was reduced, stress was redistributed to adjacent soft tissue and bone, resulting in less force acting on the septum. In all models, displacement was greatest near the intermediate crura. These models are the first step in the comprehensive mechanical analysis of nasal tip dynamics. Our model supports the concept of the caudal septum and major alar cartilage providing the majority of critical load-bearing support.

The Laryngoscope, 2013

Objectives/Hypothesis: Determine the effective electromechanical reshaping (EMR) parameters for s... more Objectives/Hypothesis: Determine the effective electromechanical reshaping (EMR) parameters for shape change and cell viability in the ex vivo rabbit costal cartilage model.

The Laryngoscope, 2013

This study attempts to characterize the biomechanical properties of a PDS-cartilage composite gra... more This study attempts to characterize the biomechanical properties of a PDS-cartilage composite graft for use in septorhinoplasty. Experimental Study. This study used a PDS analog, porcine cartilage cut to 1 × 5 × 20 mm, and a mechanical testing platform to measure flexure of a composite graft. Samples were assessed in four groups based on variations in suture pattern and orientation. The platform measured the force required to deflect the sample 2 mm in single cantilever beam geometry before and after the polymer was affixed to the specimen. Elastic Moduli were calculated before and after application of the polydioxanone polymer. The average modulus of the cartilage alone was 17 ± 0.9 MPa. The modulus of the composite cartilage-polymer graft with 2 suture fixation was 21.2 ± 1.5 MPa. The 3-suture configuration produced an increase to 25.8 ± 2.23 MPa. The four-suture configuration produced 23.1 ± 3.19 MPa. The five-suture configuration produced 25.7 ± 2.6 MPa. The modulus of the analog alone was 170 ± 30 MPa. The modulus of the 0.5 mm PDS was 692 ± 37.4 MPa. The modulus of the 0.15 mm perforated PDS was 447 ± 34.8 MPa. The study found that suturing a polymer plate to cartilage resulted in enhanced stiffness of the composite. Under the conditions of the study, there was no significant difference in elastic moduli between suture configurations, making the two-suture linear configuration optimal in the one-plane cantilever deflection model.

Lasers in Surgery and Medicine, 2008

Laser cartilage reshaping (LCR) is a promising method for the in situ treatment of structural def... more Laser cartilage reshaping (LCR) is a promising method for the in situ treatment of structural deformities in the nasal septum, external ear and trachea. Laser heating leads to changes in cartilage mechanical properties and produces relaxation of internal stress allowing formation of a new stable shape. While some animal and preliminary human studies have demonstrated clinical feasibility of LCR, application of the method outside specialized centers requires a better understanding of the evolution of cartilage mechanical properties with temperature. The purpose of this study was to (1) develop a method for reliable evaluation of mechanical changes in the porcine septal cartilage undergoing stress relaxation during laser heating and (2) model the mechanical changes in cartilage at steady state following laser heating. Rectangular cartilage specimens harvested from porcine septum were heated uniformly by a radio-frequency (RF) electric field (500 kHz) for 8 and 12 seconds to maximum temperatures from 50 to 90 degrees C. Cylindrical samples were fashioned from the heated specimens and their equilibrium elastic modulus was measured in a step unconfined compression experiment. Functional dependencies of the elastic modulus and maximum temperature were interpolated from the measurements. Profiles of the elastic modulus produced after 8 and 12 seconds of laser irradiation (Nd:YAG, lambda = 1.34 microm, spot diameter 4.8 mm, laser power 8 W) were calculated from interpolation functions and surface temperature histories measured with a thermal camera. The calculated elastic modulus profiles were incorporated into a numerical model of uniaxial unconfined compression of laser irradiated cylindrical samples. The reaction force to a 0.1 compressive strain was calculated and compared with the reaction force obtained in analogous mechanical measurements experiment. RF heating of rectangular cartilage sample produces a spatially uniform temperature field (temperature variations &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 4 degrees C) in a central region of the sample which is also large enough for reliable mechanical testing. Output power adjustment of the RF generator allows production of temperature histories that are very similar to those produced by laser heating at temperatures above 60 degrees C. This allows creation of RF cartilage samples with mechanical properties similar to laser irradiated cartilage, however with a spatially uniform temperature field. Cartilage equilibrium elastic modulus as a function of peak temperature were obtained from the mechanical testing of RF heated samples. In the temperature interval from 60 to 80 degrees C, the equilibrium modulus decreased from 0.08+/- 0.01 MPa to 0.016+/-0.007 MPa, respectively. The results of the numerical simulation of uniaxial compression of laser heated samples demonstrate good correlation with experimentally obtained reaction force. The thermal history and corresponding thermally induced modification of mechanical properties of laser irradiated septal cartilage can be mimicked by heating tissue samples with RF electric current with the added advantage of a uniform temperature profile. The spatial distribution of the mechanical properties obtained in septal cartilage after laser irradiation could be computed from mechanical testing of RF heated samples and used for numerical simulation of LCR procedure. Generalization of this methodology to incorporate orthogonal mechanical properties may aid in optimizing clinical laser cartilage reshaping procedures.

Lasers in Surgery and Medicine, 2012

Thermally mediated modalities of cartilage reshaping utilize localized heating of cartilage combi... more Thermally mediated modalities of cartilage reshaping utilize localized heating of cartilage combined with mechanical deformation to achieve new geometries. We sought to determine the steady state elastic modulus of thermally modified cartilage without deformation, as this provides a constraint in mechanical models of the shape change process. The main objective of this study was to characterize the steady state elastic modulus of porcine septal cartilage after uniform heating with radiofrequency (RF) to peak temperatures of 50 ± 5, 65 ± 5, and 85 ± 5°C. The cartilage was divided into three equally sized regions, designated as anterior, middle and posterior. Each region was then sectioned into two specimens with the proximal component serving as a paired control. The data confirm that there is high baseline variability in control steady state elastic moduli between animals. Also, the control values confirm a decreasing steady state elastic modulus from anterior to posterior. There is no statistical significance (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05) found between the elastic moduli of control and treated samples. Although shape change and retention have been fairly well characterized, little is known about the specific relation between steady state elastic modulus of cartilage and maximum treatment temperature. We determined that the difference of steady state elastic modulus between control and treated porcine septal samples was not statistically significant after uniform heating with RF to peak temperatures of 50 ± 5, 65 ± 5, and 85 ± 5°C. Ultimately, the results of this study do not pertain to the regions of heated cartilage that are shaped to hold a new form; however, it does show that the regions that are not mechanically deformed do return to the original pre-treatment elastic modulus. This is still useful information that may be used in finite element models to predict changes in internal stress distributions of cartilage after laser reshaping.

Lasers in Surgery and Medicine, 2008

Background and Objectives: Trauma, emergent tracheostomy, and prolonged intubation are common cau... more Background and Objectives: Trauma, emergent tracheostomy, and prolonged intubation are common causes of severe deformation and narrowing of the trachea. Laser technology may be used to reshape tracheal cartilage using minimally invasive methods. The objectives of this study were to determine: (1) the dependence of tracheal cartilage shape change on temperature and laser dosimetry using heated saline bath immersion and laser irradiation, respectively, (2) the effect of temperature on the mechanical behavior of cartilage, and (3) tissue viability as a function of laser dosimetry. Materials and Methods: Ex vivo rabbit trachea cartilage specimens were bent and secured around a cylinder (6 mm), and then immersed in a saline bath (45 and 728C) for 5-100 seconds. In separate experiments, tracheal specimens were irradiated with a diode laser (l ¼ 1.45 mm, 220-400 J/ cm 2 ). Mechanical analysis was then used to determine the elastic modulus in tension after irradiation. Fluorescent viability assays combined with laser scanning confocal microscopy (LSCM) were employed to image and identify thermal injury regions. Results: Shape change transition zones, between 62 and 668C in the saline heating bath and above power densities of 350 J/cm 2 (peak temperatures 65 AE 108C) for laser irradiation were identified. Above these zones, the elastic moduli were higher (8.2 AE 4 MPa) than at lower temperatures (4.5 AE 3 MPa). LSCM identified significant loss of viable chondrocytes within the laser-irradiation zones. Conclusion: Our results indicate a change in mechanical properties occurs with laser irradiation and further demonstrates that significant thermal damage is concurrent with clinically relevant shape change in the elastic cartilage tissues of the rabbit trachea using the present laser and dosimetry parameters.