Cartilage Curvature Reshaping: A Quantitative Assessment

Background Horizontal mattress suture is frequently performed procedure during Rhinoplasty and Otoplasty to control the curvature of the cartilages. Despite the popularity of mattress technique, there are no quantitative methods to determine the suture effects in cartilage reshaping. Objectives The aim of the present experimental study was to quantify the straightening effect of mattress suture on convexity of ear cartilage in rabbit models. Methods Eleven young adult male New Zealand white rabbits were used in this study. Horizontal mattress suture with spacing 3×6 mm was used in rectangle demarcated on left ear in area with maximum convexity. Preoperative and postoperative photographers were done before and immediately after surgery respectively. The Radius of curvature (ROC), first order deviation (FOD) and second order deviation (SOD) were calculated to quantify net cartilage reshaping, each point changes and homogeneity of new shaped cartilage respectively. Results The means for ROC were 1.112 and 2.169 before and after surgery respectively. ROC as indicator of net overall changing increased statistically significant. The means of FOD as each point slope index was statistically lower after surgery. (0.269 before surgery, 0.135 after surgery) The means for SOD also significantly decreased after surgery. (0.007 before surgery, 0.003 after surgery) The values of SOD remained positive after surgery that indicate changes in curve were homogenous. Conclusions A quantitative measurement method was introduced to directly quantify the controlling effect of suture. This quantifying method seems to be mandatory to compare the effect of horizontal mattress suture with other techniques in cartilage reshaping.

Lasers in Rhinology—An Update

Objectives: A wide and evolving range of lasers and their applications often makes it difficult for a busy surgeon to choose the ideal laser for a specific indication. With this in mind, this article aims to summarize the most recent literature concerning laser application in rhinology. Methods: A literature search from 2000 to 2020 using the PubMed database was employed. Keywords used included “laser,” “rhinology,” “endonasal endoscopic surgery,” “hereditary haemorrhagic telangiectasia,” “rhinitis,” “refractory rhinitis,” “Inferior turbinate hypertrophy,” “dacryocystorhinostomy,” “septoplasty,” “cartilage reshaping” and “choanal atresia.” The most up to date studies published for each rhinology condition that could potentially be treated with laser surgery was included. Results: Rhinological conditions appropriate for laser applications are discussed. We identified articles related to a number of applications including hereditary hemorrhagic telangiectasia, rhinitis, turbinate surgery, dacryocystorhinostomy, septoplasty, choanal atresia, and sphenopalatine artery ligation, paying attention to the outcomes of the studies and their limitations. Conclusions: There is currently no one-size-fits-all laser and therefore being up to date on the latest clinical application results can help the clinician decide which are the best treatments to offer their patients.

Monitoring of Biological Changes in Electromechanical Reshaping of Cartilage Using Imaging Modalities

Electromechanical reshaping (EMR) is a promising surgical technique used to reshape cartilage by direct current and mechanical deformation. It causes local stress relaxation and permanent alterations in the shape of cartilage. The major advantages of EMR are its minimally invasive nature and nonthermal electrochemical mechanism of action. The purpose of this study is to validate that EMR does not cause thermal damage and to observe structural changes in post-EMR cartilage using several imaging modalities. Three imaging modality metrics were used to validate the performance of EMR by identifying structural deformation during cartilage reshaping: infrared thermography was used to sense the temperature of the flat cartilages (16.7°C at 6 V), optical coherence tomography (OCT) was used to examine the change in the cartilage by gauging deformation in the tissue matrix during EMR, and scanning electron microscopy (SEM) was used to show that EMR-treated cartilage is irregularly arranged and the thickness of collagen fibers varies, which affects the change in shape of the cartilage. In conclusion, the three imaging modalities reveal the nonthermal and electromechanical mechanisms of EMR and demonstrate that use of an EMR device is feasible for reshaping cartilage in a minimally invasive manner.