Intraoperative long range optical coherence tomography as a novel method of imaging the pediatric upper airway before and after adenotonsillectomy

Frances B. Lazarow, Gurpreet S. Ahuja, Anthony Chin Loy, Erica Su, Tony D. Nguyen, Giriraj K. Sharma, Alex Wang, Joseph Jing, Zhongping Chen, Brian J.F. Wong

Research output: Contribution to journalArticle

Abstract

Background/ObjectivesWhile upper airway obstruction is a common problem in the pediatric population, the first-line treatment, adenotonsillectomy, fails in up to 20% of patients. The decision to proceed to surgery is often made without quantitative anatomic guidance. We evaluated the use of a novel technique, long-range optical coherence tomography (LR-OCT), to image the upper airway of children under general anesthesia immediately before and after tonsillectomy and/or adenoidectomy. We investigated the feasibility of LR-OCT to identify both normal anatomy and sites of airway narrowing and to quantitatively compare airway lumen size in the oropharyngeal and nasopharyngeal regions pre- and post-operatively. Methods46 children were imaged intraoperatively with a custom-designed LR-OCT system, both before and after adenotonsillectomy. These axial LR-OCT images were both rendered into 3D airway models for qualitative analysis and manually segmented for quantitative comparison of cross-sectional area. ResultsLR-OCT images demonstrated normal anatomic structures (base of tongue, epiglottis) as well as regions of airway narrowing. Volumetric rendering of pre- and post-operative images clearly showed regions of airway collapse and post-surgical improvement in airway patency. Quantitative analysis of cross-sectional images showed an average change of 70.52mm2 (standard deviation 47.87mm2) in the oropharynx after tonsillectomy and 105.58mm2 (standard deviation 60.62mm2) in the nasopharynx after adenoidectomy. ConclusionsLR-OCT is an emerging technology that rapidly generates 3D images of the pediatric upper airway in a feasible manner. This is the first step toward development of an office-based system to image awake pediatric subjects and thus better identify loci of airway obstruction prior to surgery.

Original languageEnglish (US)
Pages (from-to)63-70
Number of pages8
JournalInternational Journal of Pediatric Otorhinolaryngology
Volume79
Issue number1
DOIs
StatePublished - Jan 1 2015

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Keywords

  • Adenoidectomy
  • Long range optical coherence tomography
  • Tonsillectomy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Otorhinolaryngology

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