Numerical analysis of costal cartilage warping after laser modification

Grafts obtained from peripheral regions of costal cartilage have an inherent tendency to warp over time. Laser irradiation provides a potential method to control the warping process, thus yielding stable grafts for facial reconstructive surgery. In our current study, we propose a simple and well-fitting model that numerically describes the degree of warping of laser irradiated costal cartilage grafts. Using a Nd:YAG laser (λ=1.32μm) at various exposure settings, grafts harvested from the peripheral regions of porcine costal cartilage were irradiated. The resulting graft geometry was objectively fitted to a curve using a quadratic regression model. The coefficient of determination (R2) demonstrated a very strong fit for all grafts modeled. A quadratic regression is simple to perform and results in a single numerical value that appropriately describes the degree of cartilage warping. Our proposed model is valuable in assessing the effect of laser irradiation on the warping process of costal cartilage. © 2010 Copyright SPIE - The International Society for Optical Engineering

Needle Electrode-Based Electromechanical Reshaping of Cartilage

Electromechanical reshaping (EMR) of cartilage provides an alternative to the classic surgical techniques of modifying the shape of facial cartilages. The original embodiment of EMR required surface electrodes to be in direct contact with the entire cartilage region being reshaped. This study evaluates the feasibility of using needle electrode systems for EMR of facial cartilage and evaluates the relationships between electrode configuration, voltage, and application time in effecting shape change. Flat rabbit nasal septal cartilage specimens were deformed by a jig into a 90° bend, while a constant electric voltage was applied to needle electrodes that were inserted into the cartilage. The electrode configuration, voltage (0–7.5 V), and application time (1–9 min) were varied systematically to create the most effective shape change. Electric current and temperature were measured during voltage application, and the resulting specimen shape was assessed in terms of retained bend angle. In order to demonstrate the clinical feasibility of EMR, the most effective and practical settings from the septal cartilage experimentation were used to reshape intact rabbit and pig ears ex vivo. Cell viability of the cartilage after EMR was determined using confocal microscopy in conjunction with a live/dead assay. Overall, cartilage reshaping increased with increased voltage and increased application time. For all electrode configurations and application times tested, heat generation was negligible (<1 °C) up to 6 V. At 6 V, with the most effective electrode configuration, the bend angle began to significantly increase after 2 min of application time and began to plateau above 5 min. As a function of voltage at 2 min of application time, significant reshaping occurred at and above 5 V, with no significant increase in the bend angle between 6 and 7.5 V. In conclusion, electromechanical reshaping of cartilage grafts and intact ears can be effectively performed with negligible temperature elevation and spatially limited cell injury using needle electrodes

Automated audiometry using apple iOS-based application technology.

ObjectiveThe aim of this study is to determine the feasibility of an Apple iOS-based automated hearing testing application and to compare its accuracy with conventional audiometry.Study designProspective diagnostic study. Setting Academic medical center.Subjects and methodsAn iOS-based software application was developed to perform automated pure-tone hearing testing on the iPhone, iPod touch, and iPad. To assess for device variations and compatibility, preliminary work was performed to compare the standardized sound output (dB) of various Apple device and headset combinations. Forty-two subjects underwent automated iOS-based hearing testing in a sound booth, automated iOS-based hearing testing in a quiet room, and conventional manual audiometry.ResultsThe maximum difference in sound intensity between various Apple device and headset combinations was 4 dB. On average, 96% (95% confidence interval [CI], 91%-100%) of the threshold values obtained using the automated test in a sound booth were within 10 dB of the corresponding threshold values obtained using conventional audiometry. When the automated test was performed in a quiet room, 94% (95% CI, 87%-100%) of the threshold values were within 10 dB of the threshold values obtained using conventional audiometry. Under standardized testing conditions, 90% of the subjects preferred iOS-based audiometry as opposed to conventional audiometry.ConclusionApple iOS-based devices provide a platform for automated air conduction audiometry without requiring extra equipment and yield hearing test results that approach those of conventional audiometry

Stabilization of Costal Cartilage Graft Warping Using Infrared Laser Irradiation in a Porcine Model

OBJECTIVE: To develop a method to rapidly stabilize the shape change process in peripheral slices of costal cartilage by using infrared laser irradiation in a porcine model. METHODS: Forty peripheral porcine costal cartilage specimens (40×10×2 mm) were harvested. Thirty of these specimens were immediately irradiated with an Nd: YAG laser (λ=1.32 μm; spot size, 2-mm diameter) using 1 of 3 exposure treatments: 6W, 2 seconds, and 4 spots; 8 W, 3 seconds, and 4 spots; or 6 W, 2 seconds, and 8 spots. Ten control specimens were only immersed in 0.9% saline solution. Angle of curvature was measured from photographs taken at 0 minutes, immediately after irradiation, and at 30 minutes, 1 hour, 5 hours, and 24 hours. Infrared imaging was used to measure surface temperatures during irradiation. Cell viability after irradiation was determined using a live/dead assay in conjunction with fluorescent confocal microscopy. RESULTS: Compared with the untreated controls, the irradiated grafts underwent accelerated shape change within the first 30 minutes to reach a stable geometry. Thereafter, irradiated grafts underwent little or no shape change, whereas the control group exhibited significant change in curvature from 30 minutes to 24 hours (P<.001). The average peak irradiated spot temperatures ranged from 76°C to 82°C. Cell viability measurements at the laser spot sites demonstrated a hemispherically shaped region of dead cells with a depth of 0.8 to 1.2 mm and a surface diameter of 1.9 to 2.7 mm. CONCLUSIONS: Laser irradiation of peripheral costal cartilage slices provides an effective method for rapidly stabilizing acute shape change by accelerating the warping process. The temperature elevations necessary to achieve this are spatially limited and well within the limits of tolerable tissue injury