title: Minimally invasive ear reshaping with a 1450-nm diode laser using cryogen spray cooling in New Zealand white rabbits.
abstract: BACKGROUND
  Otoplasty is the current standard of care for treating prominent ears, a psychologically and sometimes functionally disabling disorder. The technically demanding procedure carries many risks such as poor aesthetic outcome, need for revision surgery, and need for general anesthesia. This study investigates the use of laser irradiation combined with cryogen skin cooling and stenting to reshape cartilage in the ears of New Zealand white rabbits.
  
  
  METHODS
  In this prospective, randomized, internally controlled animal study, the right ears of 9 rabbits were mechanically deformed with a jig and then irradiated with a 1450-nm diode laser combined with cryogen skin cooling (14 J/pulse with cryogen spray for 33 milliseconds per cycle and a 6-mm spot size). The left ear served as the control. The ears were splinted for 1, 3, or 4 weeks. The rabbits were then given a lethal dose of intravenous pentobarbital, and the splints were removed and ears examined and photographed. Light and confocal microscopy were performed on the specimens.
  
  
  RESULTS
  Shape change was observed in all 9 treated rabbit ears, while none of the control ears (stenting alone) showed significant change. Qualitatively, reshaped ears were stiffer after 4 weeks of splinting than after 1 or 3 weeks. None of the rabbits showed evidence of skin injury nor did they show signs of postprocedural pain. Findings from histologic analysis in the treated areas showed evidence of an expanded chondrocyte population in the region of laser irradiation, along with some perichondrial thickening and some fibrosis of the deep dermis. Confocal microscopy revealed minimal cellular death at 1 week and none thereafter.
  
  
  CONCLUSIONS
  Cartilage reshaping using laser energy can be performed safely transcutaneously using cryogen spray cooling in rabbits. This animal model has similarity to human ears with regard to skin and cartilage thickness and is a stepping stone toward developing minimally invasive laser auricle reshaping in humans.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, 101 The City Drive, Bldg 56, Ste 500, Orange, CA 92868, USA.
authors.forename: Paul K
authors.initials: PK
authors.lastname: Holden
authors.forename: Cara
authors.initials: C
authors.lastname: Chlebicki
authors.forename: Brian J F
authors.initials: BJ
authors.lastname: Wong
mesh_terms: D000279:Administration, Cutaneous; D000772:Anesthesia, Local / Q000379:methods*; D000818:Animals; D003131:Combined Modality Therapy; D017679:Cryotherapy / Q000379:methods*; D004425:Ear Cartilage / Q000473:pathology / Q000601:surgery; D004431:Ear, External / Q000473:pathology / Q000601:surgery*; D007150:Immunohistochemistry; D053685:Laser Therapy / Q000295:instrumentation / Q000379:methods*; D054023:Lasers, Semiconductor / Q000627:therapeutic use; D018613:Microscopy, Confocal; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D023421:Models, Animal; D010784:Photomicrography; D011817:Rabbits; D011897:Random Allocation; D014945:Wound Healing / Q000502:physiology