title: Long-range Fourier domain optical coherence tomography of the pediatric subglottis.
abstract: BACKGROUND
  Acquired subglottic stenosis (SGS) most commonly results from prolonged endotracheal intubation and is a diagnostic challenge in the intubated child. At present, no imaging modality allows for in vivo characterization of subglottic microanatomy to identify early signs of acquired SGS while the child remains intubated. Fourier domain optical coherence tomography (FD-OCT) is a minimally invasive, light-based imaging modality which provides high resolution, three dimensional (3D) cross-sectional images of biological tissue. We used long-range FD-OCT to image the subglottis in intubated pediatric patients undergoing minor head and neck surgical procedures in the operating room.
  
  
  METHODS
  A long-range FD-OCT system and rotary optical probes (1.2mm and 0.7mm outer diameters) were constructed. Forty-six pediatric patients (ages 2-16 years) undergoing minor upper airway surgery (e.g., tonsillectomy and adenoidectomy) were selected for intraoperative, trans-endotracheal tube FD-OCT of the subglottis. Images were analyzed for anatomical landmarks and subepithelial histology. Volumetric image sets were rendered into virtual 3D airway models in Mimics software.
  
  
  RESULTS
  FD-OCT was performed on 46 patients (ages 2-16 years) with no complications. Gross airway contour was visible on all 46 data sets. Twenty (43%) high-quality data sets clearly demonstrated airway anatomy (e.g., tracheal rings, cricoid and vocal folds) and layered microanatomy of the mucosa (e.g., epithelium, basement membrane and lamina propria). The remaining 26 data sets were discarded due to artifact, high signal-to-noise ratio or missing data. 3D airway models were allowed for user-controlled manipulation and multiplanar airway slicing (e.g., sagittal, coronal) for visualization of OCT data at multiple anatomic levels simultaneously.
  
  
  CONCLUSIONS
  Long-range FD-OCT produces high-resolution, 3D volumetric images of the pediatric subglottis. This technology offers a safe and practical means for in vivo evaluation of lower airway microanatomy in intubated pediatric patients. Ultimately, FD-OCT may be applied to serial monitoring of the neonatal subglottis in long-term intubated infants at risk for acquired SGS.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Ludwig Maximilian University Munich, 80539 München, Germany.
authors.forename: Veronika
authors.initials: V
authors.lastname: Volgger
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, CA 92868, USA.
authors.forename: Giriraj K
authors.initials: GK
authors.lastname: Sharma
authors.affiliation: Department of Biomedical Engineering, University of California Irvine, Irvine, CA 92612, USA.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Jing
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, CA 92868, USA.
authors.forename: Ya-Sin A
authors.initials: YS
authors.lastname: Peaks
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, CA 92868, USA.
authors.forename: Anthony Chin
authors.initials: AC
authors.lastname: Loy
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, CA 92868, USA.
authors.forename: Frances
authors.initials: F
authors.lastname: Lazarow
authors.affiliation: Beckman Laser Institute, University of California Irvine, Irvine, CA 92612, USA.
authors.forename: Alex
authors.initials: A
authors.lastname: Wang
authors.affiliation: Department of Biomedical Engineering, University of California Irvine, Irvine, CA 92612, USA.
authors.forename: Yueqiao
authors.initials: Y
authors.lastname: Qu
authors.affiliation: Beckman Laser Institute, University of California Irvine, Irvine, CA 92612, USA.
authors.forename: Erica
authors.initials: E
authors.lastname: Su
authors.affiliation: Department of Biomedical Engineering, University of California Irvine, Irvine, CA 92612, USA; Beckman Laser Institute, University of California Irvine, Irvine, CA 92612, USA.
authors.forename: Zhongping
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, CA 92868, USA; CHOC Children's Hospital of Orange County, Orange, CA 92868, USA.
authors.forename: Gurpreet S
authors.initials: GS
authors.lastname: Ahuja
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, CA 92868, USA; Beckman Laser Institute, University of California Irvine, Irvine, CA 92612, USA. Electronic address: bjwong@uci.edu.
authors.forename: Brian J-F
authors.initials: BJ
authors.lastname: Wong
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D005931:Glottis / Q000473:pathology*; D006801:Humans; D021621:Imaging, Three-Dimensional; D007442:Intubation, Intratracheal / Q000009:adverse effects; D007829:Laryngostenosis / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D008297:Male; D059629:Signal-To-Noise Ratio; D041623:Tomography, Optical Coherence
keywords: Optical coherence tomography; Pediatrics; Subglottic stenosis; Subglottis