title: Mechanical Modeling of the Human Cricoid Cartilage Using Computer-Aided Design: Applications in Airway Balloon Dilation Research.
abstract: OBJECTIVE
  Balloon dilation is generally considered first-line treatment for airway stenosis. Some dilation systems utilize a compliant balloon that can conform around rigid structures. Others use a noncompliant balloon that does not conform, allowing for dilation of more rigid stenoses. We hypothesized that subglottic dilation with a noncompliant balloon increases the likelihood of fracture of the cricoid when compared to a compliant balloon.
  
  
  METHODS
  Three fresh human cricoid cartilages were placed in a universal testing system to determine the expansile force necessary for cricoid fracture. Using these data, a 3D printer was used to construct a synthetic cricoid model possessing near identical physical characteristics to the human cricoid. Simulated dilation was then performed on the model using a compliant and a noncompliant balloon.
  
  
  RESULTS
  Human cricoid fracture occurred at 97.25 N (SD = 8.34), and the synthetic cricoid model fractured at 100.10 N (SD = 7.32). Both balloons fractured the model in every replicate experiment. Mean balloon internal pressure at fracture was 7.67 ATM (SD = 1.21) for the compliant balloon and 11.34 ATM (SD = 1.29) for the noncompliant balloon.
  
  
  CONCLUSIONS
  These data show that fracture of the cricoid is a valid concern in balloon dilation procedures where the balloon spans the subglottis. Furthermore, the hypothesis was rejected in that the compliant balloon system was at least as likely to fracture the cricoid model as the noncompliant.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery and Center for Voice Airway and Swallowing, Georgia Regents University, Augusta, Georgia, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Johnson
authors.affiliation: Independent Scholar, Cincinnati, Ohio, USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Howell
authors.affiliation: College of Dental Medicine, Georgia Regents University, Augusta, Georgia, USA.
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Mettenburg
authors.affiliation: College of Dental Medicine, Georgia Regents University, Augusta, Georgia, USA.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Rueggeberg
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery and Center for Voice Airway and Swallowing, Georgia Regents University, Augusta, Georgia, USA.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Howell
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery and Center for Voice Airway and Swallowing, Georgia Regents University, Augusta, Georgia, USA.
authors.forename: Gregory N
authors.initials: GN
authors.lastname: Postma
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery and Center for Voice Airway and Swallowing, Georgia Regents University, Augusta, Georgia, USA Georgia Regents Cancer Center, Georgia Regents University, Augusta, Georgia, USA pweinberger@gru.edu.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Weinberger
mesh_terms: D017076:Computer-Aided Design; D003413:Cricoid Cartilage / Q000503:physiopathology* / Q000601:surgery; D004106:Dilatation; D006801:Humans; D007828:Laryngoscopy; D007829:Laryngostenosis / Q000601:surgery; D008422:Materials Testing; D008954:Models, Biological; D013718:Tensile Strength; D014135:Tracheal Stenosis / Q000601:surgery
keywords: 3D printing; additive manufacturing; cricoid fracture; materials testing; subglottic stenosis; tracheal stenosis