Otolaryngology

A Real-Time Airway 3-Dimensional Reconstruction Technology Based on Visual Big Data Model Shuyan Liu, MD, Ziyang Peng, PhD, Zhibo Wang, PhD, Lei Wang, PhD, Haoqian Peng, MD, Can Xia, PhD, Rongqian Wu, PhD, Yi Lyu, PhD Xi’an Jiaotong University, Xi’an, China Introduction: Airway structure has individual differences, and traditional tracheal intubation relies on doctors’ clinical experience. Our study designed a real-time airway 3D reconstruction technique based on visual big data model, which can visualize airway anatomy and improve the efficiency and success rate of intubation. Methods: We constructed a dataset based on 3000 in-hospital chest CT images in January-June 2023, trained a real-time segmentation algorithm based on visual modeling, and established a 3D reconstruction model of the airway. A total of 2,200 pre-tracheoscopic CT images from the department in August-December 2023 were selected for airway 3D reconstruction, and the accuracy was evaluated by comparing with the airway structure under tracheoscopy. One hundred patients from the department were selected to try out the system and compare the time consumed and quality of the traditional tracheal intubation group and the group using this technology to assist tracheal intubation. Results: It took only 3 minutes from uploading the chest CT image to generating the 3D structure of the airway. The agreement between 3D reconstructed tracheal model and the tracheal anatomy in the clinical sample was 97.16%. After tracheal intubation assisted by real-time 3D airway reconstruction, the success rate of 1-time intubation increased to 96.35%; the intubation time was reduced by 42%. The accuracy of intubation was greatly improved. The damage to the airway was effectively reduced. Conclusion: This technology accurately displays the 3D structure of the airway in real time, effectively assists tracheal intubation, improves the efficiency and accuracy of intubation, and has broad clinical application prospects. Chemical Myringocautery Augmentation with Epidermal Growth Factor and Fibroblast Growth Factor Should Replace Surgical Myringoplasty Anupam Mishra, MBBS, FACS, Onkar V Vedak, MBBS, MS King George Medical University, Lucknow, Uttar Pradesh, India Introduction: Chemical myringocautery (MC) for tubotympanic disease is conventionally recommended for smaller central perforations with moderate results. This modified protocol presents excellent results in even larger perforations when technically augmented with epidermal growth factor (EGF) and fibroblast growth factor (FGF). Methods: Carbolic acid MC (3 sittings at interval of 10 days) were undertaken in 115 patients with inactive dry (2-6 mm diameter) central perforation. Those with incomplete healing were randomized to be augmented by either EGF or FGF. The final non-responders were further subjected to crossover augmentation with FGF or EGF respectively (Figure 1). The diameter of perforation and duration between MC were recorded serially, along with pure tone audiometry for comparison. Independent t-test and correlational (Pearson’s, Spearman’s) test statistics were undertaken.Figure 1Results: Complete closure rate with chemical-MC was 65%, wherein substantial response and significant closure was appreciated after MC2 and MC3 respectively, while a good response after MC1 predicted complete healing after MC3. The incomplete responders revealed 30% and 60% complete healing when augmented with EGF (p < 0.05) and FGF (p < 0.01) respectively. Following crossover design EGF + FGF and FGF + EGF revealed further 55% and 80% complete healing respectively (Figure 1). A significant correlation of audiological improvement (p < 0.02) and duration between sittings (p < 0.05) was seen with %-healing. Conclusion: This study reveals the best outcomes in current literature. Overall complete closure was attained in 95.78% of cases with MC-FGF-EGF protocol and in 90.52% with MC-EGF-FGF protocol. This office technique is extremely cost-effective and well suited for even larger sized tubotympanic perforation, with a great potential to replace operative myringoplasty. Distinct Populations of T-Cells Predict Immunotherapy Response in Head and Neck Squamous Cell Carcinoma: Insights from a Clinical Trial Muhammad Bilal Mirza*, MD, Abdullah B Naveed, MD, Kamran Idrees, MD, FACS Vanderbilt University Medical Center, Nashville, TN *Excellence in Research Award recipient. Introduction: Immune-checkpoint inhibitors (ICIs) offer promising treatment for Head and Neck Squamous Cell Carcinoma (HNSCC), yet over 70% of patients do not respond, highlighting the need for reliable biomarkers for therapeutic response. This study leverages clinical trial data to explore T-cells within the tumor-microenvironment (TME), to identify potential biomarkers for ICI response. Methods: Single-cell and bulk-RNA sequencing data from 4 and 28 HNSCC patients, respectively, pre- and post-treatment with Nivolumab, were analyzed. T-cell subpopulations were identified and validated in an external HNSCC patient-cohort treated with Pembrolizumab. Kaplan-Meier analysis predicted survival outcomes, and multiplex imaging quantified T-cells enrichment. Results: We identified 11 distinct subpopulations of CD8+ effector T-cells. Pre-ICI treatment, Granzyme-K (GZMK)+ T-cells were enriched in patients who responded ICIs and correlated with the therapeutic response (p < 0.05). In contrast, Granzyme-B (GZMB)+ T-cells were enriched in patients non-responsive to ICIs. Post-ICI treatment, T-cell infiltration increased among all patients, however, only the presence of GZMK+ T-cells was predictive of positive response. These findings were validated in an external cohort, confirming a strong correlation between GZMK+ T-cells and response to ICIs (p < 0.05). Survival analysis showed that patients with an abundance of GZMK+ T-cells had better overall survival than patients with a scarcity of GZMK+ T-cells (p < 0.05). Conclusion: Using clinical trials data, our study, for the first time, reveals that GZMK+ T-cells are key drivers of response to ICIs and are prepondent in patients who respond to ICIs. This highlights the role of GZMK+ T-cells as potential biomarkers for response to ICIs. Genetic Profiling of “Idiopathic” Tracheal Stenosis: Uncovering Underlying Mechanisms and Identifying Potential Therapeutic Options Jeffrey Luo, PhD, Russell Seth Martins, MD, Kostantinos P Poulikidis, MD, FACS, Syed S Razi, MD, FACS, M. Jawad Latif, MD, FACS, Faiz Bhora, MD, FACS Hackensack Meridian Health, Edison, NJ Introduction: Idiopathic tracheal stenosis (ITS) accounts for 15% of all cases of tracheal stenosis. These patients are often the most challenging to treat. We genetically profiled tracheal granulation tissue from patients with ITS to understand underlying molecular etiology and identify potential pharmacological therapy. Methods: We collected tracheal granulation tissue biopsy from adult patients (n = 6) with recalcitrant ITS after obtaining IRB approval. We performed RNA-seq tissue samples to obtain gene expression data. Genomic data for normal tracheal tissue (public repositories) were used as controls. We analyzed differential gene expression to determine the most highly upregulated and downregulated genes. For each dysregulated gene, we identified relevant function(s) and potential therapeutic options that favorably regulate their expression. Results: The most highly upregulated and downregulated genes of ITS are shown with their relevant functions in Table 1. Patterns of gene expression showed dysregulation in pathways related to keratinocyte activity, immune function, cytoskeletal integrity, protein secretion, and cell division. These pathophysiologies were found to be indicative of distinct etiologies related to viral infection, ciliopathy, and immune disorder. Retinoic acid derivatives (bolded in Table 1) favorably regulate 4, acetaminophen 3, 17 beta-estradiol 3, ivermectin 3, and folic acid 2 of the dysregulated genes. Table 1. - Top Dysregulated Genes Involved in Idiopathic Tracheal Stenosis Status Gene Name Function Pharmacological Agent(s) Most Upregulated (Range of Fold Change: up to +396x) CALML5 Keratinocyte differentiation • 17 beta-estradiol• Fenretinide KRT16 Immune regulation • Fenretinide/Isotretinoin • Ivermectin• Acetaminophen• Folic acid• Calcipotriol KRT14 Cytoskeleton integrity • Isotretinoin • Ivermectin• Acetaminophen• Folic acid KRT6C Cytoskeletal integrity; implicated in hyperkeratosis • 17 beta-estradiol• Ivermectin Most Downregulated (Range of Fold Change: up to -35,700x) PRB4 Secreted glycoprotein • Peretinoin PRB3 Secreted glycoprotein • 17 beta-estradiol NPAT Cell cycle regulation • Acetaminophen DPEP1 Protein metabolism • 17 beta-estradiol• Corticosterone/dexamethasone• Doxorubicin• Progesterone• Vancomycin CALM5: Calmodulin like 5; DPEP1: Dipeptidase 1; KRT6C: Keratin 6C; KRT14: Keratin 14; KRT16: Keratin 16; NPAT: Nuclear protein, coactivator of histone transcription; PRB3: Proline rich protein BstNI subfamily 3; PRB4: Proline rich protein BstNI subfamily 4. Conclusion: Genetic pathways driving tracheal hypergranulation suggest that “idiopathic” tracheal stenosis may be a consequence of underlying infection, ciliopathy, or immune dysregulation. Our results indicate that retinoic acid, ivermectin, acetaminophen, and 17 beta-estradiol may represent potential medical therapies that can serve as adjuncts to interventional management in ITS. Is Laryngectomy Closure Technique a Determinant of Time to Tracheoesophageal Voicing in Patients with Voice Prostheses? Faruque Riffat, MBBS, FACS University of Sydney, Sydney, Australia Introduction: Tracheoesophageal speech with voice prosthesis (VP) insertion is considered the gold standard of functional voice rehabilitation in the postlaryngectomy patient. Little is known about the relationship between laryngectomy closure technique and time to voicing (TTV) in patients with VP. Methods: A retrospective chart review of consecutive patients who underwent total laryngectomy or laryngopharyngectomy between 2015 and 2022 at 2 tertiary institutions, with primary or secondary VP insertion. Clinical data and information related to TTV was determined. The Kolmogorov-Smirnov test was used to study normality of data and the Wilcoxon rank-sum test and binary logistic regression were performed for statistical analysis. Results: A total of 35 laryngectomized patients with VP were included (31 men, mean age 64.9 ± 10.2 years, 16 primary VP). The mean TTV was 56 days in the total cohort and 66 and 42 days in the primary and secondary cohort respectively, however, this was not significant. In the primary cohort, closure technique (vertical closure, T-closure, or flap reconstruction) was not a significant determinant of TTV, including vertical vs non-vertical closure and flap vs primary closure. In the secondary VP cohort, flap reconstructed patients showed faster TTV on Wilcoxon rank-sum test. Univariate logistic regression analysis showed this was a significant determinant of achieving voicing by 4 weeks (odds ratio [OR] 30, p = 0.011) and 8 weeks (OR 27.5, p = 0.013) from time of VP insertion, but not at 12 weeks (OR 8.2, p = 0.103). Conclusion: Laryngectomy closure technique and presence of flap reconstruction were not significant determinants of TTV in patients who received a primary VP. For secondary VP, patients who had flap reconstruction had faster voicing compared with primary closure. Is Post-Laryngectomy Oral Intake Affected by Presence of Pseudoepiglottis? Faruque Riffat, MBBS, FACS University of Sydney, Sydney, Australia Introduction: Pharyngeal pseudodiverticulum is a known finding in the laryngectomized patient seen on video fluoroscopy. Among the different techniques of neopharynx reconstruction, there is highest incidence after vertical primary closure. It has been postulated to cause dysphagia and lack of dietary progression, despite a paucity of data. Methods: Retrospective chart review of 50 consecutive patients who underwent total laryngectomy or laryngopharyngectomy for primary or salvage management of advanced laryngeal malignancy between 2015 and 2022 at 2 tertiary institutions was conducted. The presence of pseudodiverticulum on contrast swallow study was recorded to investigate the relationship with patient’s ability to tolerate oral intake at 3 months discharge from hospital. Results: Of 50 laryngectomized patients (mean age 63.8 ± 10.0 years, 86% male gender), the main closure techniques were primary vertical (n = 9), primary T-closure (n = 14), and flap reconstruction (n = 27). Pseudodiverticulum was identified in 19 cases (38%) and was significantly associated with vertical primary closure versus non-vertical techniques, X 2 = 7.4, p = 0.007, odds ratio = 5.7, 95% CI: 1.3-24.7. Pseudodiverticulum was not associated with greater inability to tolerate solid intake or full diet compared with patients without pseudodiverticulum. A total of 26.3% of patients with pseudodiverticulum were on full diet, compared with 25.8% of patients in the absent cohort. The vertical closure technique showed no difference in ability to maintain solid intake compared with non-vertical closure. Only 1 patient with pseudodiverticulum required operative management for retention rather than dysphagia. Conclusion: Pseudodiverticulum commonly forms due to mucosal invagination in the reconstructed pharynx and is more commonly associated with vertical closure. Postlaryngectomy dysphagia is likely multifactorial, with sensorimotor aperistalsis of the pharynx and cricopharyngeal stenosis. Postlaryngectomy pseudodiverticula did not require modification of diet at higher rate than those without. ePosters A Magnetic Navigation Tracheal Intubation Technology Suitable for Pre-Hospital First Aid Shuyan Liu, MD, Ziyang Peng, PhD, Zhibo Wang, PhD, Haoqian Peng, MD, Can Xia, PhD, Yi Lyu, PhD, Rongqian Wu, PhD, Lei Wang, PhD First Affiliated Hospital of Xi ‘an Jiaotong University, Xi’an, China Introduction: Airway management is an important part of prehospital emergency care, which is related to the life safety and long-term prognosis of patients. Traditional methods of tracheal intubation rely on visual laryngoscopy and are time-consuming. This study designed a magnetic navigation tracheal intubation technique for prehospital emergency care, which utilized magnetic traction technology to assist in improving the efficiency and success rate of tracheal intubation in this scenario. Methods: Our study used the principle of in vitro magnetic conductivity reaction magnet to test 100 experimental dogs and experimental pigs respectively, and trained the optimal magnetic field strength algorithm according to the neck fat thickness to establish the magnetic navigation tracheal intubation model. In the department, 100 patients were selected for the test, simulating the prehospital emergency environment, and comparing the intubation time, effect, extubation prognosis, patient satisfaction and other indexes between the visual laryngoscope group and the magnetic navigation intubation group. Results: The technique helps clinicians complete intubation without fully clarifying airway conditions. In animal studies, tracheal intubation into the larynx was 71.3% more accurate, 40.6% less damaging, and 69.1% faster. In clinical applications, the success rate was as high as 89%; compared to visual laryngoscopy, the success rate was only 75% (p < 0.05). Conclusion: The magnetic navigation tracheal intubation technique has low operating difficulty, can be popularized in multiple scenarios, and is especially advantageous in difficult airway intubation during prehospital emergency care, which has a broad application prospect. Antibiotic Prophylaxis in Head and Neck Free Flap Reconstruction: A Systematic Review and Individual Participant Data Meta-Analysis Deepak Lakshmipathy, BS, Karthik Rajasekaran, MD, FACS University of Pennsylvania, Philadelphia, PA Introduction: Given the complex balance between flap viability and antibiotic stewardship, considerable debate exists around duration of prophylactic antibiotics for clean-contaminated free flap reconstructions of the head and neck (HN). Our aim was to assess whether continuing antibiotics beyond 24 hours significantly reduced recipient surgical site infection (SSI). Methods: Cochrane Library, Embase, PubMed, and Web of Science were used as source databases. Inclusion criteria encompassed all published studies from database inception through January 2024 involving patients who received antibiotics following clean-contaminated HN free flap reconstruction. Non-English and review publications were excluded. Selected study authors were contacted to obtain deidentified, individual-level patient data. The primary outcome was recipient SSI rate with other surgical complications being secondary outcomes. Independent variables consisted of antibiotic duration and type. Random effects meta-analysis calculated pooled relative risk (RR) with 95% confidence interval (CI). Results: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocols, 437 records were initially identified, and 4 studies met inclusion criteria. Newcastle-Ottawa Quality Assessment revealed low risk of bias among included works. Altogether 1924 total free flap patients were represented with ampicillin/sulbactam as the primary antibiotic across all studies. Pooled RR for developing recipient SSI in patients with postoperative antibiotics ≤24 hours versus those with >24 hour regimens was 1.19 (0.51-2.79 95% CI, p = 0.57). Study heterogeneity was moderate (I2 = 65%) alongside funnel plot and Egger’s test showing low publication bias. Conclusion: There is no statistically significant benefit in continuing antibiotics beyond 24 hours to limit recipient SSI following clean-contaminated HN free flap reconstruction. Evolving Trends in Facial Reanimation Procedures: A Medicare Population Analysis from 2000 to 2022 Pooja Dhupati, MPH, Shelley Noland, MD University of Arizona of - Introduction: Facial functional and related to aim for while or and expression by to often Our study Medicare in versus from 2000 to Methods: We analyzed Medicare B Data from 2000 to the of by associated were into and or in with literature. of for each in versus Results: with a by but by from to while by over the free flap with technique for a in from 2000 to In and were but by only of a significant Conclusion: Our analysis a in highlighting in the surgical management of over the The of Surgical in Ziyang Peng, Zhibo Wang, PhD, Lei Wang, PhD, Shuyan Liu, PhD, Haoqian Peng, MD, Can Xia, PhD, PhD, PhD, Rongqian Wu, PhD, Yi Lyu, MBBS, FACS First Affiliated Hospital of Xi ‘an Jiaotong University, Xi’an, China Introduction: the of has by patients and as laryngeal and damage are In this study, we by our designed surgical in this Methods: We constructed a dataset by a of from We an surgical algorithm to effectively assist in of the surgical Clinical trials were to compare the of using the surgical Results: The algorithm in the field of of a model, of the of the laryngeal and It effectively identified during and we found that the reduced damage by damage by and surgical time by postoperative was reduced by Conclusion: The surgical in the surgical and with more and surgical This to an patient and for further and for Head and Neck A Systematic Review and Meta-Analysis BS, BS, V MD, MD, University of University of Introduction: to the are for patients with head and neck This meta-analysis to risk for and rate Methods: We PubMed, Embase, and for with after We did using and study quality with the of Assessment A meta-analysis was performed on the data. Results: studies met the inclusion criteria. The overall rate across all head and neck and was to be confidence The rate has in the and of 1. 35 were associated with higher and were not significantly included studies had an overall low risk of bias. Conclusion: as and head and neck treatment as flap and a of were associated with a higher risk of as and were not significantly associated with

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