Clinical and surgical implications of intraoperative optical coherence tomography imaging for benign pediatric vocal fold lesions

Abstract

Introduction: Benign vocal disorders in children include an extensive list of abnormalities creating a variety of debilitating levels of dysphonia. Precise delineation of the benign lesion type and margins may have significant public health implications in children. An innovative technology such as optical coherence tomography (OCT) is being explored to delineate pediatric benign laryngeal lesions. An accurate assessment of the subepithelial morphology may help towards tailoring more personalized therapeutic treatments. This study was established to highlight key morphological and optical features of benign pediatric laryngeal lesions using intraoperative OCT and to suggest clinical implications that arise from such optical imaging.

Methods and materials: This in vivo study was performed at Massachusetts Eye and Ear Infirmary. Intraoperative imaging was performed on twenty-five pediatric patients ranging from 1 year to 16 years of age presenting hoarseness. Three-dimensional OCT images of benign laryngeal lesions or a subsite of the lesion were acquired.

Results: High-resolution OCT images of 25 patients with benign laryngeal lesions such as nodules, cysts, Reinke's edema, vocalis sulcus, and papilloma revealed distinct and specific morphological differences with normal tissue. Nodules show a symmetrical superficial remodeling of the vocal fold epithelial layer and the basement membrane. Cysts have oval-like shape and are either superficial or deeply located in the lamina propria. Sulcus vocalis OCT imaging allows characterizing if the lesion is shallow or deep according to Ford's classification system. Reinke's edema of the mucosa can be observed and quantified, which may lead to suspicion on the underlying social and medical conditions. Finally, the ability to assess margins and depth of invasion of papilloma lesions is demonstrated, raising the possibility to use OCT with angiolytic lasers for patient-tailored treatments.

Conclusions: OCT imaging of benign pediatric vocal lesions is promising as it could improve preoperative decision-making and possibly peroperative imaging-guidance for patient-tailored treatments. An assessment of the optical contrast between healthy and abnormal tissue may help towards a more qualitative and quantitative approach to current standard care, especially when diagnosis remains unclear.

Keywords: Benign vocal fold lesions; OCT; Optical imaging; Pediatric laryngology.