Nasal Airway Computer Modeling and Tissue Engineering

2010 Official Program Abstracts erratum front of patient safety and quality improvement over the past year. Two studies from the PSQI Committee will be presented – inadvertent intubation of post-laryngectomy patients and tracheotomy in obese patients. Sentinel articles regarding patient safety and quality improvement will be discussed including the WHO Surgical Checklist and the use of chlorohexadine as a surgical prep solution. EDUCATIONAL OBJECTIVES: 1) Understand the current “state of the union” in patient safety. 2) Understand the patient safety scenarios presented so you may practically utilize the information presented. 3) Understand the latest tools available to assist physicians with patient safety.

Facial Plastic and Reconstructive Surgery Cartilage Tissue Reshaping and Nerve Injury John S Rhee, MD, MPH (moderator); Tessa Hadlock, MD; Brian J F Wong, MD PROGRAM DESCRIPTION: A 25-year-old woman with a broad nasal tip and thin skin desires refinement in her nasal contour. Classic surgical maneuvers could be performed including a myriad of endonasal and open techniques. Regardless of technique, incisions would be needed to expose the lower lateral cartilages to be cut, sutured, scored, or morselized in order to balance the intrinsic forces that resist deformation. What if cartilage could be shaped without the need for these classic maneuvers? Cartilage is a charged polymer hydrogel and shares similarities with many polymers and plastics. Can it be shaped in the same way plastics are reshaped? Recently, several approaches have been developed in the US and Europe to reshape cartilage in living tissues by exploiting the visco-elastic nature of this unique tissue. As with all polymers, changing the physical and chemical environment of the cartilage tissue matrix leads to profound changes in the mechanical properties so that they can be exploited to achieve shape change. Several methods, techniques and devices will be discussed, including: thermoforming, lasers, and electromechanical shaping. Collectively, these minimally invasive approaches may lead to minimally invasive needle-based methods to reshape the cartilage in the face and upper airway. EDUCATIONAL OBJECTIVES: 1) Understand the current “state of the union” in translational research in facial plastics. 2) Understand the patient scenarios presented so you may practically utilize the information presented. 3) Understand the near- and longer-term possibilities either in treatment or other innovations.

How to Protect Your Intellectual Property John S Rhee, MD, MPH (moderator); Lita Nelsen, MS PROGRAM DESCRIPTION: Patents and other intellectual property ideas are an important mechanisms through which medical inventions attract investment for development and market introduction. Without IP protection from later competitors, companies and venture investors will not

717 take the risk of investment. The more innovative the invention is, the higher the risk of ultimate market adoption, and the more IP protection is needed. This presentation will briefly review the ground rules for IP protection in the academic environment. We will then discuss mechanisms for moving biomedical inventions into product development, through translational research and licensing to companies or entrepreneurial startups. MIT’s experience in working with its local business and investment community via its “entrepreneurial eco-system” will inform the discussion. EDUCATIONAL OBJECTIVES: 1) Understand how to protect your intellectual property. 2) Understand the ground rules for IP protection in the academic environment. 3) Understand mechanisms for moving biomedical inventions into product development, translational research, licensing to companies.

Nasal Airway Computer Modeling and Tissue Engineering John S Rhee, MD, MPH (moderator); Julia Kimbell, PhD; Deborah Watson, MD PROGRAM DESCRIPTION: Computer modeling: Wouldn’t it be extremely useful to have a universal or gold standard objective test, consistently predictive of surgical outcomes, providing clinicians and the healthcare industry the ability to better select surgically treatable patients and help guide the best surgical intervention to target the particular nasal anatomic deformity? With increasing sophistication of computer technology, powerful bioengineering tools are now available for investigating airflow and air conditioning in the nasal cavity. Computational fluid dynamics (CFD) techniques allow for the merger of anatomy with physiology by creating a virtual model of the nasal cavity with computed measures of airflow, heat transfer, and air humidification. Furthermore, the computed nasal geometry can be virtually modified in a manner reflecting surgical techniques and new patterns of airflow, heat and water vapor transport can be predicted that could effectively estimate surgical outcomes: e.g., virtual surgery. In this session we will review the state of the art in nasal CFD modeling, with examples of model creation, simulation, and results analysis, and provide a glimpse of the enormous promise that CFD modeling has for optimizing treatment and correction of nasal deformities. Tissue Engineering: Can you foresee a future where there are no tissue limitations for craniofacial reconstruction? Tissue engineering of human cartilage offers a unique opportunity to bridge the gap between basic science and the application of a fabricated tissue product for patients undergoing nasal, or more broadly, craniofacial reconstruction. Autologous tissue-engineered septal cartilage can now be created from a small sample of septal cartilage taken from a patient. This tissue-engineered product could eventually provide a surgeon with adequate grafting material with which to complete a nasal reconstructive case without the

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Otolaryngology–Head and Neck Surgery, Vol 143, No 5, November 2010

known limitations of tissue availability and tissue quantity. A review and update on this technology is presented during this session. EDUCATIONAL OBJECTIVES: 1) Understand the current “state of the union” in translational research in facial plastics. 2) Understand the patient scenarios presented so you may practically utilize the information presented. 3) Understand the near- and longer-term possibilities either in treatment or other innovations.

Wound Healing and Flap Physiology John S Rhee, MD, MPH (moderator); David Hom, MD; Timothy Lian, MD PROGRAM DESCRIPTION: Flap Physiology: 65-yearold male with history of a T4aN2bM0 squamous cell carcinoma of the anterior floor of mouth underwent resection including partial glossectomy, excision of the floor of mouth and anterior arch of the mandible, as well as removal of the associated overlying soft tissues and skin. The resulting complex defect was addressed with a scapula osteocutaneous free flap with subsequent unexpected results and consequences. This case led to a number of questions, including those pertaining to basic flap physiology, ischemia reperfusion injury, flap monitoring, and boney reconstruction. Subsequently, a continuing journey involving intravital microscopy, development of animal models, use of recombinant bone morphogenic proteins, and novel imaging techniques began. Interactions at the departmental, institutional, and industry levels present interesting challenges and opportunities, while navigating through this realm of investigation and exploration that holds the promise of improved wound healing and tissue regeneration. Wound Healing: 47-year-old male with a 12 year history of a persistent painful nonhealing full-thickness dermal wound on left neck; history of a T2N2bM0 nasopharyngeal cancer (high grade SCCA) treated with combined chemoradiation; tumor-free for 12 years. His painful full thickness open wound is not responsive to debridement, dressing care, antibiotics, skin grafts, or hyperbaric oxygen. Patient refuses skin flap surgeries for fear of further poor healing. The off-label use of topical rhPlatelet Derived Growth Factor was used to jump-start the chronic wound, allowing for additional granulation tissue to form and making it possible for a skin graft to later cover and close the defect. Can Supplemental Growth Factors (SGF) improve healing of impaired and normal soft tissue wounds? Over the last 20 years with the advent of recombinant growth factors, research was pursued on whether SGF improves soft tissue wound healing. Initially, using the porcine skin flap model, healing of vascular compromised skin flaps (irradiated and nonirradiated) were studied with the angiogenic basic fibroblastic growth factor (bFGF), which appears to increase random skin flap viability, suggesting its utility in increasing skin flap survival and soft tissue wound healing. Next, to explore if growth factors improve normal wound healing, research investigated if autologous platelet rich plasma

(PRP), a physiological cocktail, can expedite healing of full thickness skin wounds in healthy human volunteers. Preliminary findings show that PRP had faster wound closure rates compared to control wounds (in same patients). With more research, growth factor mixtures such as PRP treatment during surgery may significantly enhance wound healing. EDUCATIONAL OBJECTIVES: 1) Understand the current “state of the union” in translational research in facial plastics. 2) Understand the patient scenarios presented so you may practically utilize the information presented. 3) Understand the near and longer term possibilities either in treatment or other innovations.

General Otolaryngology Global Health 2010: Our Academy around the World Gregory Randolph, MD (moderator); Ronald B Kuppersmith, MD, MBA; Terry A Day, MD; Ramon J Franco, Jr, MD; G Richard Holt, MD; David W Kennedy, MD; K J Lee, MD; Eugene N Myers, MD; James L Netterville, MD; James E Saunders, MD; J Pablo Stolovitzky, MD; J Regan Thomas, MD; Karl Hormann, MD; Nikhil J Bhatt, MD PROGRAM DESCRIPTION: This international symposium offered for the first time at the annual meeting will showcase Academy relationships and activities in seven regions of the world. President Kuppersmith will welcome the audience, and President-elect J. Regan Thomas will describe his vision for enhanced international collaboration. Moderated by Dr Randolph, Coordinator for International Affairs, guest speakers will be introduced by Regional Advisors on the Academy’s International Steering Committee: Terry Day (Caribbean), Ramon Franco, Jr., (Central America), G. Richard Holt (Middle East), David Kennedy (Europe), Karl Hormann (Europe), KJ Lee (Pacific Rim), Eugene Myers (Balkans, Greece & Turkey), James Netterville (Africa), James Saunders (Africa), J. Pablo Stolovitzky (Latin America), and Nikhil J. Bhatt, MD. Eight guest speakers from Australia, Germany, Haiti, New Zealand, Serbia, Venezuela, and Zimbabwe will offer updates on otolaryngology communities in their regions or a short clinical presentation. EDUCATIONAL OBJECTIVES: 1) Understand the myriad ways the Academy interacts with otolaryngology communities in different regions. 2) Appreciate the opportunities for collaboration in scientific exchange, research, fellowships and observerships. 3) Learn the Academy’s resources available to members, subscribers, meeting attendees, and web visitors.

Laryngology/Bronchoesophagology Voice and the Law Robert Sataloff, MD (moderator); Michael Benninger, MD; Gerald Berke, MD; Thomas Murry, PhD; Lucian Sulica, MD; Jeffrey Adler, Esq