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Optical nerve identification in head and neck surgery after Er:YAG laser ablation

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Abstract

Facial nerve function may be hampered by iatrogenic damage during head and neck laser surgery procedures. Optical techniques can serve as a basis for feedback-controlled tissue-specific laser surgery on the jaw bone and the parotid gland. In order to preserve nerve tissue during laser surgery, the alteration of optical tissue properties through laser-tissue interactions have to be taken into account. It was the aim of this study to evaluate the viability of optical tissue differentiation through diffuse reflectance spectroscopy after exposure to laser light as a basis for a feedback system for tissue-specific laser surgery. Spectra of diffuse reflectance (wavelength, 350–650 nm) of nerves, salivary glands, and cortical and cancellous bone of the midfacial region (ex vivo domestic pig heads) were acquired before/after Er:YAG laser (wavelength, 2.94 μm) ablation (each 16,800 spectra). Principal component analysis was computed followed by quadratic discriminant analysis. The tissue classification performance as well as area under the curve (AUC) sensitivity and specificity for tissue differentiation was assessed before and after laser-tissue exposure. A high classification performance was observed before laser ablation (total error, 7.74 %). Nerve tissue was differentiated from bone and salivary glands with results greater than 0.96 in AUC, sensitivity and specificity. After laser exposure, a total classification error of 18.61 % was observed. The differentiation of nerve tissue was reduced with an AUC of >0.94, sensitivity of >0.95, and specificity >0.87. Er:YAG laser ablation only slightly reduces the differentiation performance through diffuse reflectance in the investigated tissue types. The results show the general viability of diffuse reflectance spectroscopy in identifying neural structures in the vicinity of salivary glands and bone as a basis for nerve preservation during feedback-controlled laser surgery.

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Acknowledgments

The authors gratefully acknowledge the funding by the ELAN-Funds, University of Erlangen-Nuremberg (AZ:07.03.06.1) and the Erlangen Graduate School in Advanced Optical Technologies (SAOT) by the German National Science Foundation (DFG) (AZ: STE 1877/2-1) as part of the Excellence Initiative.

Conflict of interests

The authors declare that there is no conflict of interest.

Ethics approval

Ethics approval is not necessary. The experimental study was carried out on tissues that were provided by a slaughterhouse.

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Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, Friedrich-Alexander-University, Erlangen-Nuremberg, Glückstrasse 11, 91054, Erlangen, Germany

    Florian Stelzle, Christian Knipfer, Bastian Bergauer, Maximilian Rohde & Emeka Nkenke

  2. blz - Bavarian Laser Center, Erlangen, Germany

    Katja Tangermann-Gerk & Michael Schmidt

  3. Chair of Photonic Technologies, Friedrich-Alexander-University, Erlangen-Nuremberg, Erlangen, Germany

    Michael Schmidt

  4. SAOT–Graduate School in Advanced Optical Technologies, Friedrich-Alexander University, Erlangen-Nuremberg, Erlangen, Germany

    Florian Stelzle & Michael Schmidt

  5. Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander University, Erlangen-Nuremberg, Erlangen, Germany

    Werner Adler

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  1. Florian Stelzle
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  2. Christian Knipfer
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  3. Bastian Bergauer
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  4. Maximilian Rohde
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  5. Werner Adler
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  6. Katja Tangermann-Gerk
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  7. Emeka Nkenke
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  8. Michael Schmidt
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Correspondence to Florian Stelzle.

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Stelzle, F., Knipfer, C., Bergauer, B. et al. Optical nerve identification in head and neck surgery after Er:YAG laser ablation. Lasers Med Sci 29, 1641–1648 (2014). https://doi.org/10.1007/s10103-014-1569-5

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  • DOI: https://doi.org/10.1007/s10103-014-1569-5

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