Optical Coherence Tomography (OCT) Applications to Oral & Maxillofacial Surgery: A Potentially Innovative Method of Assessing Soft and Hard Tissues

Introduction:  As technological advancements progress in the basic sciences, their utilization in the clinical sciences becomes more prominent.  Clinically -- in particular surgically -- the trend toward less-invasive approaches has taken a larger role in both diagnosis and treatments.  Similarly, soft and hard tissue diagnoses, which once required large sections of tissue for biopsy, now require smaller amounts of tissue with the advent of newer technology.  While the list of pathologic lesions is varied both in origin and severity, we are choosing to focus on improving soft tissue analysis and diagnosis using optical coherence tomography (OCT), a high-resolution imaging tool.  OCT has gained prominent use in several medical fields, but its applications to dentistry and, in particular, oral & maxillofacial surgery remains limited.  It is our goal to introduce its concepts and discuss its potential applications to the field of oral & maxillofacial surgery. 

 

Optical Coherence Tomography:  Optical coherence tomography uses an optical signal to capture images using near-infrared light, which allows for high-resolution analysis of the tissue in question.  In ophthalmology, for example, OCT is used to obtain images that can aid in assessing macular degeneration.  Cardiology is also taking full advantage of this high-resolution analysis, as its imaging has provided the ability to image coronary arteries and the amount of plaque within them.  While this use is applicable in nearly all areas of the body, we are interested epithelial surfaces.  We performed a literature review on epithelial evaluations using OCT to note any trends regarding differences in their assessment.  Evaluation, for example, of skin lesions diagnosed histologically as actinic keratosis, were found to correlate well with the imaging discrepancies found with OCT; and the in-vivo assessment of atypical keratinocytes was firmly established. 

OCT In Oral & Maxillofacial Surgery:  The ability of OCT to produce cross-sectional images of tissue morphology can prove vital in aiding clinicians to potentially distinguish various soft tissue pathologies from one another.  However, it has been demonstrated to possess the ability to measure the change in light intensity of a tissue-fluid interface, which can provide clinicians with the ability to non-invasively visualize the oral mucosa.  OCT has also been shown to be a potentially effective diagnostic indicator for oral cancer and pre-cancerous lesions.  Abnormal oral epithelium, which contains dysplastic cells, shows different light scattering than normal epithelium due to the cellular differences.   However, OCT is not just limited to the surface epithelial layer, as it has demonstrated the ability to analyze the collagen condition of the oral mucosa, which is altered in such states as inflammation. 

Materials and Methods:  We have taken several tissue samples from the maxillofacial region and analyzed them using an OCT device at our institution.  Our analysis has shown high-resolution images of soft tissue/bone interface, titanium implant/bone interface, and other anatomical sites within the oral cavity. 

Conclusion:  OCT is a potentially diagnostic-altering technique for oral & maxillofacial surgeons.  Coupled with histological findings, it’s ability to discern tissue at the cellular level could prove advantageous in terms of time, costs, and above all, patient care.  It is our goal with this abstract to introduce OCT so that its unique abilities can help to provide better care to patients and aid clinicians in oral & maxillofacial surgery.  

HamdoonZ, Jerjes W, Upile T, MCKEnzie G, Jay A, Hopper C. Optical coherence tomography in the assessment of suspicious oral lesions: An immediate ex vivo study. Photodiagnosis and Photodynamic therapy. 10 (1) 2013.

Tsai MT, Lee HC, LU CW, Wang YM, Lee CK, Yang CC, Chiang CP. Delineation of an oral cancer lesion with swept-source optical coherence tomography. Journal of biomedical optics. 13(4) 2008.