The use of optical coherence tomography in maxillofacial surgery

The ever-evolving medical field continues to trend toward less invasive approaches to the diagnosis and treatment of pathological conditions. Basic sciences research has allowed for improved technologies that are translated to the clinical sciences. Similarly, advancements in imaging modalities continue to improve and their applications become more varied. As such, surgeons and pathologists are able to depend on smaller samples for tissue diagnosis of pathological disease, where once large sections of tissue were needed. Optical coherence tomography (OCT), a high-resolution imaging technique, has been used extensively in different medical fields to improve diagnostic yield. Its use in dental fields, particularly in oral and maxillofacial surgery, remains limited. Our goal is to assess the use of OCT for improving soft tissue analysis and diagnosis, particularly for its applications in the field of oral and maxillofacial surgery. Optical coherence tomography is a modality that uses an optical signal using safe near-infrared light which is reflected off the sub-surface structures. This allows for high-resolution cross-sectional images of the tissue morphology to be obtained. Ophthalmologists have been using OCT to obtain images of the retina to assess for age-related macular degeneration. More recently, OCT has been used by Interventional Cardiology to image coronary arteries, and assess plaque thickness and morphology. This technology is now being investigated in several medical fields as a form of optical biopsy, providing in situ images with high-resolution morphology of tissues. We are particularly interested in its use on epithelial tissues, and therefore performed a literature review on the use of OCT for assessing epithelium. Evaluation of histologically-diagnosed actinic keratosis, for example, was found to correlate well with the imaging discrepancies found on OCT; and the in vivo assessment of atypical keratinocytes was firmly established. Additionally, studies have shown a potential application in that OCT may provide a method for studying the evolution of epithelial lesions OCT's potential in producing high-resolution images of tissue morphology can prove to be a valuable tool for characterizing different soft tissue pathological disorders. Furthermore, it has been shown to measure changes in light intensity at tissue-fluid interfaces, which can provide surgeons the ability to characterize oral mucosal surfaces noninvasively. OCT can also prove to be valuable in detecting oral cancerous and pre-cancerous lesions, as altered epithelium containing increased dysplasia shows differences in light scattering than normal epithelium. Additionally, OCT has been shown to analyze deeper collagen tissues of the oral mucosa and is not limited to the surface epithelium. This can aid in characterizing such inflammatory conditions that alter these tissues. Several tissue samples from the maxillofacial region were obtained and assessed using an OCT device at our institution. The analysis has shown high-resolution images of soft tissue-bone interface, titanium implant-bone interface, and other anatomical sites within the oral cavity. OCT has been shown to be a valuable modality in different medical fields. Its use in oral and maxillofacial surgery can potentially aid in diagnostic techniques. Alongside traditional histological technique, it can be help characterize tissues at the cellular level, which would improve costs, time, and most importantly, patient care. We aim to introduce OCT and its diagnostic abilities to the field of oral and maxillofacial surgery to help aid clinicians and provide improved care for patients.