Glenn E. Green

• MD
• Professor (Associate) at University of Michigan

An infant with localized bronchial malacia was treated with a computer-printed bioresorbable three-dimensional splint. Placement of the splint resulted in improved ventilation.

Three-dimensional (3D) printing offers the potential for rapid customization of medical devices. The advent of 3D-printable biomaterials has created the potential for device control in the fourth dimension: 3D-printed objects that exhibit a designed shape change under tissue growth and resorption conditions over time. Tracheobronchomalacia (TBM) is...

Dietary supplements consisting of beta-carotene (precursor to vitamin A), vitamins C and E and the mineral magnesium (ACEMg) can be beneficial for reducing hearing loss due to aminoglycosides and overstimulation. This regimen also slowed progression of deafness for a boy with GJB2 (CONNEXIN 26) mutations. To assess the potential for treating GJB2 a...

Auriculocondylar syndrome (ACS) is a rare, autosomal-dominant craniofacial malformation syndrome characterized by variable micrognathia, temporomandibular joint ankylosis, cleft palate, and a characteristic "question-mark" ear malformation. Careful phenotypic characterization of severely affected probands in our cohort suggested the presence of a m...

We report that mutation of COL11A2 causes deafness previously mapped to the DFNA13 locus on chromosome 6p. We found two families (one American and one Dutch) with autosomal dominant, non-syndromic hearing loss to have mutations in COL11A2 that are predicted to affect the triple-helix domain of the collagen protein. In both families, deafness is non...

Objective Despite being life-saving, tracheostomies carry numerous social, functional and quality of life (QOL) drawbacks. The aim of this study was to design and test the use of small, discrete, customised tracheostomy stoma plugs in patients who are not tracheostomy-dependent during the day, with the overall goals to demonstrate the feasibility o...

Objective Our objective was to create and evaluate a novel virtual platform dissection course to complement pediatric otolaryngology fellowship training in the setting of the COVID-19 pandemic. Methods A four-station, four-simulator virtual course was delivered to pediatric otolaryngology fellows virtually using teleconferencing software. The four...

Introduction Cricotracheal resection (CTR) and tracheal resection (TR) are open surgical options to treat airway stenoses. One of the most devastating complications is anastomosal dehiscence, owing to excessive tension on the anastomosis from cervical extension. To prevent excessive tension on the anastomosis during the postoperative period, the ne...

We fabricated personalized non-invasive ventilation (NIV) mask interfaces for amyotrophic lateral sclerosis (ALS) participants. A NIV cushion design was fit to a contact profile from the participant's topographic facial model obtained from a 3D scanner then converted to a mold that was 3D-printed and subsequently cast with medical grade silicone an...

Additive manufacturing, or 3D printing, of the bioresorbable polymer ε-polycaprolactone (PCL) is an emerging tissue engineering solution addressing patient specific anatomies. Predictively modeling the mechanical behavior of 3D printed parts comprised of PCL improves the ability to develop patient specific devices that meet design requirements whil...

Tracheobronchomalacia is a condition of dynamic collapse of the trachea and mainstem bronchi. The clinical significance of tracheobronchomalacia depends on its severity. Mild cases may be medically managed with limited symptomology, while severe cases require advanced therapies, lengthy hospital stays, and carry significant morbidity and mortality....

Objective/hypothesis: To assess the use of a three-dimensional (3D) printed, multilayer facial flap model for use in trainee education as an alternative method of teaching surgical techniques of facial reconstruction. Study design: Cohort study. Methods: A 3D printed facial flap simulator was designed from a computed tomography scan and manufa...

Introduction: Cricotracheal resections and tracheal resections are highly successful procedures for the treatment of severe airway pathology including high-grade stenoses. The major complication of resection is anastomotic dehiscence and various methods have been developed to decrease this complication including cervical flexion, the guardian sutur...

Tracheal anomalies in children represent one of the greater challenges in pediatric otolaryngology. In addition to the compromised airway, there is a high prevalence of associated anomalies. Despite surgical and technologic advances, significant morbidity and mortality remain. The anomalies include tracheobronchomalacia, congenital tracheal stenosi...

Background Current limitations in the supply of ventilators during the Covid19 pandemic have limited respiratory support for patients with respiratory failure. Split ventilation allows a single ventilator to be used for more than one patient but is not practicable due to requirements for matched patient settings, risks of cross-contamination, harmf...

The worst complication of cricotracheal resection (CTR) is anastomotic dehiscence, and to limit it, postoperative management at Michigan Medicine included the use of a modified Minerva cervical-thoracic orthosis (MMCTO). To date, there has been no analysis of the risks and benefits of the brace’s use following CTR. We analyze this with our retrospe...

Importance Facial flap procedures may be difficult for surgical trainees to conceptualize and challenging for supervising surgeons to allow entrustment early in training. Simulation outside of the operating room may accelerate and enhance the surgical education experience. Objective To design and manufacture a 3-dimensional (3-D)–printed, multilay...

Objectives/Hypothesis To report the clinical safety and efficacy of three‐dimensional (3D)–printed, patient‐specific, bioresorbable airway splints in a cohort of critically ill children with severe tracheobronchomalacia. Study Design Case series. Methods From 2012 to 2018, 15 subjects received 29 splints on their trachea, right and/or left mainst...

Background: Pediatric-specific difficult airway guidelines include algorithms for 3 scenarios: unanticipated difficult tracheal intubation, difficult mask ventilation, and cannot intubate/cannot ventilate. While rare, these instances may require front-of-neck access (FONA) to secure an airway until a definitive airway can be established. The aim o...

Objectives/hypothesis: Reconstruction of craniofacial cartilagenous defects are among the most challenging surgical procedures in facial plastic surgery. Bioengineered craniofacial cartilage holds immense potential to surpass current reconstructive options, but limitations to clinical translation exist. We endeavored to determine the viability of...

We show the presence of lymphoid tissue-resident PLZF+ CD45RA+ RO+ CD4 T cells in humans. They express HLA-DR, granzyme B, and perforin and are low on CCR7 like terminally differentiated effector memory (Temra) cells and are likely generated from effector T cells (Te) or from central (Tcm) or effector (Tem) memory T (Tcm) cells during immune respon...

Cleft Palate-Craniofacial Journal. 54(3):e26, May 2017

Autologous cartilage grafting during open airway reconstruction is a complex skill instrumental to the success of the operation. Most trainees lack adequate opportunities to develop proficiency in this skill. We hypothesized that 3-dimensional (3D) printing and computer-aided design can be used to create a high-fidelity simulator for developing ski...

Tracheobronchomalacia (TBM) is a disease of excessive collapse of the primary airways resulting from intrinsic weakness or extrinsic compression. While infantile TBM typically regresses in severity over time, adult-phenotype TBM is more often persistent and progressive.¹ Severe TBM carries substantial morbidity and mortality, and interventions such...

Objectives/hypothesis: To explore the perioperative utility of three-dimensionally (3D)-printed temporal bone models of patients undergoing repair of lateral skull base defects and spontaneous cerebrospinal fluid leaks with the middle cranial fossa approach. Study design: Case series. Methods: 3D-printed temporal bone models-based on patient-s...

http://deepblue.lib.umich.edu/bitstream/2027.42/134796/1/ajmga37629_am.pdf

Importance: Three-dimensional (3-D) printing is an exponentially growing technology that enables the use of a patient's image data to create patient-specific models, devices, and implants. Three-dimensional printing, developed in the 1980s, has emerged in the past decade with the potential to create new paradigms in personalized medicine. Observa...

Despite significant advances in 3D biomaterial printing, the potential of 3D printing for patient specific implants and tissue reconstruction has not been fully exploited. This is due in part to the lack of integration of image-based patient specific design with 3D biomaterial printing within a relevant regulatory framework, namely design control,...

Introduction: With the advent of improved neonatal and pediatric intensive care management, tracheostomy is increasingly performed in children requiring prolonged ventilation. Even though tracheostomy is generally a safe procedure, there remains mortality and morbidity associated with it. Objective: We report a rare complication of a tracheostom...

This study examined potential prevention of music-induced temporary threshold shift (TTS) in normal-hearing participants. A dietary supplement composed of β-carotene, vitamins C and E, and magnesium was assessed using a randomized, placebo-controlled, double-blind study design. Dosing began 3 days prior to the music exposure with the final dose con...

Scientific Reports 6: Article number: 2269010.1038/srep22690; published online: March112016; updated: April202016 This Article contains errors in the legend of Fig. 5. “Post-weaning dietary supplement slowed or reversed hearing loss in Diap3-Tg mutant mice.” should read: “Post-weaning dietary supplement accelerated hearing loss in Diap3-Tg muta...

CHARGE syndrome is a dominant disorder characterized by ocular colobomata, heart defects, choanal atresia, retardation of growth and development, genital hypoplasia, and ear abnormalities including deafness and vestibular disorders. The majority of individuals with CHARGE have pathogenic variants in the gene encoding CHD7, a chromatin remodeling pr...

3D printing has become widely utilized for regenerative medicine research due to its ability to fabricate patient-specific scaffolds with well-controlled porous architecture and the capability of printing cells in 3D configurations. These characteristics, combined with the unique capability of producing implants and scaffolds for small, specific pa...

A summary of current 3D printing applications in otolaryngology-head & neck surgery explored at the University of Michigan.

CHARGE syndrome (Coloboma of the eye, Heart defects, Atresia of the choanae, Retardation of growth and/or development, Genital and/or urinary anomalies, and Ear malformations, including deafness and vestibular disorders) is a genetic condition characterized by a specific and recognizable pattern of features. Heterozygous pathogenic variants in the...

Congenital airway obstruction poses a life-threatening challenge to the newborn. We present the first case of three-dimensional (3D) modeling and 3D printing of complex fetal maxillofacial anatomy after prenatal ultrasound indicated potential upper airway obstruction from a midline mass of the maxilla. Using fetal MRI and patient-specific computer-...

Objectives: (1) Describe current treatment options for severe acquired tracheomalacia. (2) Learn about a novel technology for treatment of severe tracheomalacia using a 3-dimensionally (3D) printed patient-specific external tracheal splint. Methods: A 14-year-old girl presented with life-threatening tracheomalacia due to compression between the inn...

Three-dimensional (3D) printing, or additive manufacturing, technology has rapidly penetrated the medical device industry over the past several years, and innovative groups have harnessed it to create devices with unique composition, structure, and customizability. These distinctive capabilities afforded by 3D printing have introduced new regulator...

The high prevalence of obstructive sleep apnea (OSA) in children with craniofacial anomalies has been welldescribed. Failure of continuous positive airway pressure (CPAP) therapy may require potentially morbid surgery. Yet, achieving a functional mask-face interface using conventional masks is difficult due to leak and discomfort resulting from aty...

Objectives/HypothesisThe mechanical properties of normal auricular cartilage provide a benchmark against which to characterize changes in auricular structure/function due to genetic defects creating phenotypic abnormalities in collagen subtypes. Such properties also provide inputs/targets for auricular reconstruction scaffold design. Several studie...

The primary thrust of tissue engineering is the clinical translation of scaffolds and/or biologics to reconstruct tissue defects. Despite this thrust, clinical translation of tissue engineering therapies from academic research has been minimal in the 27 year history of tissue engineering. Academic research by its nature focuses on, and rewards, ini...

Hearing loss may be caused by exclusively genetic effects, exclusively environmental insults, or a combination of both. Genetic susceptibility determines the residual hearing after many environmental insults including aminoglycosides, noise, and otitis media. As we increase our understanding of the specific genes and pathways underlying hearing los...

INTRODUCTION: Obstructive Sleep Apnea (OSA) is highly prevalent among children with craniofacial anomalies and syndromes involving the mid-face and mandible. Traditional surgical interventions to treat OSA are often unsuccessful in these children, who therefore frequently require continuous positive airway pressure (CPAP). Mask fit issues are commo...

Tracheobronchomalacia, a condition of excessive collapse of the primary airways, can lead to life-threatening apneas and death. We have previously developed an external tracheobronchial splint (TBS), designed from images of the patient’s airway and manufactured from poly(ε-caprolactone) using a 3-D printer, for treating tracheobronchomalacia. One p...

Objective: To determine the potential of an integrated, image-based computer-aided design (CAD) and 3-dimensional (3D) printing approach to engineer scaffolds for head and neck cartilaginous reconstruction for auricular and nasal reconstruction. Study design: Proof of concept revealing novel methods for bioscaffold production with in vitro and i...

Objectives (1) Describe the treatment options for severe bronchomalacia. (2) Learn about a novel technology for treatment of severe bronchomalacia using a 3-dimensionally (3D) printed patient-specific external bronchial splint. Methods A 16-month-old patient previously underwent tracheostomy for severe bronchomalacia but had been unable to be disc...

http://deepblue.lib.umich.edu/bitstream/2027.42/107487/1/ajmga36505.pdf

Objective: To determine whether patients with semicircular canal dysplasia have mutations in CHD7. Background: CHARGE syndrome is a nonrandom clustering of congenital anomalies, including ocular coloboma, heart defects, choanal atresia or stenosis, retarded growth and development, genital hypoplasia, and inner and outer ear anomalies including d...

Introduction: Our group has recently introduced a novel method utilizing image-based design and 3-dimensionally (3D) printed bioscaffolds for auricular tissue engineering. One of the advantages of computer-aided design is the ability to customize the microarchitecture of the scaffolding prior to fabrication. This study endeavors to elucidate whethe...

Review of current innovations from the University of Michigan focused on harnessing the power of 3D printing and patient-specific CAD for personalized medical devices.

Very few eustachian tube anomalies have been published in the literature and have consisted of descriptions of diverticula, hypoplasia/aplasia, fistula, or aberrant associated musculature. We present a girl with a novel anomaly consisting of a eustachian tube duplication that originates in the nasopharynx and exits posterior to a microtic and atret...

: One of the challenges for evaluating new otoprotective agents for potential benefit in human populations is the availability of an established clinical paradigm with real-world relevance. These studies were explicitly designed to develop a real-world digital music exposure that reliably induces temporary threshold shift (TTS) in normal-hearing hu...

To determine the prevalence of jugular bulb and vestibular aqueduct dehiscence (JBVAD) in pediatric patients undergoing temporal bone computed tomography (CT) scans and to assess the relationship between JBVAD and hearing loss. Cross-sectional study with chart review. Tertiary academic medical center. All patients 18 years of age or younger who had...

Noise-induced hearing loss (NIHL) is a significant clinical, social, and economic issue. The development of novel therapeutic agents to reduce NIHL will potentially benefit multiple very large noise-exposed populations. Oxidative stress has been identified as a significant contributor to noise-induced sensory cell death and NIHL, and several antiox...

Campomelic dysplasia is a rare and historically lethal skeletal dysplasia with a variable but recognizable phenotype; it affects the long bones and is associated with a variety of head and neck anomalies. Mutations in or around the SOX9 gene have been identified as the molecular origin in most patients. We briefly present 2 children who meet the di...

Objective: Determine the prevalence of dehiscence of the jugular bulb and vestibular aqueduct (JBVAD) in pediatric patients undergoing temporal bone computed tomography (CT) scans and assess the correlation between JBVAD and hearing loss. Method: All patients 18 years of age or younger who underwent temporal bone CT scans and audiometric testing be...

To determine the importance of prelinguistic babbling by studying patterns of speech and language development after cricotracheal resection in aphonic children. Retrospective review of seven previously aphonic children who underwent cricotracheal resection by our pediatric thoracic airway team. The analyzed variables include age, sex, comorbidity,...

A variety of congenital syndromes affecting the face occur due to defects involving the first and second BAs. Radiographic evaluation of craniofacial deformities is necessary to define aberrant anatomy, plan surgical procedures, and evaluate the effects of craniofacial growth and surgical reconstructions. High-resolution CT has proved vital in dete...

To determine the effectiveness of cricotracheal resection and hilar release for high-grade, long-segment airway stenosis. We identified 16 patients who underwent cricotracheal resection and hilar release, performed from January 1, 2004, through December 31, 2008, and conducted a retrospective review, emphasizing preoperative findings, operative tec...

A variety of congenital syndromes affecting the face occur due to defects involving the first and second BAs. Radiographic evaluation of craniofacial deformities is necessary to define aberrant anatomy, plan surgical procedures, and evaluate the effects of craniofacial growth and surgical reconstructions. High-resolution CT has proved vital in dete...

Connexin 26 (Cx26) deafness is the most common type of congenital deafness in many countries. The diagnosis is dependent on the molecular identification of pathogenic DNA mutations, and carries prognostic and therapeutic implications that can be used to provide improved medical and audiological care. Although variability in the level of residual he...

Adenotonsillectomy (T&A) is a very common surgical procedure in children. With the rising prevalence of childhood overweight and obesity, our goal was to describe the prevalence of overweight/obesity in children presenting for T&A in our institution. We also sought to compare the frequency of peri-operative complications and the likelihood of being...

Obesity is a highly prevalent chronic problem with health and fiscal consequences. Data from adults and nonsurgical pediatric patients suggest that obesity has serious implications for the US economy. Our goal was to describe the impact of BMI on hospital charges in children undergoing adenotonsillectomy (AT). We carried out a retrospective compara...

We report on 20 individuals in 4 kindreds with auriculo-condylar syndrome (ACS), an autosomal dominant disorder characterized by congenital auricular clefts, mandibular condyle hypoplasia, temporomandibular joint (TMJ) abnormalities, micrognathia, microstomia, and a round facial appearance with prominent cheeks. Affected individuals have varying de...

Unlabelled: This report reviews the speech and language development of a child who, as result of complete subglottic stenosis, was aphonic from birth until 2 years and 11 months of age at which time laryngotracheal reconstruction provided normal respiration. The boy had congenital subglottic stenosis requiring neonatal tracheostomy. The congenital...

alpha9/alpha10 Subunits are thought to constitute the nicotinic acetylcholine receptors mediating cholinergic efferent modulation of vertebrate hair cells. The present report describes the cloning and sequence analysis of subunits of the alpha9-containing receptor of a hair-cell layer from the saccule of the rainbow trout (Oncorhynchus mykiss). A m...

Full-length sequence (>6.5 kb) has been determined for the Ca(V)1.3 pore-forming subunit of the voltage-gated Ca(2+) channel from the saccular hair cells of the rainbow trout (Oncorhynchus mykiss). Primary structure was obtained from overlapping PCR and cloned fragments, amplified by primers based on teleost, avian, and mammalian sources. Trout sac...

Clinical otosclerosis (OMIM 166800/605727) has a prevalence of 0.2-1% among white adults, making it the single most common cause of hearing impairment in this group. It is caused by abnormal bone homeostasis of the otic capsule with the consequent development of sclerotic foci that invade the stapedio-vestibular joint (oval window) interfering with...

Congenital profound hearing loss affects 0.05-0.1% of children and has many causes, some of which are associated with cognitive delay. For prelingually-deafened cochlear implant recipients, the etiology of deafness is usually unknown. Mutations in GJB2 have been established as the most common cause of heritable deafness in the United States. In thi...

This chapter reviews various ways that genes can impact on a genetic disorder and ways of delineating that risk. The presence of a genetic component of a disease can be difficult to identify. Evidence supporting a genetic component includes familial clustering of cases, increased incidence in consanguineous matings, and increased incidence within g...