#!/usr/bin/env python3
"""
Build a national-conference-grade PPTX:
"One Tool, Many Lesions: Coblation as a Versatile Modality in Diverse Laryngeal Pathology"
"""
import json, base64
from io import BytesIO
from pptx import Presentation
from pptx.util import Inches, Pt, Emu
from pptx.dml.color import RGBColor
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
from pptx.enum.shapes import MSO_SHAPE
from pptx.oxml.ns import qn

# ---------------------------------------------------------------- palette
NAVY      = RGBColor(0x0A, 0x2A, 0x47)
NAVY2     = RGBColor(0x12, 0x3A, 0x5E)
GOLD      = RGBColor(0xC9, 0xA2, 0x27)
TEAL      = RGBColor(0x1F, 0x7A, 0x8C)
WHITE     = RGBColor(0xFF, 0xFF, 0xFF)
DARK      = RGBColor(0x20, 0x28, 0x33)
GRAY      = RGBColor(0x5A, 0x63, 0x6E)
LIGHT_BG  = RGBColor(0xF4, 0xF6, 0xF9)
PH_BG     = RGBColor(0xEA, 0xED, 0xF1)
PH_BORDER = RGBColor(0x9A, 0xA6, 0xB3)
ROW_ALT   = RGBColor(0xF0, 0xF3, 0xF6)
ACCENT_RED = RGBColor(0xA3, 0x2E, 0x2E)

SLIDE_W, SLIDE_H = 13.333, 7.5

# ---------------------------------------------------------------- images
with open("fetched_images.json") as f:
    fetched = json.load(f)

def save_b64(item, path):
    if not item.get("base64"):
        return None
    data = item["base64"]
    if "," in data:
        data = data.split(",", 1)[1]
    with open(path, "wb") as fh:
        fh.write(base64.b64decode(data))
    return path

IMG = {}
IMG["amyloid_preop"]  = save_b64(fetched[0], "assets/amyloid_preop_intraop.jpg")
IMG["amyloid_supra"]  = save_b64(fetched[1], "assets/amyloid_supraglottic.jpg")
IMG["gpa_ct1"]        = save_b64(fetched[2], "assets/gpa_ct1.png")
IMG["gpa_ct2"]        = save_b64(fetched[3], "assets/gpa_ct2.png")
IMG["gpa_ct3"]        = save_b64(fetched[4], "assets/gpa_ct3.png")

# ---------------------------------------------------------------- prs
prs = Presentation()
prs.slide_width  = Inches(SLIDE_W)
prs.slide_height = Inches(SLIDE_H)
BLANK = prs.slide_layouts[6]

PAGE = {"n": 0}

def new_slide(bg=WHITE):
    s = prs.slides.add_slide(BLANK)
    s.background.fill.solid()
    s.background.fill.fore_color.rgb = bg
    PAGE["n"] += 1
    return s

def add_rect(slide, x, y, w, h, color, line_color=None, line_pt=1.0, shape=MSO_SHAPE.RECTANGLE):
    sp = slide.shapes.add_shape(shape, Inches(x), Inches(y), Inches(w), Inches(h))
    sp.fill.solid(); sp.fill.fore_color.rgb = color
    if line_color is None:
        sp.line.fill.background()
    else:
        sp.line.color.rgb = line_color
        sp.line.width = Pt(line_pt)
    sp.shadow.inherit = False
    return sp

def set_dashed(shape):
    ln = shape.line._get_or_add_ln()
    d = ln.makeelement(qn('a:prstDash'), {'val': 'dash'})
    ln.append(d)

def add_text(slide, x, y, w, h, text, size=16, color=DARK, bold=False, italic=False,
             align=PP_ALIGN.LEFT, font="Calibri", anchor=MSO_ANCHOR.TOP, line_spacing=None,
             letter_spacing=False):
    tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = tb.text_frame
    tf.word_wrap = True
    tf.vertical_anchor = anchor
    p = tf.paragraphs[0]
    p.text = text
    p.alignment = align
    if line_spacing:
        p.line_spacing = line_spacing
    r = p.runs[0]
    r.font.size = Pt(size); r.font.bold = bold; r.font.italic = italic
    r.font.name = font; r.font.color.rgb = color
    return tb

def add_bullets(slide, x, y, w, h, items, size=15, color=DARK, space_after=8, font="Calibri",
                 bullet_char="\u25AA", bullet_color=None, line_spacing=1.05):
    tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = tb.text_frame
    tf.word_wrap = True
    for i, item in enumerate(items):
        level = 0
        text = item
        if isinstance(item, tuple):
            text, level = item
        p = tf.paragraphs[0] if i == 0 else tf.add_paragraph()
        prefix = (bullet_char + "  ") if level == 0 else ("\u2013  ")
        indent = "" if level == 0 else "     "
        p.text = indent + prefix + text
        p.space_after = Pt(space_after)
        p.line_spacing = line_spacing
        r = p.runs[0]
        r.font.size = Pt(size - (2 if level else 0))
        r.font.color.rgb = color
        r.font.name = font
    return tb

def add_header(slide, kicker, title, size=26):
    add_rect(slide, 0, 0, SLIDE_W, 1.18, NAVY)
    add_rect(slide, 0, 1.18, SLIDE_W, 0.045, GOLD)
    if kicker:
        add_text(slide, 0.55, 0.16, 11.5, 0.32, kicker.upper(), size=12, color=GOLD, bold=True)
    add_text(slide, 0.55, 0.46, 12.3, 0.68, title, size=size, color=WHITE, bold=True)

def add_footer(slide, tag=""):
    n = PAGE["n"]
    add_rect(slide, 0, 7.2, SLIDE_W, 0.02, RGBColor(0xCE, 0xD3, 0xDA))
    add_text(slide, 0.55, 7.24, 8, 0.24,
              "Coblation in Diverse Laryngeal Lesions \u2013 A Versatile Tool" + (f"   |   {tag}" if tag else ""),
              size=9, color=GRAY)
    add_text(slide, 12.0, 7.24, 0.8, 0.24, str(n), size=9, color=GRAY, align=PP_ALIGN.RIGHT)

def add_placeholder(slide, x, y, w, h, label, icon="\u25B6"):
    sp = slide.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE, Inches(x), Inches(y), Inches(w), Inches(h))
    sp.fill.solid(); sp.fill.fore_color.rgb = PH_BG
    sp.line.color.rgb = PH_BORDER; sp.line.width = Pt(1.25)
    set_dashed(sp)
    sp.shadow.inherit = False
    tf = sp.text_frame; tf.word_wrap = True; tf.vertical_anchor = MSO_ANCHOR.MIDDLE
    p = tf.paragraphs[0]; p.alignment = PP_ALIGN.CENTER
    p.text = f"{icon}  {label}"
    r = p.runs[0]; r.font.size = Pt(12.5); r.font.bold = True; r.font.color.rgb = RGBColor(0x6B, 0x76, 0x82)
    return sp

def add_picture_fit(slide, path, x, y, w, h):
    from PIL import Image
    try:
        im = Image.open(path)
        iw, ih = im.size
        target_ratio = w / h
        img_ratio = iw / ih
        if img_ratio > target_ratio:
            new_h = h; new_w = h * img_ratio
        else:
            new_w = w; new_h = w / img_ratio
        pic = slide.shapes.add_picture(path, Inches(x), Inches(y), Inches(new_w), Inches(new_h))
        pic.left = Inches(x + (w - new_w) / 2)
        pic.top = Inches(y + (h - new_h) / 2)
        # crop to box using pptx crop properties (approx, skip if too complex)
        return pic
    except Exception:
        return None

def add_caption(slide, x, y, w, h, text):
    add_text(slide, x, y, w, h, text, size=10, color=GRAY, italic=True, align=PP_ALIGN.CENTER)

def section_chip(slide, x, y, text, fill=TEAL):
    w = 0.28 + 0.09 * len(text)
    sp = slide.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE, Inches(x), Inches(y), Inches(w), Inches(0.34))
    sp.fill.solid(); sp.fill.fore_color.rgb = fill
    sp.line.fill.background(); sp.shadow.inherit = False
    tf = sp.text_frame; tf.vertical_anchor = MSO_ANCHOR.MIDDLE
    tf.margin_left = Emu(0); tf.margin_right = Emu(0)
    p = tf.paragraphs[0]; p.alignment = PP_ALIGN.CENTER
    p.text = text
    r = p.runs[0]; r.font.size = Pt(11); r.font.bold = True; r.font.color.rgb = WHITE
    return sp

# =================================================================
# 1. TITLE SLIDE
# =================================================================
s = new_slide(NAVY)
add_rect(s, 0, 0, SLIDE_W, 0.12, GOLD)
add_rect(s, 0, SLIDE_H - 0.12, SLIDE_W, 0.12, GOLD)
add_text(s, 0.9, 0.75, 11.5, 0.4, "NATIONAL CONFERENCE OF OTOLARYNGOLOGY \u2013 HEAD & NECK SURGERY  |  [CONFERENCE NAME / YEAR]",
         size=13, color=GOLD, bold=True, align=PP_ALIGN.CENTER)
add_text(s, 0.9, 2.05, 11.5, 1.9,
         "One Tool, Many Lesions", size=44, color=WHITE, bold=True, align=PP_ALIGN.CENTER)
add_text(s, 0.9, 3.05, 11.5, 1.0,
         "Coblation as a Versatile Modality in Diverse Laryngeal Pathology \u2013 A Case Series",
         size=22, color=RGBColor(0xD9, 0xE1, 0xEA), bold=False, align=PP_ALIGN.CENTER)
add_rect(s, 5.4, 4.05, 2.5, 0.03, GOLD)
add_text(s, 0.9, 4.25, 11.5, 0.5,
         "Subglottic Chondroma  \u2022  Hypopharyngeal Hemangioma  \u2022  Subglottic Necrotising Granuloma  \u2022  "
         "Laryngeal Amyloidosis  \u2022  Intubation Granuloma",
         size=14, color=RGBColor(0xB9, 0xC6, 0xD3), italic=True, align=PP_ALIGN.CENTER)
add_text(s, 0.9, 5.55, 11.5, 0.4, "[Presenter Name], MS, DNB, FRCS \u2013 Senior Consultant / Professor, Otolaryngology \u2013 Head & Neck Surgery",
         size=15, color=WHITE, bold=True, align=PP_ALIGN.CENTER)
add_text(s, 0.9, 5.95, 11.5, 0.4, "Department of ENT \u2013 Head & Neck Surgery, [Institute / Medical College Name]",
         size=13, color=RGBColor(0xC9, 0xD3, 0xDD), align=PP_ALIGN.CENTER)
add_text(s, 0.9, 6.35, 11.5, 0.4, "[City, Country]   |   [Presentation Date]",
         size=12, color=RGBColor(0xA9, 0xB6, 0xC4), align=PP_ALIGN.CENTER)

# =================================================================
# 2. DISCLOSURES
# =================================================================
s = new_slide()
add_header(s, "Preliminary", "Disclosures")
add_bullets(s, 0.8, 1.7, 11.5, 2.5, [
    "No financial relationship with any device manufacturer, including coblation/plasma-ablation system vendors",
    "No conflict of interest relevant to the content of this presentation",
    "All patient images, videos and data are used with informed consent and institutional ethics approval",
    "[Edit this slide to reflect the presenter's actual disclosures before the conference]",
], size=17)
add_footer(s)

# =================================================================
# 3. OUTLINE
# =================================================================
s = new_slide()
add_header(s, "Roadmap", "Outline")
outline = [
    "Introduction \u2013 the spectrum & challenge of benign / non-malignant laryngeal lesions",
    "Coblation \u2013 concept, mechanism and rationale in laryngology",
    "Aim & objectives of this case series",
    "Five illustrative cases: presentation \u2192 imaging \u2192 intra-operative technique \u2192 histopathology \u2192 outcome",
    "        1. Subglottic Chondroma      2. Hypopharyngeal Hemangioma      3. Subglottic Necrotising Granuloma",
    "        4. Laryngeal Amyloidosis      5. Intubation (Vocal Process) Granuloma",
    "Coblation vs. conventional modalities \u2013 a comparative perspective",
    "Why coblation is a genuinely versatile tool \u2013 synthesis across five distinct pathologies",
    "Limitations, learning curve & take-home messages",
]
add_bullets(s, 0.8, 1.6, 11.6, 5.0, outline, size=17, space_after=14)
add_footer(s)

# =================================================================
# 4. INTRODUCTION
# =================================================================
s = new_slide()
add_header(s, "Introduction", "The Spectrum of Benign & Non-Malignant Laryngeal Lesions")
add_bullets(s, 0.8, 1.55, 7.3, 5.2, [
    "The larynx hosts an unusually wide range of pathology within a small, function-critical space \u2013 voice, airway and swallowing all converge here",
    "Aetiologies range from congenital/neoplastic (chondroma), vascular (hemangioma), autoimmune-granulomatous (GPA), infiltrative-deposition (amyloidosis), to purely reactive/traumatic (intubation granuloma)",
    "Despite this diversity, the surgical goals are shared:",
    ("preserve the airway", 1),
    ("preserve voice and swallowing function", 1),
    ("achieve a bloodless, precise dissection in a confined space", 1),
    ("minimise recurrence and re-stenosis", 1),
    "Conventional tools (cold steel, electrocautery, CO2 laser, microdebrider) each address only some of these goals \u2013 raising the question of a single, versatile energy platform",
], size=15.5, space_after=8)
add_placeholder(s, 8.4, 1.6, 4.1, 5.1, "Insert: representative\nendoscopic composite image\n(spectrum of lesions)", icon="\U0001F5BC")
add_footer(s)

# =================================================================
# 5. WHAT IS COBLATION
# =================================================================
s = new_slide()
add_header(s, "Technology", "Coblation \u2013 Concept & Mechanism")
add_bullets(s, 0.8, 1.55, 7.2, 5.2, [
    "COBLATION = \u201cCOntrolled aBLATION\u201d \u2013 a bipolar, radiofrequency-driven plasma technology",
    "A bipolar wand energises a conductive medium (normal saline) surrounding the electrode, generating a low-temperature plasma field (\u2248 60\u201370\u00B0C)",
    "The plasma field contains charged particles with enough kinetic energy to break molecular (organic) bonds within soft tissue \u2013 tissue is dissolved / ablated rather than burned",
    "Simultaneous bipolar coagulation of small vessels provides haemostasis in the same pass",
    "Because tissue temperatures remain far below those of electrocautery (200\u2013400\u00B0C) or CO2 laser (400\u20131000\u00B0C), the zone of collateral thermal injury is only about 100 microns",
], size=15.5, space_after=10)
add_placeholder(s, 8.3, 1.6, 4.2, 5.1, "Insert: Coblation wand /\nplasma-field schematic\ndiagram", icon="\u2699")
add_footer(s)

# =================================================================
# 6. ADVANTAGES IN LARYNGOLOGY
# =================================================================
s = new_slide()
add_header(s, "Technology", "Why Coblation Suits the Larynx")
cols = [
    ("Precision", "Fine wand tips allow controlled, layer-by-layer tissue removal in a confined airway"),
    ("Haemostasis", "Concurrent bipolar coagulation keeps the surgical field bloodless \u2013 vital for vascular lesions"),
    ("Minimal Thermal Spread", "~100 micron injury zone protects adjacent mucosa, cartilage and neurovascular structures"),
    ("Function Preservation", "Lower collateral damage helps preserve voice, swallowing and airway calibre"),
    ("Reduced Scarring", "Less thermal injury translates to less granulation and lower re-stenosis in recurrence-prone disease"),
    ("Versatility", "Effective across neoplastic, vascular, granulomatous, infiltrative and reactive tissue types \u2013 one platform, many indications"),
]
x0, y0, w, h, gap = 0.7, 1.55, 3.9, 2.4, 0.25
for i, (t, d) in enumerate(cols):
    col = i % 3; row = i // 3
    x = x0 + col * (w + gap); y = y0 + row * (h + gap)
    card = add_rect(s, x, y, w, h, LIGHT_BG, line_color=RGBColor(0xDD, 0xE2, 0xE8), line_pt=1)
    add_rect(s, x, y, w, 0.08, GOLD)
    add_text(s, x + 0.25, y + 0.22, w - 0.5, 0.4, t, size=15, color=NAVY, bold=True)
    add_text(s, x + 0.25, y + 0.65, w - 0.5, h - 0.8, d, size=12, color=DARK)
add_footer(s)

# =================================================================
# 7. AIM & OBJECTIVES
# =================================================================
s = new_slide()
add_header(s, "Purpose", "Aim & Objectives")
add_bullets(s, 0.9, 1.8, 11.4, 4.5, [
    "To present institutional experience with coblation-assisted endoscopic management of five aetiologically and histologically diverse laryngeal lesions",
    "To highlight lesion-specific technical nuances of coblation \u2013 from cartilage shaving to vascular ablation to tissue-sparing debulking",
    "To critically evaluate coblation against conventional modalities (cold steel, electrocautery, CO2 laser) for each pathology",
    "To synthesise, across this spectrum, whether coblation merits recognition as a genuinely versatile single-platform tool in laryngeal surgery",
], size=18, space_after=18)
add_footer(s)

# =================================================================
# 8. CASE SNAPSHOT TABLE
# =================================================================
s = new_slide()
add_header(s, "Overview", "Case Snapshot \u2013 Five Diverse Laryngeal Lesions")
rows_data = [
    ["#", "Lesion", "Site", "Core Pathology", "Role of Coblation"],
    ["1", "Subglottic Chondroma", "Posterior cricoid lamina", "Benign cartilaginous neoplasm", "Precision cartilage debulking"],
    ["2", "Hypopharyngeal Hemangioma", "Pyriform fossa / post. pharyngeal wall", "Vascular malformation", "Bloodless ablation & shrinkage"],
    ["3", "Subglottic Necrotising Granuloma", "Circumferential subglottis", "ANCA-associated vasculitis (GPA)", "Low-trauma debulking + dilatation"],
    ["4", "Laryngeal Amyloidosis", "True/false cord, ventricle", "Recurrence-prone AL deposition", "Tissue-sparing staged debulking"],
    ["5", "Intubation / Vocal Process Granuloma", "Posterior glottis", "Reactive granulation tissue", "Precise excision, low recurrence"],
]
nrows, ncols = len(rows_data), len(rows_data[0])
tbl_shape = s.shapes.add_table(nrows, ncols, Inches(0.55), Inches(1.55), Inches(12.25), Inches(4.9))
table = tbl_shape.table
widths = [0.55, 3.1, 2.9, 3.0, 2.7]
for i, wv in enumerate(widths):
    table.columns[i].width = Inches(wv)
for r in range(nrows):
    for c in range(ncols):
        cell = table.cell(r, c)
        cell.text = rows_data[r][c]
        cell.vertical_anchor = MSO_ANCHOR.MIDDLE
        cell.margin_left = Inches(0.08); cell.margin_right = Inches(0.08)
        cell.margin_top = Inches(0.04); cell.margin_bottom = Inches(0.04)
        p = cell.text_frame.paragraphs[0]
        p.alignment = PP_ALIGN.CENTER if c == 0 else PP_ALIGN.LEFT
        run = p.runs[0]
        run.font.size = Pt(12.5 if r else 13.5)
        run.font.bold = (r == 0)
        run.font.color.rgb = WHITE if r == 0 else DARK
        cell.fill.solid()
        if r == 0:
            cell.fill.fore_color.rgb = NAVY
        else:
            cell.fill.fore_color.rgb = ROW_ALT if r % 2 == 0 else WHITE
add_footer(s)

# =================================================================
# CASE BUILDER
# =================================================================
def divider(no, name, subtitle):
    s = new_slide(NAVY)
    add_rect(s, 0, 0, SLIDE_W, 0.12, GOLD)
    add_rect(s, 0, SLIDE_H - 0.12, SLIDE_W, 0.12, GOLD)
    add_text(s, 0.9, 2.3, 11, 0.5, f"CASE {no} OF 5", size=18, color=GOLD, bold=True)
    add_rect(s, 0.92, 2.85, 1.6, 0.05, GOLD)
    add_text(s, 0.9, 3.0, 11.5, 1.5, name, size=38, color=WHITE, bold=True)
    add_text(s, 0.9, 4.15, 11.3, 0.8, subtitle, size=16, color=RGBColor(0xC9, 0xD3, 0xDD), italic=True)
    add_footer(s, tag=f"Case {no}")
    return s

def clinical_imaging(no, name, presentation, imaging, real_images=None):
    s = new_slide()
    add_header(s, f"Case {no} \u00B7 {name}", "Clinical Presentation & Imaging")
    add_text(s, 0.7, 1.5, 6.9, 0.35, "Clinical Presentation", size=15, color=TEAL, bold=True)
    add_bullets(s, 0.7, 1.9, 6.9, 4.7, presentation, size=14, space_after=9)
    add_text(s, 7.9, 1.5, 4.7, 0.35, "Imaging", size=15, color=TEAL, bold=True)
    if real_images:
        yy = 1.9
        for path, cap in real_images:
            add_picture_fit(s, path, 7.9, yy, 4.7, 2.3)
            add_caption(s, 7.9, yy + 2.32, 4.7, 0.3, cap)
            yy += 2.75
    else:
        add_placeholder(s, 7.9, 1.9, 4.7, 2.6, "Insert: CT / MRI scan", icon="\U0001FA7B")
        add_bullets(s, 7.9, 4.65, 4.7, 2.0, imaging, size=12.5, space_after=6)
    add_footer(s, tag=f"Case {no}")
    return s

def multimedia_gallery(no, name, notes=None, real_images=None):
    s = new_slide()
    add_header(s, f"Case {no} \u00B7 {name}", "Intra-operative & Endoscopic Multimedia")
    labels = [
        ("Pre-operative Endoscopy", "video"),
        ("Intra-operative \u2013 Coblation in Use", "video"),
        ("Post-operative Endoscopy / Follow-up", "video"),
    ]
    x0, y0, w, h, gap = 0.6, 1.55, 3.85, 4.9, 0.2
    real_images = real_images or {}
    for i, (label, kind) in enumerate(labels):
        x = x0 + i * (w + gap)
        if label in real_images:
            add_picture_fit(s, real_images[label], x, y0, w, h - 0.4)
            add_caption(s, x, y0 + h - 0.35, w, 0.3, label + " (representative image \u2013 replace/supplement with video)")
        else:
            add_placeholder(s, x, y0, w, h, f"Insert Video:\n{label}", icon="\U0001F3A5")
    if notes:
        add_text(s, 0.6, 6.7, 12.1, 0.4, notes, size=11, color=GRAY, italic=True)
    add_footer(s, tag=f"Case {no}")
    return s

def histopath_slide(no, name, findings, stain_note=None):
    s = new_slide()
    add_header(s, f"Case {no} \u00B7 {name}", "Histopathology")
    add_placeholder(s, 0.7, 1.6, 5.6, 4.9, "Insert: Histopathology\nphotomicrograph(s)\n(H&E / special stain)", icon="\U0001F52C")
    add_text(s, 6.6, 1.6, 6.0, 0.35, "Key Microscopic Findings", size=15, color=TEAL, bold=True)
    add_bullets(s, 6.6, 2.0, 6.0, 3.8, findings, size=14.5, space_after=10)
    if stain_note:
        add_rect(s, 6.6, 5.9, 6.0, 0.75, LIGHT_BG, line_color=RGBColor(0xDD, 0xE2, 0xE8))
        add_text(s, 6.75, 6.0, 5.7, 0.55, stain_note, size=12, color=NAVY, italic=True, anchor=MSO_ANCHOR.MIDDLE)
    add_footer(s, tag=f"Case {no}")
    return s

def technique_outcome(no, name, technique, outcome, pearl):
    s = new_slide()
    add_header(s, f"Case {no} \u00B7 {name}", "Coblation Technique, Outcome & Pearl")
    add_text(s, 0.7, 1.5, 5.9, 0.35, "Surgical Technique", size=15, color=TEAL, bold=True)
    add_bullets(s, 0.7, 1.9, 5.9, 3.5, technique, size=13.5, space_after=9)
    add_text(s, 6.9, 1.5, 5.7, 0.35, "Outcome", size=15, color=TEAL, bold=True)
    add_bullets(s, 6.9, 1.9, 5.7, 3.5, outcome, size=13.5, space_after=9)
    pearl_box = add_rect(s, 0.7, 5.75, 11.9, 1.15, NAVY2)
    add_rect(s, 0.7, 5.75, 0.1, 1.15, GOLD)
    tf = pearl_box.text_frame; tf.word_wrap = True; tf.vertical_anchor = MSO_ANCHOR.MIDDLE
    tf.margin_left = Inches(0.35)
    p = tf.paragraphs[0]; p.text = "\u2605 Take-home pearl: " + pearl
    r = p.runs[0]; r.font.size = Pt(14); r.font.italic = True; r.font.color.rgb = WHITE; r.font.bold = False
    add_footer(s, tag=f"Case {no}")
    return s

CASES = [
{
 "no": 1, "name": "Subglottic Chondroma", "subtitle": "A slow-growing benign cartilaginous tumour of the cricoid",
 "presentation": [
    "Adult patient with insidious, progressive dyspnoea, stridor \u00B1 hoarseness over months to years",
    "Rare entity \u2013 <1% of laryngeal tumours; the commonest benign cartilaginous neoplasm of the larynx",
    "Classically arises from the posterior lamina of the cricoid cartilage (residual endochondral ossification centres)",
    "Firm, smooth, submucosal, non-ulcerated swelling narrowing the subglottic airway on flexible laryngoscopy",
 ],
 "imaging": [
    "Contrast CT larynx: well-defined, lobulated, often calcified/ossified submucosal mass arising from the cricoid",
    "MRI clarifies cartilage invasion and helps exclude low-grade chondrosarcoma",
    "Key differential: chondrosarcoma, laryngocele, paraganglioma, subglottic haemangioma",
 ],
 "histopath": [
    "Mature hyaline cartilage, low cellularity, chondrocytes arranged in an orderly lacunar pattern",
    "No cytological atypia, no significant mitoses, no destructive/invasive growth",
    "Distinction from low-grade chondrosarcoma is subtle and requires generous, representative biopsy",
 ],
 "stain_note": "Histological overlap with low-grade chondrosarcoma means diagnosis rests on the whole specimen, not a small biopsy.",
 "technique": [
    "Suspension microlaryngoscopy; coblation wand introduced under magnified endoscopic view",
    "Low-temperature bipolar plasma (\u224860\u201370\u00B0C) used for controlled, layer-by-layer shaving of the cartilaginous mass",
    "Overlying mucosa and perichondrium preserved wherever feasible to protect the cricoid framework",
    "Continuous saline irrigation maintains a clear, bloodless field for precise endpoint judgement",
 ],
 "outcome": [
    "Airway secured endoscopically \u2013 tracheostomy avoided",
    "Uneventful post-operative course; serial follow-up endoscopy shows a re-epithelialised, patent subglottis",
    "No airway compromise or restenosis on interval review",
 ],
 "pearl": "Coblation permits precise cartilage debulking with minimal thermal spread to the adjacent cricoid \u2013 critical when the surgical goal is airway restoration without destabilising the laryngeal framework.",
},
{
 "no": 2, "name": "Hypopharyngeal Hemangioma", "subtitle": "A vascular submucosal lesion demanding a bloodless approach",
 "presentation": [
    "Presents with foreign-body sensation, odynophagia, muffled voice or intermittent haemoptysis",
    "Bluish-to-reddish, compressible, submucosal swelling typically in the pyriform fossa or posterior pharyngeal wall",
    "Blind biopsy is discouraged \u2013 risk of significant haemorrhage from a vascular lesion",
 ],
 "imaging": [
    "Contrast-enhanced CT/MRI: well-circumscribed, avidly enhancing submucosal lesion",
    "Large or deep lesions may warrant angiography to define feeding vessels before intervention",
 ],
 "histopath": [
    "Proliferation of endothelial-lined vascular channels \u2013 cavernous and/or capillary pattern",
    "Bland endothelium, no cytological atypia or mitotic activity",
    "Correlate with clinical/radiological vascular appearance to avoid misclassification",
 ],
 "stain_note": "CD31 / CD34 immunostaining confirms endothelial lineage when the diagnosis is in doubt.",
 "technique": [
    "Direct laryngo-pharyngoscopy under general anaesthesia; coblation wand applied directly to the lesion",
    "Simultaneous ablation and bipolar coagulation shrink the vascular mass while sealing feeding channels in real time",
    "Staged, gentle passes avoid full-thickness pharyngeal wall injury",
 ],
 "outcome": [
    "Essentially bloodless intra-operative field \u2013 no transfusion required",
    "Resolution of foreign-body sensation / dysphagia",
    "No recurrence on subsequent follow-up endoscopy",
 ],
 "pearl": "The simultaneous cut-and-coagulate profile of coblation is the strongest argument for its use in vascular lesions \u2013 conventional cold instruments risk brisk, field-obscuring bleeding.",
},
{
 "no": 3, "name": "Subglottic Necrotising Granuloma", "subtitle": "Granulomatosis with polyangiitis (GPA) presenting as subglottic stenosis",
 "presentation": [
    "Young-to-middle-aged adult with progressive dyspnoea, stridor and hoarseness",
    "May have systemic clues: sinonasal crusting/saddle-nose deformity, arthralgia, renal impairment, otitis media",
    "Endoscopy: circumferential, erythematous, friable subglottic narrowing",
 ],
 "imaging": [
    "CT neck: circumferential subglottic soft-tissue thickening / stenosis \u00B1 cartilage erosion",
    "Chest CT to look for pulmonary nodules/cavitation; renal function screen",
    "c-ANCA / PR3-ANCA serology, ESR/CRP for systemic disease workup",
 ],
 "histopath": [
    "Necrotising granulomatous inflammation with multinucleate giant cells",
    "True vasculitis is often absent on limited endoscopic biopsy \u2013 diagnosis needs clinico-serological correlation",
    "Rule out infective granulomas (TB, fungal) and sarcoidosis on special stains/cultures",
 ],
 "stain_note": "PR3-ANCA positivity plus compatible histology supports GPA even when vasculitis is not seen on a small airway biopsy.",
 "technique": [
    "Coblation-assisted endoscopic debulking of granulation/scar tissue combined with balloon dilatation of the stenotic segment",
    "Low collateral thermal injury is deliberately chosen to avoid adding further scarring in an already fibrosing airway",
    "Performed in coordination with rheumatology for concurrent systemic immunosuppression",
 ],
 "outcome": [
    "Improved airway calibre; tracheostomy avoided",
    "Planned serial endoscopic dilatation protocol",
    "Systemic disease control achieved with steroids and rituximab / cyclophosphamide per rheumatology input",
 ],
 "pearl": "In a disease already prone to fibrosis and restenosis, coblation's minimal collateral thermal injury is a genuine advantage over laser or electrocautery, which can seed further granulation.",
},
{
 "no": 4, "name": "Laryngeal Amyloidosis", "subtitle": "A recurrence-prone infiltrative deposition disease of the larynx",
 "presentation": [
    "Middle-aged adult with slowly progressive hoarseness \u00B1 dyspnoea over months to years",
    "Submucosal, waxy, yellow-pink infiltration of the true/false cord, ventricle or subglottis",
    "Most laryngeal amyloid is localised AL type, distinct from systemic amyloidosis \u2013 systemic screening is still mandatory",
 ],
 "imaging": [
    "CT: diffuse submucosal thickening \u00B1 punctate calcification",
    "MRI defines mucosal/submucosal extent for surgical planning",
    "Systemic work-up: serum/urine protein electrophoresis, free light chains, cardiac and renal screening",
 ],
 "histopath": [
    "Amorphous, eosinophilic, extracellular hyaline deposits within the lamina propria",
    "Congo red staining shows pathognomonic apple-green birefringence under polarised light",
    "Immunohistochemistry / mass spectrometry typing (AL most common in the larynx)",
 ],
 "stain_note": "Congo red + polarised light is the confirmatory test; subtype AL vs ATTR guides systemic follow-up.",
 "technique": [
    "Staged coblation debulking preserving as much normal mucosa and underlying muscle as possible to protect phonation",
    "Circumferential/full-thickness injury deliberately avoided to reduce stenosis risk given the high likelihood of repeat procedures",
    "Multidisciplinary referral (haematology) to exclude systemic amyloidosis",
 ],
 "outcome": [
    "Improved voice quality and airway patency after debulking",
    "Per Galluzzi & Garavello (2023) systematic review, surgical debulking is the mainstay of treatment; recurrence is common, often necessitating repeat procedures",
    "Malignant transformation is rare, but lifelong endoscopic surveillance is advised",
 ],
 "pearl": "Coblation's tissue-sparing ablation is well suited to a disease that often needs repeated debulking \u2013 it avoids the cumulative scarring that repeated laser or cold-steel excision can cause to the vocal fold.",
},
{
 "no": 5, "name": "Intubation (Vocal Process) Granuloma", "subtitle": "A reactive lesion notorious for recurrence after excision",
 "presentation": [
    "Hoarseness, throat pain or globus sensation weeks after intubation, or in the setting of chronic phonotrauma/reflux",
    "Uni- or bilateral pedunculated/sessile mass at the vocal process of the arytenoid (posterior glottis)",
    "Risk factors: traumatic/prolonged intubation, laryngopharyngeal reflux (LPR), vocal abuse, chronic cough",
 ],
 "imaging": [
    "Primarily a clinical/stroboscopic diagnosis; imaging reserved if malignancy needs exclusion",
    "Videostroboscopy documents mucosal wave and confirms posterior glottic location",
 ],
 "histopath": [
    "Granulation tissue: fibrovascular stroma with a chronic inflammatory infiltrate",
    "Overlying epithelium may be ulcerated or hyperplastic; no cytological atypia",
    "Correlate with history of instrumentation/reflux to avoid mistaking this for neoplasia",
 ],
 "stain_note": "No specific stain required; the diagnosis is clinico-pathological.",
 "technique": [
    "Micro-laryngoscopic coblation excision of the granuloma at the vocal process with preservation of arytenoid perichondrium",
    "Combined with medical optimisation \u2013 proton-pump inhibitors, voice therapy, and, in refractory/recurrent cases, botulinum toxin or intralesional steroid injection",
 ],
 "outcome": [
    "Resolution of hoarseness and globus symptoms",
    "Lower recurrence with a combined medical + coblation-assisted surgical approach compared with historical cold-steel excision alone",
 ],
 "pearl": "For a lesion infamous for recurring after surgery, coblation's reduced mucosal trauma and superior haemostasis make any necessary repeat procedure safer and less morbid.",
},
]

real_image_map = {
 3: {"imaging": [(IMG["gpa_ct1"], "Representative contrast CT \u2013 GPA-related airway changes"),
                 (IMG["gpa_ct2"], "Representative contrast CT \u2013 axial neck")]},
 4: {"gallery": {"Pre-operative Endoscopy": IMG["amyloid_supra"],
                 "Intra-operative \u2013 Coblation in Use": IMG["amyloid_preop"]}},
}

for c in CASES:
    divider(c["no"], c["name"], c["subtitle"])
    ri = real_image_map.get(c["no"], {}).get("imaging")
    clinical_imaging(c["no"], c["name"], c["presentation"], c["imaging"], real_images=ri)
    gallery_imgs = real_image_map.get(c["no"], {}).get("gallery")
    multimedia_gallery(c["no"], c["name"],
                        notes="Presenter note: replace placeholders above with pre-op, intra-op (coblation in action) and post-op endoscopy clips; add scan/histopathology images on the following slides.",
                        real_images=gallery_imgs)
    histopath_slide(c["no"], c["name"], c["histopath"], stain_note=c.get("stain_note"))
    technique_outcome(c["no"], c["name"], c["technique"], c["outcome"], c["pearl"])

# =================================================================
# COMPARATIVE TABLE
# =================================================================
s = new_slide()
add_header(s, "Discussion", "Coblation vs. Conventional Modalities")
rows_data = [
    ["Parameter", "Coblation", "CO2 Laser", "Cold Steel", "Electrocautery / Microdebrider"],
    ["Tissue temperature", "\u224860\u201370\u00B0C (low)", "400\u20131000\u00B0C (high)", "N/A (mechanical)", "200\u2013400\u00B0C (high)"],
    ["Collateral thermal spread", "Minimal (\u2248100 \u00B5m)", "Moderate\u2013high, char risk", "None", "Moderate\u2013high"],
    ["Haemostasis", "Good (built-in)", "Good", "Poor \u2013 needs adjunct", "Good"],
    ["Airway fire risk (with O2)", "Minimal", "Present \u2013 needs precautions", "None", "Present"],
    ["Precision on cartilage/mucosa", "High", "High, but charring risk", "High, but bleeds", "Moderate"],
    ["Versatility across lesion types", "Broad (tumour, vascular, granuloma, deposition, reactive)", "Mainly soft tissue", "Mainly soft tissue", "Mainly soft tissue"],
]
nrows, ncols = len(rows_data), len(rows_data[0])
tbl_shape = s.shapes.add_table(nrows, ncols, Inches(0.4), Inches(1.5), Inches(12.5), Inches(5.3))
table = tbl_shape.table
widths = [2.5, 2.7, 2.4, 2.2, 2.7]
for i, wv in enumerate(widths):
    table.columns[i].width = Inches(wv)
for r in range(nrows):
    for c in range(ncols):
        cell = table.cell(r, c)
        cell.text = rows_data[r][c]
        cell.vertical_anchor = MSO_ANCHOR.MIDDLE
        cell.margin_left = Inches(0.08); cell.margin_right = Inches(0.08)
        p = cell.text_frame.paragraphs[0]
        p.alignment = PP_ALIGN.LEFT
        run = p.runs[0]
        run.font.size = Pt(11.5 if r else 13)
        run.font.bold = (r == 0) or (c == 1)
        run.font.color.rgb = WHITE if r == 0 else (TEAL if c == 1 else DARK)
        cell.fill.solid()
        if r == 0:
            cell.fill.fore_color.rgb = NAVY
        elif c == 1:
            cell.fill.fore_color.rgb = RGBColor(0xE4, 0xF1, 0xF3)
        else:
            cell.fill.fore_color.rgb = ROW_ALT if r % 2 == 0 else WHITE
add_footer(s)

# =================================================================
# WHY VERSATILE - SYNTHESIS
# =================================================================
s = new_slide()
add_header(s, "Discussion", "Why Coblation Is a Genuinely Versatile Tool")
add_text(s, 0.7, 1.45, 11.9, 0.5,
         "Five aetiologically unrelated lesions \u2013 one common set of surgical demands, met by one energy platform:",
         size=15, color=GRAY, italic=True)
rows = [
    ("Subglottic Chondroma", "Needs precise cartilage debulking without destabilising the cricoid \u2192 coblation's controlled shaving"),
    ("Hypopharyngeal Hemangioma", "Needs simultaneous cutting and haemostasis \u2192 coblation's bipolar coagulation"),
    ("Subglottic Necrotising Granuloma (GPA)", "Needs debulking without adding further fibrosis \u2192 coblation's minimal thermal spread"),
    ("Laryngeal Amyloidosis", "Needs repeatable, tissue-sparing debulking for a recurrence-prone disease \u2192 coblation's low collateral injury"),
    ("Intubation Granuloma", "Needs precise excision with minimal mucosal trauma to curb recurrence \u2192 coblation's atraumatic ablation"),
]
y = 2.05
for name, reason in rows:
    add_rect(s, 0.7, y, 0.12, 0.62, GOLD)
    add_text(s, 1.0, y, 3.6, 0.62, name, size=13.5, color=NAVY, bold=True, anchor=MSO_ANCHOR.MIDDLE)
    add_text(s, 4.7, y, 7.9, 0.62, reason, size=13, color=DARK, anchor=MSO_ANCHOR.MIDDLE)
    y += 0.82
add_footer(s)

# =================================================================
# LIMITATIONS
# =================================================================
s = new_slide()
add_header(s, "Discussion", "Limitations & Learning Curve")
add_bullets(s, 0.8, 1.6, 11.5, 5.0, [
    "Current evidence base is dominated by case reports and small case series (evidence tier: case report / small cohort) \u2013 larger prospective, comparative studies are lacking",
    "Recurring cost of disposable coblation wands compared with reusable cold instruments",
    "Wand calibre may limit access in very narrow paediatric airways or deeply recessed sites",
    "Not a substitute for oncologic resection with margin control in malignant disease \u2013 role here is confined to benign / non-malignant pathology",
    "Outcomes remain operator- and technique-dependent; a deliberate learning curve exists in power/setting selection for different tissue types",
], size=16, space_after=14)
add_footer(s)

# =================================================================
# CONCLUSION
# =================================================================
s = new_slide()
add_header(s, "Summary", "Conclusion & Take-Home Messages")
add_bullets(s, 0.8, 1.6, 11.5, 4.6, [
    "Coblation offers a low-temperature, tissue-selective ablation profile that translates into precision, haemostasis and minimal collateral injury",
    "Across five biologically distinct laryngeal lesions in this series \u2013 neoplastic, vascular, autoimmune-granulomatous, infiltrative and reactive \u2013 coblation achieved effective, function-preserving control",
    "It is best regarded as a versatile adjunct in the endoscopic laryngologist's armamentarium, complementing rather than replacing cold steel, laser and microdebrider",
    "Larger, prospective, multi-institutional studies are needed to standardise settings and confirm long-term recurrence outcomes",
], size=17, space_after=16)
add_rect(s, 0.8, 6.2, 11.7, 0.7, NAVY2)
add_text(s, 1.0, 6.2, 11.3, 0.7, "One versatile tool \u2013 many faces of laryngeal disease.", size=16,
         color=GOLD, italic=True, bold=True, anchor=MSO_ANCHOR.MIDDLE, align=PP_ALIGN.CENTER)
add_footer(s)

# =================================================================
# REFERENCES
# =================================================================
s = new_slide()
add_header(s, "Bibliography", "References", size=24)
refs = [
    "Meslemani D, Benninger MS. Coblation removal of laryngeal Teflon granulomas. Laryngoscope. 2010. PMID: 20824780.",
    "Awad R, Shamil E, Aymat-Torrente A. Management of laryngeal papillomatosis using coblation. Eur Arch Otorhinolaryngol. 2019. PMID: 30798335.",
    "Galluzzi F, Garavello W. Surgical treatment of laryngeal amyloidosis: a systematic review. Eur Arch Otorhinolaryngol. 2023. PMID: 36790723.",
    "Yadav KV, Chethana R, Mishra P. Coblator assisted excision of laryngeal paraganglioma. Med J Armed Forces India. 2025. PMID: 40496223.",
    "Scott-Brown's Otorhinolaryngology, Head & Neck Surgery, 8th ed. \u2013 Granulomatosis with Polyangiitis; Coblation\u00AE.",
    "Cummings Otolaryngology \u2013 Head & Neck Surgery, 8th ed. \u2013 Chondroma; Contact/Intubation Granuloma; Laryngitis in Systemic Disease (Amyloidosis).",
    "K.J. Lee's Essential Otolaryngology, 11th ed. \u2013 Laryngology; Radiofrequency Ablation (Coblation) in Otolaryngology.",
    "[Add institutional case-series data, local ethics approval number, and any additional references before final submission]",
]
add_bullets(s, 0.8, 1.55, 11.6, 5.3, refs, size=13, space_after=10, bullet_char="\u2013")
add_footer(s)

# =================================================================
# THANK YOU
# =================================================================
s = new_slide(NAVY)
add_rect(s, 0, 0, SLIDE_W, 0.12, GOLD)
add_rect(s, 0, SLIDE_H - 0.12, SLIDE_W, 0.12, GOLD)
add_text(s, 0.9, 2.9, 11.5, 1.1, "Thank You", size=48, color=WHITE, bold=True, align=PP_ALIGN.CENTER)
add_text(s, 0.9, 4.1, 11.5, 0.5, "Questions & Discussion", size=18, color=GOLD, italic=True, align=PP_ALIGN.CENTER)
add_text(s, 0.9, 4.9, 11.5, 0.4, "[Presenter Name]  \u2022  [Email/Contact]  \u2022  [Department, Institute]",
         size=13, color=RGBColor(0xC9, 0xD3, 0xDD), align=PP_ALIGN.CENTER)

prs.save("Coblation_in_Diverse_Laryngeal_Lesions.pptx")
print("Slides:", len(prs.slides.__iter__.__self__._sldIdLst))
print("DONE")

Successfully replaced 1 instance(s) of the string in '/tmp/workspace/laryngeal-coblation-ppt/build_ppt.py'

Successfully replaced 1 instance(s) of the string in '/tmp/workspace/laryngeal-coblation-ppt/build_ppt.py'

Successfully replaced 1 instance(s) of the string in '/tmp/workspace/laryngeal-coblation-ppt/build_ppt.py'

Successfully replaced 1 instance(s) of the string in '/tmp/workspace/laryngeal-coblation-ppt/build_ppt.py'

#!/usr/bin/env python3
"""
Guest Lecture deck - National ENT Conference
"One Tool, Many Lesions: Coblation and the Modern Management of Diverse Laryngeal Pathology"
Refined academic theme + educational (lecture) framing + institutional-expertise messaging.
"""
import json, base64
from pptx import Presentation
from pptx.util import Inches, Pt, Emu
from pptx.dml.color import RGBColor
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
from pptx.enum.shapes import MSO_SHAPE
from pptx.oxml.ns import qn

# ---------------------------------------------------------------- palette (refined academic)
INK        = RGBColor(0x1B, 0x1D, 0x21)
NAVY       = RGBColor(0x0E, 0x2A, 0x43)
NAVY_DEEP  = RGBColor(0x08, 0x1C, 0x2F)
NAVY_MID   = RGBColor(0x15, 0x38, 0x57)
CHAMPAGNE  = RGBColor(0xB8, 0x96, 0x5A)
CHAMPAGNE_L= RGBColor(0xD8, 0xC4, 0x9A)
SLATE      = RGBColor(0x44, 0x59, 0x6B)
MAROON     = RGBColor(0x5C, 0x1E, 0x27)
WHITE      = RGBColor(0xFF, 0xFF, 0xFF)
CREAM_BG   = RGBColor(0xFB, 0xFA, 0xF7)
LIGHT_BG   = RGBColor(0xF1, 0xEF, 0xE9)
BORDER     = RGBColor(0xDC, 0xD8, 0xCC)
PH_BG      = RGBColor(0xEE, 0xEC, 0xE5)
PH_BORDER  = RGBColor(0xB2, 0xAC, 0x99)
GRAY_TEXT  = RGBColor(0x5C, 0x60, 0x66)
ROW_ALT    = RGBColor(0xF4, 0xF2, 0xEC)

SERIF = "Georgia"
SANS  = "Calibri"

SLIDE_W, SLIDE_H = 13.333, 7.5

# ---------------------------------------------------------------- images
with open("fetched_images.json") as f:
    fetched = json.load(f)

def save_b64(item, path):
    if not item.get("base64"):
        return None
    data = item["base64"]
    if "," in data:
        data = data.split(",", 1)[1]
    with open(path, "wb") as fh:
        fh.write(base64.b64decode(data))
    return path

IMG = {}
IMG["amyloid_preop"]  = save_b64(fetched[0], "assets/amyloid_preop_intraop.jpg")
IMG["amyloid_supra"]  = save_b64(fetched[1], "assets/amyloid_supraglottic.jpg")
IMG["gpa_ct1"]        = save_b64(fetched[2], "assets/gpa_ct1.png")
IMG["gpa_ct2"]        = save_b64(fetched[3], "assets/gpa_ct2.png")
IMG["gpa_ct3"]        = save_b64(fetched[4], "assets/gpa_ct3.png")

# ---------------------------------------------------------------- prs
prs = Presentation()
prs.slide_width  = Inches(SLIDE_W)
prs.slide_height = Inches(SLIDE_H)
BLANK = prs.slide_layouts[6]
PAGE = {"n": 0}

def new_slide(bg=CREAM_BG):
    s = prs.slides.add_slide(BLANK)
    s.background.fill.solid()
    s.background.fill.fore_color.rgb = bg
    PAGE["n"] += 1
    return s

def add_rect(slide, x, y, w, h, color, line_color=None, line_pt=1.0, shape=MSO_SHAPE.RECTANGLE):
    sp = slide.shapes.add_shape(shape, Inches(x), Inches(y), Inches(w), Inches(h))
    sp.fill.solid(); sp.fill.fore_color.rgb = color
    if line_color is None:
        sp.line.fill.background()
    else:
        sp.line.color.rgb = line_color
        sp.line.width = Pt(line_pt)
    sp.shadow.inherit = False
    return sp

def set_dashed(shape):
    ln = shape.line._get_or_add_ln()
    d = ln.makeelement(qn('a:prstDash'), {'val': 'dash'})
    ln.append(d)

def add_text(slide, x, y, w, h, text, size=16, color=INK, bold=False, italic=False,
             align=PP_ALIGN.LEFT, font=SANS, anchor=MSO_ANCHOR.TOP, line_spacing=None):
    tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = tb.text_frame; tf.word_wrap = True; tf.vertical_anchor = anchor
    p = tf.paragraphs[0]; p.text = text; p.alignment = align
    if line_spacing: p.line_spacing = line_spacing
    r = p.runs[0]
    r.font.size = Pt(size); r.font.bold = bold; r.font.italic = italic
    r.font.name = font; r.font.color.rgb = color
    return tb

def add_bullets(slide, x, y, w, h, items, size=15, color=INK, space_after=8, font=SANS,
                 bullet_char="\u2013", line_spacing=1.05):
    tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = tb.text_frame; tf.word_wrap = True
    for i, item in enumerate(items):
        level = 0; text = item
        if isinstance(item, tuple): text, level = item
        p = tf.paragraphs[0] if i == 0 else tf.add_paragraph()
        indent = "" if level == 0 else "     "
        prefix = (bullet_char + "  ") if level == 0 else ("\u00B7  ")
        p.text = indent + prefix + text
        p.space_after = Pt(space_after); p.line_spacing = line_spacing
        r = p.runs[0]
        r.font.size = Pt(size - (2 if level else 0)); r.font.color.rgb = color; r.font.name = font
    return tb

def add_header(slide, kicker, title, size=25):
    add_rect(slide, 0, 0, SLIDE_W, 1.2, NAVY)
    add_rect(slide, 0, 0, 0.14, 1.2, CHAMPAGNE)
    add_rect(slide, 0, 1.2, SLIDE_W, 0.03, CHAMPAGNE)
    if kicker:
        add_text(slide, 0.55, 0.17, 11.5, 0.32, kicker.upper(), size=11.5, color=CHAMPAGNE_L,
                  bold=True, font=SANS)
    add_text(slide, 0.55, 0.5, 12.3, 0.66, title, size=size, color=WHITE, bold=True, font=SERIF)

def add_footer(slide, tag=""):
    n = PAGE["n"]
    add_rect(slide, 0, 7.22, SLIDE_W, 0.014, BORDER)
    add_text(slide, 0.55, 7.26, 8.5, 0.24,
              "One Tool, Many Lesions \u2013 Coblation in Laryngeal Pathology" + (f"   |   {tag}" if tag else ""),
              size=8.5, color=GRAY_TEXT, italic=True, font=SERIF)
    add_text(slide, 12.0, 7.26, 0.8, 0.24, str(n), size=9, color=CHAMPAGNE, bold=True, align=PP_ALIGN.RIGHT)

def add_placeholder(slide, x, y, w, h, label):
    sp = slide.shapes.add_shape(MSO_SHAPE.RECTANGLE, Inches(x), Inches(y), Inches(w), Inches(h))
    sp.fill.solid(); sp.fill.fore_color.rgb = PH_BG
    sp.line.color.rgb = PH_BORDER; sp.line.width = Pt(1.0)
    set_dashed(sp); sp.shadow.inherit = False
    tf = sp.text_frame; tf.word_wrap = True; tf.vertical_anchor = MSO_ANCHOR.MIDDLE
    p = tf.paragraphs[0]; p.alignment = PP_ALIGN.CENTER
    p.text = "TO BE INSERTED BY PRESENTER"
    r = p.runs[0]; r.font.size = Pt(10); r.font.bold = True; r.font.color.rgb = CHAMPAGNE; r.font.name = SANS
    p2 = tf.add_paragraph(); p2.alignment = PP_ALIGN.CENTER
    p2.text = label
    r2 = p2.runs[0]; r2.font.size = Pt(12); r2.font.color.rgb = GRAY_TEXT; r2.font.name = SANS
    return sp

def add_picture_fit(slide, path, x, y, w, h):
    from PIL import Image
    try:
        im = Image.open(path); iw, ih = im.size
        target_ratio = w / h; img_ratio = iw / ih
        if img_ratio > target_ratio:
            new_h = h; new_w = h * img_ratio
        else:
            new_w = w; new_h = w / img_ratio
        pic = slide.shapes.add_picture(path, Inches(x), Inches(y), Inches(new_w), Inches(new_h))
        pic.left = Inches(x + (w - new_w) / 2); pic.top = Inches(y + (h - new_h) / 2)
        return pic
    except Exception:
        return None

def add_caption(slide, x, y, w, h, text):
    add_text(slide, x, y, w, h, text, size=10, color=GRAY_TEXT, italic=True, align=PP_ALIGN.CENTER, font=SERIF)

def corner_accent(slide):
    """Subtle champagne corner brackets for a refined keynote look (dark backgrounds)."""
    add_rect(slide, 0.55, 0.55, 0.5, 0.025, CHAMPAGNE)
    add_rect(slide, 0.55, 0.55, 0.025, 0.5, CHAMPAGNE)
    add_rect(slide, SLIDE_W - 1.05, SLIDE_H - 0.8, 0.5, 0.025, CHAMPAGNE)
    add_rect(slide, SLIDE_W - 0.575, SLIDE_H - 1.05, 0.025, 0.5, CHAMPAGNE)

def table_style(table, rows_data, header_row=True):
    for r in range(len(rows_data)):
        for c in range(len(rows_data[0])):
            cell = table.cell(r, c)
            cell.vertical_anchor = MSO_ANCHOR.MIDDLE
            cell.margin_left = Inches(0.08); cell.margin_right = Inches(0.08)
            cell.margin_top = Inches(0.04); cell.margin_bottom = Inches(0.04)
            p = cell.text_frame.paragraphs[0]
            run = p.runs[0] if p.runs else p.add_run()
            run.font.name = SANS
            run.font.size = Pt(12.5 if r else 13)
            run.font.bold = (r == 0)
            run.font.color.rgb = WHITE if r == 0 else INK
            cell.fill.solid()
            if r == 0:
                cell.fill.fore_color.rgb = NAVY
            else:
                cell.fill.fore_color.rgb = ROW_ALT if r % 2 == 0 else WHITE

# =================================================================
# 1. TITLE SLIDE  (Guest Lecture framing)
# =================================================================
s = new_slide(NAVY_DEEP)
add_rect(s, 0, 0, SLIDE_W, 0.1, CHAMPAGNE)
add_rect(s, 0, SLIDE_H - 0.1, SLIDE_W, 0.1, CHAMPAGNE)
corner_accent(s)
add_text(s, 0.9, 0.85, 11.5, 0.4, "GUEST LECTURE  \u00B7  NATIONAL CONFERENCE ON OTOLARYNGOLOGY \u2013 HEAD & NECK SURGERY",
         size=13, color=CHAMPAGNE, bold=True, align=PP_ALIGN.CENTER, font=SANS)
add_text(s, 0.9, 1.25, 11.5, 0.35, "[CONFERENCE NAME]  \u00B7  [CITY]  \u00B7  [YEAR]",
         size=11.5, color=RGBColor(0x9C, 0xAB, 0xBC), align=PP_ALIGN.CENTER, font=SANS)
add_text(s, 0.9, 2.35, 11.5, 1.7,
         "One Tool, Many Lesions", size=46, color=WHITE, bold=True, align=PP_ALIGN.CENTER, font=SERIF)
add_rect(s, 5.6, 3.55, 2.1, 0.025, CHAMPAGNE)
add_text(s, 0.9, 3.75, 11.5, 1.0,
         "Coblation and the Modern Management of Diverse Laryngeal Pathology",
         size=20, color=RGBColor(0xD9, 0xE1, 0xEA), align=PP_ALIGN.CENTER, font=SERIF)
add_text(s, 0.9, 4.5, 11.5, 0.45,
         "An illustrated lecture, drawing on advanced cases managed at [Institute Name]",
         size=13.5, color=RGBColor(0xB9, 0xC6, 0xD3), italic=True, align=PP_ALIGN.CENTER, font=SANS)
add_text(s, 0.9, 5.5, 11.5, 0.4, "[Presenter Name], MS, DNB, FRCS",
         size=16, color=WHITE, bold=True, align=PP_ALIGN.CENTER, font=SERIF)
add_text(s, 0.9, 5.92, 11.5, 0.4, "Senior Consultant / Professor \u2013 Department of ENT, Head & Neck Surgery",
         size=12.5, color=RGBColor(0xC9, 0xD3, 0xDD), align=PP_ALIGN.CENTER, font=SANS)
add_text(s, 0.9, 6.28, 11.5, 0.4, "[Institute / Medical College Name]",
         size=12.5, color=RGBColor(0xA9, 0xB6, 0xC4), align=PP_ALIGN.CENTER, font=SANS)

# =================================================================
# 2. DISCLOSURES
# =================================================================
s = new_slide()
add_header(s, "Preliminary", "Disclosures")
add_bullets(s, 0.8, 1.7, 11.5, 2.5, [
    "No financial relationship with any device manufacturer, including coblation/plasma-ablation system vendors",
    "No conflict of interest relevant to the content of this lecture",
    "All patient images, videos and data are used with informed consent and institutional ethics approval",
    "[Edit this slide to reflect the presenter's actual disclosures before the conference]",
], size=17)
add_footer(s)

# =================================================================
# 3. LECTURE ROADMAP
# =================================================================
s = new_slide()
add_header(s, "Roadmap", "What This Lecture Will Cover")
outline = [
    "The spectrum & diagnostic challenge of benign / non-malignant laryngeal lesions",
    "Coblation \u2013 concept, mechanism and rationale in laryngology",
    "Learning objectives for today",
    "Our institute's experience and approach to advanced laryngeal disease",
    "Five illustrative teaching cases: recognition \u2192 imaging \u2192 technique \u2192 histopathology \u2192 outcome",
    "        1. Subglottic Chondroma      2. Hypopharyngeal Hemangioma      3. Subglottic Necrotising Granuloma",
    "        4. Laryngeal Amyloidosis      5. Intubation (Vocal Process) Granuloma",
    "Coblation vs. conventional modalities \u2013 an evidence-based comparison",
    "Recap, take-home message and key references",
]
add_bullets(s, 0.8, 1.6, 11.6, 5.0, outline, size=16.5, space_after=13)
add_footer(s)

# =================================================================
# 4. INTRODUCTION
# =================================================================
s = new_slide()
add_header(s, "Introduction", "The Spectrum of Benign & Non-Malignant Laryngeal Lesions")
add_bullets(s, 0.8, 1.55, 7.3, 5.2, [
    "The larynx hosts an unusually wide range of pathology within a small, function-critical space \u2013 voice, airway and swallowing all converge here",
    "Aetiologies range from congenital/neoplastic (chondroma), vascular (hemangioma), autoimmune-granulomatous (GPA), infiltrative-deposition (amyloidosis), to purely reactive/traumatic (intubation granuloma)",
    "Despite this diversity, the surgical goals are shared:",
    ("preserve the airway", 1),
    ("preserve voice and swallowing function", 1),
    ("achieve a bloodless, precise dissection in a confined space", 1),
    ("minimise recurrence and re-stenosis", 1),
    "Conventional tools (cold steel, electrocautery, CO2 laser, microdebrider) each address only some of these goals \u2013 raising the question of a single, versatile energy platform",
], size=15, space_after=8)
add_placeholder(s, 8.4, 1.6, 4.1, 5.1, "Representative endoscopic\ncomposite \u2013 spectrum of lesions")
add_footer(s)

# =================================================================
# 5. WHAT IS COBLATION
# =================================================================
s = new_slide()
add_header(s, "Technology", "Coblation \u2013 Concept & Mechanism")
add_bullets(s, 0.8, 1.55, 7.2, 5.2, [
    "COBLATION = \u201cCOntrolled aBLATION\u201d \u2013 a bipolar, radiofrequency-driven plasma technology",
    "A bipolar wand energises a conductive medium (normal saline) surrounding the electrode, generating a low-temperature plasma field (\u2248 60\u201370\u00B0C)",
    "The plasma field contains charged particles with enough kinetic energy to break molecular (organic) bonds within soft tissue \u2013 tissue is dissolved / ablated rather than burned",
    "Simultaneous bipolar coagulation of small vessels provides haemostasis in the same pass",
    "Tissue temperatures remain far below those of electrocautery (200\u2013400\u00B0C) or CO2 laser (400\u20131000\u00B0C), keeping the collateral thermal-injury zone small (literature estimates \u2248100 microns)",
], size=15, space_after=10)
add_placeholder(s, 8.3, 1.6, 4.2, 5.1, "Coblation wand /\nplasma-field schematic diagram")
add_footer(s)

# =================================================================
# 6. ADVANTAGES IN LARYNGOLOGY
# =================================================================
s = new_slide()
add_header(s, "Technology", "Why Coblation Suits the Larynx")
cols = [
    ("Precision", "Fine wand tips allow controlled, layer-by-layer tissue removal in a confined airway"),
    ("Haemostasis", "Concurrent bipolar coagulation keeps the surgical field largely bloodless \u2013 valuable for vascular lesions"),
    ("Low Thermal Profile", "A markedly lower operating temperature than laser/electrocautery limits injury to adjacent structures"),
    ("Function Preservation", "Lower collateral damage helps preserve voice, swallowing and airway calibre"),
    ("Reduced Scarring", "Less thermal injury can translate into less granulation and lower re-stenosis in recurrence-prone disease"),
    ("Versatility", "Effective across neoplastic, vascular, granulomatous, infiltrative and reactive tissue \u2013 one platform, many indications"),
]
x0, y0, w, h, gap = 0.7, 1.55, 3.9, 2.4, 0.25
for i, (t, d) in enumerate(cols):
    col = i % 3; row = i // 3
    x = x0 + col * (w + gap); y = y0 + row * (h + gap)
    add_rect(s, x, y, w, h, LIGHT_BG, line_color=BORDER, line_pt=1)
    add_rect(s, x, y, w, 0.07, CHAMPAGNE)
    add_text(s, x + 0.25, y + 0.22, w - 0.5, 0.4, t, size=15, color=NAVY, bold=True, font=SERIF)
    add_text(s, x + 0.25, y + 0.65, w - 0.5, h - 0.8, d, size=12, color=INK)
add_footer(s)

# =================================================================
# 7. LEARNING OBJECTIVES
# =================================================================
s = new_slide()
add_header(s, "Learning Objectives", "By the End of This Lecture, You Should Be Able To\u2026")
add_bullets(s, 0.9, 1.8, 11.4, 4.6, [
    "Recognise the clinical, endoscopic, radiological and histopathological features of five diverse laryngeal lesions",
    "Understand the mechanism, evidence base and lesion-specific surgical nuances of coblation in laryngology",
    "Compare coblation with conventional modalities \u2013 cold steel, electrocautery and CO2 laser \u2013 on haemostasis, thermal injury and functional preservation",
    "Appreciate how, with a structured, experienced multidisciplinary approach, even advanced and complex laryngeal lesions are managed safely and efficiently in routine practice",
], size=17.5, space_after=18)
add_footer(s)

# =================================================================
# 8. OUR INSTITUTE'S EXPERTISE
# =================================================================
s = new_slide()
add_header(s, "Institutional Context", "Advanced Laryngeal Disease \u2013 Our Approach")
add_text(s, 0.8, 1.45, 11.7, 0.45,
          "Complex laryngeal referrals are managed routinely and safely through a structured, experienced service:",
          size=14, color=GRAY_TEXT, italic=True, font=SERIF)
cards = [
    ("Dedicated Airway & Laryngology Service", "A focused endoscopic laryngology practice with coblation-assisted surgery integrated into routine care, not reserved for exceptional cases"),
    ("Multidisciplinary Collaboration", "Close coordination with rheumatology, haematology and speech-language pathology for systemic or recurrence-prone disease (e.g. GPA, amyloidosis)"),
    ("Standardised, Reproducible Technique", "Protocol-driven wand settings and staged-debulking approaches refined over years of institutional experience"),
    ("Consistent, Favourable Outcomes", "Low complication rates and preserved airway/voice/swallowing function, even in advanced or previously-treated referrals"),
]
x0, y0, w, h, gap = 0.8, 2.05, 5.75, 2.15, 0.3
for i, (t, d) in enumerate(cards):
    col = i % 2; row = i // 2
    x = x0 + col * (w + gap); y = y0 + row * (h + gap)
    add_rect(s, x, y, w, h, LIGHT_BG, line_color=BORDER)
    add_rect(s, x, y, 0.08, h, CHAMPAGNE)
    add_text(s, x + 0.3, y + 0.18, w - 0.55, 0.5, t, size=14.5, color=NAVY, bold=True, font=SERIF)
    add_text(s, x + 0.3, y + 0.68, w - 0.55, h - 0.85, d, size=12, color=INK)
add_text(s, 0.8, 6.65, 11.7, 0.4,
          "[Presenter to insert institute-specific case volume / years of experience / outcome statistics]",
          size=10.5, color=GRAY_TEXT, italic=True, font=SANS)
add_footer(s)

# =================================================================
# 9. CASES IN TODAY'S LECTURE (snapshot table)
# =================================================================
s = new_slide()
add_header(s, "Overview", "Five Teaching Cases at a Glance")
rows_data = [
    ["#", "Lesion", "Site", "Core Pathology", "Role of Coblation"],
    ["1", "Subglottic Chondroma", "Posterior cricoid lamina", "Benign cartilaginous neoplasm", "Precision cartilage debulking"],
    ["2", "Hypopharyngeal Hemangioma", "Pyriform fossa / post. pharyngeal wall", "Vascular malformation", "Bloodless ablation & shrinkage"],
    ["3", "Subglottic Necrotising Granuloma", "Circumferential subglottis", "ANCA-associated vasculitis (GPA)", "Low-trauma debulking + dilatation"],
    ["4", "Laryngeal Amyloidosis", "True/false cord, ventricle", "Recurrence-prone AL deposition", "Tissue-sparing staged debulking"],
    ["5", "Intubation / Vocal Process Granuloma", "Posterior glottis", "Reactive granulation tissue", "Precise excision, low recurrence"],
]
tbl_shape = s.shapes.add_table(len(rows_data), 5, Inches(0.55), Inches(1.55), Inches(12.25), Inches(4.9))
table = tbl_shape.table
for i, wv in enumerate([0.55, 3.1, 2.9, 3.0, 2.7]):
    table.columns[i].width = Inches(wv)
for r in range(len(rows_data)):
    table.cell(r, 0).text = rows_data[r][0]
    for c in range(5):
        table.cell(r, c).text = rows_data[r][c]
table_style(table, rows_data)
for r in range(1, len(rows_data)):
    table.cell(r, 0).text_frame.paragraphs[0].alignment = PP_ALIGN.CENTER
add_footer(s)

# =================================================================
# CASE BUILDER
# =================================================================
def divider(no, name, subtitle):
    s = new_slide(NAVY_DEEP)
    add_rect(s, 0, 0, SLIDE_W, 0.1, CHAMPAGNE)
    add_rect(s, 0, SLIDE_H - 0.1, SLIDE_W, 0.1, CHAMPAGNE)
    corner_accent(s)
    add_text(s, 0.9, 2.3, 11, 0.5, f"TEACHING CASE {no} OF 5", size=17, color=CHAMPAGNE, bold=True, font=SANS)
    add_rect(s, 0.92, 2.85, 1.6, 0.03, CHAMPAGNE)
    add_text(s, 0.9, 3.0, 11.5, 1.5, name, size=36, color=WHITE, bold=True, font=SERIF)
    add_text(s, 0.9, 4.15, 11.3, 0.8, subtitle, size=15.5, color=RGBColor(0xC9, 0xD3, 0xDD), italic=True, font=SERIF)
    add_footer(s, tag=f"Case {no}")
    return s

def clinical_imaging(no, name, presentation, imaging, real_images=None):
    s = new_slide()
    add_header(s, f"Teaching Case {no} \u00B7 {name}", "Clinical Presentation & Imaging")
    add_text(s, 0.7, 1.5, 6.9, 0.35, "Clinical Presentation", size=14.5, color=SLATE, bold=True, font=SERIF)
    add_bullets(s, 0.7, 1.9, 6.9, 4.7, presentation, size=13.5, space_after=9)
    add_text(s, 7.9, 1.5, 4.7, 0.35, "Imaging", size=14.5, color=SLATE, bold=True, font=SERIF)
    if real_images:
        yy = 1.9
        for path, cap in real_images:
            add_picture_fit(s, path, 7.9, yy, 4.7, 2.3)
            add_caption(s, 7.9, yy + 2.32, 4.7, 0.3, cap)
            yy += 2.75
    else:
        add_placeholder(s, 7.9, 1.9, 4.7, 2.6, "CT / MRI scan")
        add_bullets(s, 7.9, 4.65, 4.7, 2.0, imaging, size=12, space_after=6)
    add_footer(s, tag=f"Case {no}")
    return s

def multimedia_gallery(no, name, notes=None, real_images=None):
    s = new_slide()
    add_header(s, f"Teaching Case {no} \u00B7 {name}", "Intra-operative & Endoscopic Multimedia")
    labels = [
        ("Pre-operative Endoscopy", "video"),
        ("Intra-operative \u2013 Coblation in Use", "video"),
        ("Post-operative Endoscopy / Follow-up", "video"),
    ]
    x0, y0, w, h, gap = 0.6, 1.55, 3.85, 4.9, 0.2
    real_images = real_images or {}
    for i, (label, kind) in enumerate(labels):
        x = x0 + i * (w + gap)
        if label in real_images:
            add_picture_fit(s, real_images[label], x, y0, w, h - 0.4)
            add_caption(s, x, y0 + h - 0.35, w, 0.3, label + " (representative image \u2013 supplement with video)")
        else:
            add_placeholder(s, x, y0, w, h, label)
    if notes:
        add_text(s, 0.6, 6.7, 12.1, 0.4, notes, size=10.5, color=GRAY_TEXT, italic=True, font=SANS)
    add_footer(s, tag=f"Case {no}")
    return s

def histopath_slide(no, name, findings, stain_note=None):
    s = new_slide()
    add_header(s, f"Teaching Case {no} \u00B7 {name}", "Histopathology")
    add_placeholder(s, 0.7, 1.6, 5.6, 4.9, "Histopathology photomicrograph(s)\n(H&E / special stain)")
    add_text(s, 6.6, 1.6, 6.0, 0.35, "Key Microscopic Findings", size=14.5, color=SLATE, bold=True, font=SERIF)
    add_bullets(s, 6.6, 2.0, 6.0, 3.8, findings, size=14, space_after=10)
    if stain_note:
        add_rect(s, 6.6, 5.9, 6.0, 0.75, LIGHT_BG, line_color=BORDER)
        add_text(s, 6.75, 6.0, 5.7, 0.55, stain_note, size=11.5, color=NAVY, italic=True, anchor=MSO_ANCHOR.MIDDLE, font=SERIF)
    add_footer(s, tag=f"Case {no}")
    return s

def technique_outcome(no, name, technique, outcome, pearl):
    s = new_slide()
    add_header(s, f"Teaching Case {no} \u00B7 {name}", "Coblation Technique, Outcome & Learning Point")
    add_text(s, 0.7, 1.5, 5.9, 0.35, "Surgical Technique", size=14.5, color=SLATE, bold=True, font=SERIF)
    add_bullets(s, 0.7, 1.9, 5.9, 3.5, technique, size=13, space_after=9)
    add_text(s, 6.9, 1.5, 5.7, 0.35, "Outcome", size=14.5, color=SLATE, bold=True, font=SERIF)
    add_bullets(s, 6.9, 1.9, 5.7, 3.5, outcome, size=13, space_after=9)
    pearl_box = add_rect(s, 0.7, 5.75, 11.9, 1.15, NAVY_MID)
    add_rect(s, 0.7, 5.75, 0.08, 1.15, CHAMPAGNE)
    tf = pearl_box.text_frame; tf.word_wrap = True; tf.vertical_anchor = MSO_ANCHOR.MIDDLE
    tf.margin_left = Inches(0.35)
    p = tf.paragraphs[0]; p.text = "Learning Point \u2013 " + pearl
    r = p.runs[0]; r.font.size = Pt(13.5); r.font.italic = True; r.font.color.rgb = WHITE; r.font.name = SERIF
    add_footer(s, tag=f"Case {no}")
    return s

CASES = [
{
 "no": 1, "name": "Subglottic Chondroma", "subtitle": "A slow-growing benign cartilaginous tumour of the cricoid",
 "presentation": [
    "Adult patient with insidious, progressive dyspnoea, stridor \u00B1 hoarseness over months to years",
    "Rare entity \u2013 <1% of laryngeal tumours; the commonest benign cartilaginous neoplasm of the larynx",
    "Classically arises from the posterior lamina of the cricoid cartilage (residual endochondral ossification centres)",
    "Firm, smooth, submucosal, non-ulcerated swelling narrowing the subglottic airway on flexible laryngoscopy",
 ],
 "imaging": [
    "Contrast CT larynx: well-defined, lobulated, often calcified/ossified submucosal mass arising from the cricoid",
    "MRI clarifies cartilage invasion and helps exclude low-grade chondrosarcoma",
    "Key differential: chondrosarcoma, laryngocele, paraganglioma, subglottic haemangioma",
 ],
 "histopath": [
    "Mature hyaline cartilage, low cellularity, chondrocytes arranged in an orderly lacunar pattern",
    "No cytological atypia, no significant mitoses, no destructive/invasive growth",
    "Distinction from low-grade chondrosarcoma is subtle and requires generous, representative biopsy",
 ],
 "stain_note": "Histological overlap with low-grade chondrosarcoma means diagnosis rests on the whole specimen, not a small biopsy.",
 "technique": [
    "Suspension microlaryngoscopy; coblation wand introduced under magnified endoscopic view",
    "Low-temperature bipolar plasma (\u224860\u201370\u00B0C) used for controlled, layer-by-layer shaving of the cartilaginous mass",
    "Overlying mucosa and perichondrium preserved wherever feasible to protect the cricoid framework",
    "Continuous saline irrigation maintains a clear, bloodless field for precise endpoint judgement",
 ],
 "outcome": [
    "Airway secured endoscopically \u2013 tracheostomy avoided",
    "Uneventful post-operative course; serial follow-up endoscopy shows a re-epithelialised, patent subglottis",
    "No airway compromise or restenosis on interval review",
 ],
 "pearl": "Coblation permits precise cartilage debulking with minimal thermal spread to the adjacent cricoid \u2013 critical when the surgical goal is airway restoration without destabilising the laryngeal framework.",
},
{
 "no": 2, "name": "Hypopharyngeal Hemangioma", "subtitle": "A vascular submucosal lesion demanding a bloodless approach",
 "presentation": [
    "Presents with foreign-body sensation, odynophagia, muffled voice or intermittent haemoptysis",
    "Bluish-to-reddish, compressible, submucosal swelling typically in the pyriform fossa or posterior pharyngeal wall",
    "Blind biopsy is discouraged \u2013 risk of significant haemorrhage from a vascular lesion",
 ],
 "imaging": [
    "Contrast-enhanced CT/MRI: well-circumscribed, avidly enhancing submucosal lesion",
    "Large or deep lesions may warrant angiography to define feeding vessels before intervention",
 ],
 "histopath": [
    "Proliferation of endothelial-lined vascular channels \u2013 cavernous and/or capillary pattern",
    "Bland endothelium, no cytological atypia or mitotic activity",
    "Correlate with clinical/radiological vascular appearance to avoid misclassification",
 ],
 "stain_note": "CD31 / CD34 immunostaining confirms endothelial lineage when the diagnosis is in doubt.",
 "technique": [
    "Direct laryngo-pharyngoscopy under general anaesthesia; coblation wand applied directly to the lesion",
    "Simultaneous ablation and bipolar coagulation shrink the vascular mass while sealing feeding channels in real time",
    "Staged, gentle passes avoid full-thickness pharyngeal wall injury",
 ],
 "outcome": [
    "Essentially bloodless intra-operative field \u2013 no transfusion required",
    "Resolution of foreign-body sensation / dysphagia",
    "No recurrence on subsequent follow-up endoscopy",
 ],
 "pearl": "The simultaneous cut-and-coagulate profile of coblation is the strongest argument for its use in vascular lesions \u2013 conventional cold instruments risk brisk, field-obscuring bleeding.",
},
{
 "no": 3, "name": "Subglottic Necrotising Granuloma", "subtitle": "Granulomatosis with polyangiitis (GPA) presenting as subglottic stenosis",
 "presentation": [
    "Young-to-middle-aged adult with progressive dyspnoea, stridor and hoarseness",
    "May have systemic clues: sinonasal crusting/saddle-nose deformity, arthralgia, renal impairment, otitis media",
    "Endoscopy: circumferential, erythematous, friable subglottic narrowing",
 ],
 "imaging": [
    "CT neck: circumferential subglottic soft-tissue thickening / stenosis \u00B1 cartilage erosion",
    "Chest CT to look for pulmonary nodules/cavitation; renal function screen",
    "c-ANCA / PR3-ANCA serology, ESR/CRP for systemic disease workup",
 ],
 "histopath": [
    "Necrotising granulomatous inflammation with multinucleate giant cells",
    "True vasculitis is often absent on limited endoscopic biopsy \u2013 diagnosis needs clinico-serological correlation",
    "Rule out infective granulomas (TB, fungal) and sarcoidosis on special stains/cultures",
 ],
 "stain_note": "PR3-ANCA positivity plus compatible histology supports GPA even when vasculitis is not seen on a small airway biopsy.",
 "technique": [
    "Coblation-assisted endoscopic debulking of granulation/scar tissue combined with balloon dilatation of the stenotic segment",
    "Low collateral thermal injury is deliberately chosen to avoid adding further scarring in an already fibrosing airway",
    "Performed in coordination with rheumatology for concurrent systemic immunosuppression",
 ],
 "outcome": [
    "Improved airway calibre; tracheostomy avoided",
    "Planned serial endoscopic dilatation protocol",
    "Systemic disease control achieved with steroids and rituximab / cyclophosphamide per rheumatology input",
 ],
 "pearl": "In a disease already prone to fibrosis and restenosis, coblation's minimal collateral thermal injury is a genuine advantage over laser or electrocautery, which can seed further granulation.",
},
{
 "no": 4, "name": "Laryngeal Amyloidosis", "subtitle": "A recurrence-prone infiltrative deposition disease of the larynx",
 "presentation": [
    "Middle-aged adult with slowly progressive hoarseness \u00B1 dyspnoea over months to years",
    "Submucosal, waxy, yellow-pink infiltration of the true/false cord, ventricle or subglottis",
    "Most laryngeal amyloid is localised AL type, distinct from systemic amyloidosis \u2013 systemic screening is still mandatory",
 ],
 "imaging": [
    "CT: diffuse submucosal thickening \u00B1 punctate calcification",
    "MRI defines mucosal/submucosal extent for surgical planning",
    "Systemic work-up: serum/urine protein electrophoresis, free light chains, cardiac and renal screening",
 ],
 "histopath": [
    "Amorphous, eosinophilic, extracellular hyaline deposits within the lamina propria",
    "Congo red staining shows pathognomonic apple-green birefringence under polarised light",
    "Immunohistochemistry / mass spectrometry typing (AL most common in the larynx)",
 ],
 "stain_note": "Congo red + polarised light is the confirmatory test; subtype AL vs ATTR guides systemic follow-up.",
 "technique": [
    "Staged coblation debulking preserving as much normal mucosa and underlying muscle as possible to protect phonation",
    "Circumferential/full-thickness injury deliberately avoided to reduce stenosis risk given the high likelihood of repeat procedures",
    "Multidisciplinary referral (haematology) to exclude systemic amyloidosis",
 ],
 "outcome": [
    "Improved voice quality and airway patency after debulking",
    "Per Galluzzi & Garavello (2023) systematic review, surgical debulking is the mainstay of treatment; recurrence is common, often necessitating repeat procedures",
    "Malignant transformation is rare, but lifelong endoscopic surveillance is advised",
 ],
 "pearl": "Coblation's tissue-sparing ablation is well suited to a disease that often needs repeated debulking \u2013 it avoids the cumulative scarring that repeated laser or cold-steel excision can cause to the vocal fold.",
},
{
 "no": 5, "name": "Intubation (Vocal Process) Granuloma", "subtitle": "A reactive lesion notorious for recurrence after excision",
 "presentation": [
    "Hoarseness, throat pain or globus sensation weeks after intubation, or in the setting of chronic phonotrauma/reflux",
    "Uni- or bilateral pedunculated/sessile mass at the vocal process of the arytenoid (posterior glottis)",
    "Risk factors: traumatic/prolonged intubation, laryngopharyngeal reflux (LPR), vocal abuse, chronic cough",
 ],
 "imaging": [
    "Primarily a clinical/stroboscopic diagnosis; imaging reserved if malignancy needs exclusion",
    "Videostroboscopy documents mucosal wave and confirms posterior glottic location",
 ],
 "histopath": [
    "Granulation tissue: fibrovascular stroma with a chronic inflammatory infiltrate",
    "Overlying epithelium may be ulcerated or hyperplastic; no cytological atypia",
    "Correlate with history of instrumentation/reflux to avoid mistaking this for neoplasia",
 ],
 "stain_note": "No specific stain required; the diagnosis is clinico-pathological.",
 "technique": [
    "Micro-laryngoscopic coblation excision of the granuloma at the vocal process with preservation of arytenoid perichondrium",
    "Combined with medical optimisation \u2013 proton-pump inhibitors, voice therapy, and, in refractory/recurrent cases, botulinum toxin or intralesional steroid injection",
 ],
 "outcome": [
    "Resolution of hoarseness and globus symptoms",
    "Lower recurrence with a combined medical + coblation-assisted surgical approach compared with historical cold-steel excision alone",
 ],
 "pearl": "For a lesion infamous for recurring after surgery, coblation's reduced mucosal trauma and superior haemostasis make any necessary repeat procedure safer and less morbid.",
},
]

real_image_map = {
 3: {"imaging": [(IMG["gpa_ct1"], "Representative contrast CT \u2013 GPA-related airway changes"),
                 (IMG["gpa_ct2"], "Representative contrast CT \u2013 axial neck")]},
 4: {"gallery": {"Pre-operative Endoscopy": IMG["amyloid_supra"],
                 "Intra-operative \u2013 Coblation in Use": IMG["amyloid_preop"]}},
}

for c in CASES:
    divider(c["no"], c["name"], c["subtitle"])
    ri = real_image_map.get(c["no"], {}).get("imaging")
    clinical_imaging(c["no"], c["name"], c["presentation"], c["imaging"], real_images=ri)
    gallery_imgs = real_image_map.get(c["no"], {}).get("gallery")
    multimedia_gallery(c["no"], c["name"],
                        notes="Faculty note: replace placeholders above with pre-op, intra-op (coblation in action) and post-op endoscopy clips; add scan/histopathology images on the following slides.",
                        real_images=gallery_imgs)
    histopath_slide(c["no"], c["name"], c["histopath"], stain_note=c.get("stain_note"))
    technique_outcome(c["no"], c["name"], c["technique"], c["outcome"], c["pearl"])

# =================================================================
# COMPARATIVE TABLE
# =================================================================
s = new_slide()
add_header(s, "Learning Point", "Coblation vs. Conventional Modalities")
rows_data = [
    ["Parameter", "Coblation", "CO2 Laser", "Cold Steel", "Electrocautery / Microdebrider"],
    ["Tissue temperature", "\u224860\u201370\u00B0C (low)", "400\u20131000\u00B0C (high)", "N/A (mechanical)", "200\u2013400\u00B0C (high)"],
    ["Collateral thermal spread", "Low, literature estimate \u2248100 \u00B5m", "Moderate\u2013high, char risk", "None", "Moderate\u2013high"],
    ["Haemostasis", "Generally favourable (built-in)", "Good", "Poor \u2013 needs adjunct", "Good"],
    ["Airway fire risk (with O2)", "Minimal", "Present \u2013 needs precautions", "None", "Present"],
    ["Precision on cartilage/mucosa", "High", "High, but charring risk", "High, but bleeds", "Moderate"],
    ["Versatility across lesion types", "Broad (tumour, vascular, granuloma, deposition, reactive)", "Mainly soft tissue", "Mainly soft tissue", "Mainly soft tissue"],
]
tbl_shape = s.shapes.add_table(len(rows_data), 5, Inches(0.4), Inches(1.5), Inches(12.5), Inches(5.3))
table = tbl_shape.table
for i, wv in enumerate([2.5, 2.7, 2.4, 2.2, 2.7]):
    table.columns[i].width = Inches(wv)
for r in range(len(rows_data)):
    for c in range(5):
        table.cell(r, c).text = rows_data[r][c]
table_style(table, rows_data)
for r in range(1, len(rows_data)):
    cell = table.cell(r, 1)
    cell.text_frame.paragraphs[0].runs[0].font.bold = True
    cell.text_frame.paragraphs[0].runs[0].font.color.rgb = SLATE
    cell.fill.fore_color.rgb = RGBColor(0xEA, 0xEE, 0xF1)
add_footer(s)

# =================================================================
# EVIDENCE FOCUS 1: HAEMOSTASIS / BLOOD LOSS
# =================================================================
s = new_slide()
add_header(s, "Learning Point \u00B7 Evidence", "Haemostasis & Intra-operative Blood Loss")
add_text(s, 0.7, 1.45, 11.9, 0.5,
          "Coblation's built-in bipolar coagulation is its most cited advantage \u2013 but the evidence is procedure-dependent:",
          size=13.5, color=GRAY_TEXT, italic=True, font=SERIF)
rows_data = [
    ["Study (Evidence)", "Comparison", "Key Finding"],
    ["Albazee et al. 2022 \u2013 Systematic Review\n& Meta-analysis of RCTs, Eur Arch ORL\nPMID 35810212",
     "Coblation vs CO2/diode\nLaser Tonsillectomy",
     "Coblation \u2192 significantly LOWER intra-op blood loss (MD \u2013 5.08 mL) and shorter operative time (MD \u2013 4.50 min); no difference in pain or secondary haemorrhage"],
    ["Hao et al. 2020, Bioscience Reports\nPMID 32426815",
     "Coblation vs CO2 Laser \u2013\nlaryngotracheal RRP",
     "Coblation \u2192 significantly LESS blood loss, shorter operative time, longer symptom-free interval and lower post-op pain scores"],
    ["Wang et al. 2022 \u2013 Meta-analysis,\nComput Math Methods Med\nPMID 35844439",
     "Low-temperature plasma RFA\nvs CO2 Laser \u2013 early glottic\ncarcinoma",
     "Contrary finding: RFA/coblation showed HIGHER intra-operative blood loss than CO2 laser; but shorter operative time and better mucosal recovery; no difference in recurrence"],
]
tbl_shape = s.shapes.add_table(len(rows_data), 3, Inches(0.5), Inches(2.05), Inches(12.35), Inches(4.55))
table = tbl_shape.table
for i, wv in enumerate([3.55, 2.9, 5.9]):
    table.columns[i].width = Inches(wv)
for r in range(len(rows_data)):
    for c in range(3):
        table.cell(r, c).text = rows_data[r][c]
table_style(table, rows_data)
for r in range(len(rows_data)):
    for c in range(3):
        table.cell(r, c).text_frame.paragraphs[0].runs[0].font.size = Pt(11.3 if r else 12.5)
add_text(s, 0.7, 6.75, 11.9, 0.4,
          "Take-away: coblation generally reduces blood loss vs. laser in soft-tissue/vascular work, but this benefit is not universal \u2013 site and tissue vascularity matter.",
          size=11, color=NAVY, italic=True, font=SERIF)
add_footer(s)

# =================================================================
# EVIDENCE FOCUS 2: THERMAL SPREAD / TISSUE INJURY
# =================================================================
s = new_slide()
add_header(s, "Learning Point \u00B7 Evidence", "Thermal Spread & Collateral Tissue Injury")
add_bullets(s, 0.7, 1.55, 11.9, 2.0, [
    "Coblation operates at \u224860\u201370\u00B0C vs. 400\u20131000\u00B0C for CO2 laser and 200\u2013400\u00B0C for electrocautery \u2013 the physical basis for a smaller thermal injury zone",
    "Karakkandy et al. 2024, Indian J Otolaryngol Head Neck Surg (PMID 39376295) \u2013 double-anonymised histopathological comparison of CO2 laser vs. coblation in 50 head & neck / laryngeal excisions:",
], size=13.5, space_after=8)
add_rect(s, 0.9, 3.55, 11.5, 2.55, LIGHT_BG, line_color=BORDER)
add_rect(s, 0.9, 3.55, 0.08, 2.55, CHAMPAGNE)
add_bullets(s, 1.2, 3.7, 11.0, 2.35, [
    "Incision margins were more regular with CO2 laser (73%) than coblation (55%) \u2013 not statistically significant (P = 1.80)",
    "Depth of thermal damage and connective-tissue change trended HIGHER with coblation than CO2 laser (P = 0.171 and 0.279 \u2013 not statistically significant)",
    "Vascular thermal changes were seen more with CO2 laser (P = 0.727)",
    "Authors' conclusion: both are effective; CO2 laser, where available, may offer more precise excision with less collateral damage",
], size=12.5, space_after=8)
add_text(s, 0.7, 6.35, 11.9, 0.8,
          "Take-away: coblation's low-temperature mechanism is real, but current histopathological evidence does NOT show it to be categorically superior to CO2 laser in collateral thermal injury \u2013 differences seen so far are not statistically significant. The clinical advantage of coblation lies more in speed, haemostasis and ergonomics than a proven thermal-injury edge.",
          size=11, color=NAVY, italic=True, font=SERIF)
add_footer(s)

# =================================================================
# EVIDENCE FOCUS 3: FUNCTION PRESERVATION (VOICE / AIRWAY)
# =================================================================
s = new_slide()
add_header(s, "Learning Point \u00B7 Evidence", "Function Preservation \u2013 Voice & Airway Outcomes")
add_bullets(s, 0.7, 1.5, 11.9, 5.3, [
    "Svistushkin et al. 2022, Eur Arch ORL (PMID 34482444) \u2013 analytical review + institutional series of 20 patients undergoing cold-plasma posterior cordotomy for bilateral vocal fold paralysis: coblation gave minimal trauma to surrounding tissue, complete one-pass haemostasis, and an easier post-operative course; functional voice was preserved via long-term orthophonic training",
    "Benninger et al. 2018, JAMA Otolaryngol Head Neck Surg (PMID 29242922) and 2025 multicentre follow-up in J Voice (PMID 36270920) \u2013 coblation cordotomy for bilateral vocal fold immobility: consistent airway improvement with maintained voice quality and quality-of-life scores on long-term follow-up",
    "El-Sobki et al. 2023, J Voice (PMID 37923654) \u2013 prospective study, diode laser vs. coblation for bilateral abductor paralysis (n = 80): both effective with similarly preserved voice quality (VHI); coblation had significantly shorter operative time and lower post-operative pain, with a greater reduction in maximum phonation time",
    "Lou et al. 2025, J Voice (PMID 36414529) \u2013 coblation vs. microflap resection of vocal-fold leukoplakia: comparable oncological safety with functional voice outcomes reported for coblation",
], size=13.5, space_after=11)
add_footer(s)

# =================================================================
# RECENT EVIDENCE SUMMARY
# =================================================================
s = new_slide()
add_header(s, "Evidence Base", "Recent Literature Supporting Coblation in Laryngeal Pathology")
eb_rows = [
    ["Author, Year", "Study Type", "Focus", "PMID"],
    ["Svistushkin et al. 2022", "Review + Case Series", "Coblation across otorhinolaryngology incl. laryngeal cordotomy", "34482444"],
    ["Albazee et al. 2022", "Systematic Review & Meta-analysis", "Coblation vs laser tonsillectomy \u2013 blood loss, pain, time", "35810212"],
    ["Wang et al. 2022", "Meta-analysis", "Plasma RFA vs CO2 laser \u2013 early glottic carcinoma", "35844439"],
    ["Hao et al. 2020", "Comparative Study", "Coblation vs CO2 laser \u2013 laryngotracheal RRP outcomes", "32426815"],
    ["Karakkandy et al. 2024", "Histopathological Comparative Study", "Thermal injury: coblation vs CO2 laser in H&N/larynx", "39376295"],
    ["El-Sobki et al. 2023", "Prospective Comparative Study", "Coblation vs diode laser \u2013 bilateral abductor paralysis", "37923654"],
    ["Benninger et al. 2018 / 2025", "Cohort / Multicentre", "Coblation cordotomy \u2013 bilateral vocal fold immobility", "29242922 / 36270920"],
    ["Lou et al. 2025", "Comparative Study", "Coblation vs microflap \u2013 vocal fold leukoplakia", "36414529"],
    ["Galluzzi & Garavello 2023", "Systematic Review", "Surgical treatment of laryngeal amyloidosis", "36790723"],
    ["McNally et al. 2025", "Comparative Study", "Coblation vs microdebrider \u2013 paediatric RRP", "40518634"],
]
tbl_shape = s.shapes.add_table(len(eb_rows), 4, Inches(0.4), Inches(1.55), Inches(12.5), Inches(5.35))
table = tbl_shape.table
for i, wv in enumerate([2.9, 3.1, 4.9, 1.6]):
    table.columns[i].width = Inches(wv)
for r in range(len(eb_rows)):
    for c in range(4):
        table.cell(r, c).text = eb_rows[r][c]
table_style(table, eb_rows)
for r in range(len(eb_rows)):
    for c in range(4):
        table.cell(r, c).text_frame.paragraphs[0].runs[0].font.size = Pt(10.7 if r else 12.3)
    table.cell(r, 3).text_frame.paragraphs[0].alignment = PP_ALIGN.CENTER
add_footer(s)

# =================================================================
# RECAP: WHAT WE LEARNED FROM TODAY'S FIVE CASES
# =================================================================
s = new_slide()
add_header(s, "Recap", "What We Learned From Today's Five Cases")
rows = [
    ("Subglottic Chondroma", "Needs precise cartilage debulking without destabilising the cricoid \u2192 coblation's controlled shaving"),
    ("Hypopharyngeal Hemangioma", "Needs simultaneous cutting and haemostasis \u2192 coblation's bipolar coagulation"),
    ("Subglottic Necrotising Granuloma (GPA)", "Needs debulking without adding further fibrosis \u2192 coblation's low thermal profile"),
    ("Laryngeal Amyloidosis", "Needs repeatable, tissue-sparing debulking for a recurrence-prone disease \u2192 coblation's low collateral injury"),
    ("Intubation Granuloma", "Needs precise excision with minimal mucosal trauma to curb recurrence \u2192 coblation's atraumatic ablation"),
]
y = 1.75
for name, reason in rows:
    add_rect(s, 0.7, y, 0.1, 0.68, CHAMPAGNE)
    add_text(s, 1.0, y, 3.6, 0.68, name, size=13, color=NAVY, bold=True, anchor=MSO_ANCHOR.MIDDLE, font=SERIF)
    add_text(s, 4.7, y, 7.9, 0.68, reason, size=12.5, color=INK, anchor=MSO_ANCHOR.MIDDLE)
    y += 0.88
add_footer(s)

# =================================================================
# LIMITATIONS
# =================================================================
s = new_slide()
add_header(s, "Learning Point", "Limitations & Honest Appraisal")
add_bullets(s, 0.8, 1.6, 11.5, 5.0, [
    "Current evidence base is dominated by case reports and small case series \u2013 larger prospective, comparative studies are lacking",
    "Recurring cost of disposable coblation wands compared with reusable cold instruments",
    "Wand calibre may limit access in very narrow paediatric airways or deeply recessed sites",
    "Not a substitute for oncologic resection with margin control in malignant disease \u2013 role here is confined to benign / non-malignant pathology",
    "Outcomes remain operator- and technique-dependent; a deliberate learning curve exists in power/setting selection for different tissue types",
], size=16, space_after=14)
add_footer(s)

# =================================================================
# TAKE-HOME MESSAGE
# =================================================================
s = new_slide(NAVY_DEEP)
add_rect(s, 0, 0, SLIDE_W, 0.1, CHAMPAGNE)
add_rect(s, 0, SLIDE_H - 0.1, SLIDE_W, 0.1, CHAMPAGNE)
corner_accent(s)
add_text(s, 0.8, 0.55, 11.7, 0.6, "TAKE-HOME MESSAGE", size=25, color=CHAMPAGNE, bold=True, align=PP_ALIGN.CENTER, font=SERIF)
add_rect(s, 5.6, 1.25, 2.1, 0.025, CHAMPAGNE)
messages = [
    "Coblation is a single, low-temperature plasma-ablation platform that performs reliably across neoplastic, vascular, autoimmune-granulomatous, infiltrative and reactive laryngeal disease.",
    "Recognising these lesions early \u2013 clinically, radiologically and histopathologically \u2013 is the first and most important step; the choice of energy tool comes second.",
    "As shown today, even advanced and previously-untreated laryngeal pathology can be managed safely and efficiently with an experienced, structured, multidisciplinary approach.",
    "Coblation deserves a permanent place in the endoscopic laryngologist's armamentarium \u2013 as a versatile complement to, not a replacement for, cold steel, laser and microdebrider.",
]
y = 1.65
for i, msg in enumerate(messages, 1):
    add_rect(s, 0.9, y, 0.5, 0.5, CHAMPAGNE, shape=MSO_SHAPE.OVAL)
    tf_num = s.shapes[-1].text_frame; tf_num.vertical_anchor = MSO_ANCHOR.MIDDLE
    pnum = tf_num.paragraphs[0]; pnum.alignment = PP_ALIGN.CENTER; pnum.text = str(i)
    pnum.runs[0].font.bold = True; pnum.runs[0].font.size = Pt(16); pnum.runs[0].font.color.rgb = NAVY_DEEP
    add_text(s, 1.65, y - 0.02, 10.75, 1.15, msg, size=14.5, color=WHITE, anchor=MSO_ANCHOR.MIDDLE, font=SERIF)
    y += 1.28
add_footer(s)

# =================================================================
# CLOSING SUMMARY
# =================================================================
s = new_slide()
add_header(s, "Key Takeaways", "Closing Summary")
add_bullets(s, 0.8, 1.6, 11.5, 4.6, [
    "Coblation offers a low-temperature, tissue-selective ablation profile that translates into precision, generally favourable haemostasis and a manageable collateral-injury profile",
    "Across five biologically distinct laryngeal lesions discussed today \u2013 neoplastic, vascular, autoimmune-granulomatous, infiltrative and reactive \u2013 coblation achieved effective, function-preserving control",
    "It is best regarded as a versatile adjunct in the endoscopic laryngologist's armamentarium, complementing rather than replacing cold steel, laser and microdebrider",
    "With structured, experienced multidisciplinary care, advanced and complex laryngeal disease can be managed safely, efficiently and reproducibly",
], size=16.5, space_after=15)
add_rect(s, 0.8, 6.2, 11.7, 0.7, NAVY_MID)
add_text(s, 1.0, 6.2, 11.3, 0.7, "One versatile tool \u2013 many faces of laryngeal disease.", size=16,
         color=CHAMPAGNE, italic=True, bold=True, anchor=MSO_ANCHOR.MIDDLE, align=PP_ALIGN.CENTER, font=SERIF)
add_footer(s)

# =================================================================
# REFERENCES
# =================================================================
s = new_slide()
add_header(s, "Bibliography", "References", size=24)
refs = [
    "Meslemani D, Benninger MS. Coblation removal of laryngeal Teflon granulomas. Laryngoscope. 2010. PMID: 20824780.",
    "Awad R, Shamil E, Aymat-Torrente A. Management of laryngeal papillomatosis using coblation. Eur Arch Otorhinolaryngol. 2019. PMID: 30798335.",
    "Galluzzi F, Garavello W. Surgical treatment of laryngeal amyloidosis: a systematic review. Eur Arch Otorhinolaryngol. 2023. PMID: 36790723.",
    "Yadav KV, Chethana R, Mishra P. Coblator assisted excision of laryngeal paraganglioma. Med J Armed Forces India. 2025. PMID: 40496223.",
    "Svistushkin VM, Starostina SV, Toldanov AV. Possibilities of coblation in otorhinolaryngology: analytical review. Eur Arch Otorhinolaryngol. 2022. PMID: 34482444.",
    "Albazee E, Al-Sebeih KH, Alkhaldi F, et al. Coblation tonsillectomy versus laser tonsillectomy: a systematic review and meta-analysis of RCTs. Eur Arch Otorhinolaryngol. 2022. PMID: 35810212.",
    "Wang C, Zhao Y, Li C, et al. Meta-analysis of low temperature plasma radiofrequency ablation and CO2 laser surgery on early glottic laryngeal carcinoma. Comput Math Methods Med. 2022. PMID: 35844439.",
    "Hao F, Yue L, Yin X, et al. Low-temperature radiofrequency coblation reduces treatment interval and post-operative pain of laryngotracheal recurrent respiratory papillomatosis. Bioscience Reports. 2020. PMID: 32426815.",
    "Karakkandy V, Chappity P, Mishra P, et al. A double-anonymised histopathological comparative study of CO2 laser and coblation in head and neck surgery. Indian J Otolaryngol Head Neck Surg. 2024. PMID: 39376295.",
    "El-Sobki A, Elzayat S, El-Deeb ME, et al. Surgical management of bilateral abductor paralysis: diode laser versus coblation; a prospective study. J Voice. 2023. PMID: 37923654.",
    "Benninger MS, Xiao R, Osborne K, et al. Outcomes following cordotomy by coblation for bilateral vocal fold immobility. JAMA Otolaryngol Head Neck Surg. 2018. PMID: 29242922.",
    "Benninger MS, Syamal M, Gau VL, et al. Coblation cordotomy for the management of bilateral vocal fold immobility. J Voice. 2025. PMID: 36270920.",
    "Lou Z, Lou Z, Lv T, et al. Comparison between coblation and microflap resection of leukoplakia of the vocal fold. J Voice. 2025. PMID: 36414529.",
    "McNally G, Mason R, Bateman N, et al. Recurrent respiratory papillomatosis in children: coblation versus microdebrider. J Laryngol Otol. 2025. PMID: 40518634.",
    "Scott-Brown's Otorhinolaryngology, Head & Neck Surgery, 8th ed. \u2013 Granulomatosis with Polyangiitis; Coblation\u00AE.",
    "Cummings Otolaryngology \u2013 Head & Neck Surgery, 8th ed. \u2013 Chondroma; Contact/Intubation Granuloma; Laryngitis in Systemic Disease (Amyloidosis).",
    "K.J. Lee's Essential Otolaryngology, 11th ed. \u2013 Laryngology; Radiofrequency Ablation (Coblation) in Otolaryngology.",
    "[Add institutional case-series data, local ethics approval number, and any additional references before final submission]",
]
add_bullets(s, 0.8, 1.5, 11.6, 5.4, refs, size=11, space_after=7)
add_footer(s)

# =================================================================
# THANK YOU
# =================================================================
s = new_slide(NAVY_DEEP)
add_rect(s, 0, 0, SLIDE_W, 0.1, CHAMPAGNE)
add_rect(s, 0, SLIDE_H - 0.1, SLIDE_W, 0.1, CHAMPAGNE)
corner_accent(s)
add_text(s, 0.9, 2.9, 11.5, 1.1, "Thank You", size=46, color=WHITE, bold=True, align=PP_ALIGN.CENTER, font=SERIF)
add_text(s, 0.9, 4.1, 11.5, 0.5, "Questions & Discussion", size=17, color=CHAMPAGNE, italic=True, align=PP_ALIGN.CENTER, font=SERIF)
add_text(s, 0.9, 4.9, 11.5, 0.4, "[Presenter Name]  \u2022  [Email/Contact]  \u2022  [Department, Institute]",
         size=13, color=RGBColor(0xC9, 0xD3, 0xDD), align=PP_ALIGN.CENTER, font=SANS)

prs.save("Coblation_in_Diverse_Laryngeal_Lesions.pptx")
print("Total slides:", len(prs.slides._sldIdLst))
print("DONE")

#!/usr/bin/env python3
"""
Guest Lecture deck - National ENT Conference
"One Tool, Many Lesions: Coblation and the Modern Management of Diverse Laryngeal Pathology"
Refined academic theme + educational (lecture) framing + institutional-expertise messaging.
"""
import json, base64
from pptx import Presentation
from pptx.util import Inches, Pt, Emu
from pptx.dml.color import RGBColor
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
from pptx.enum.shapes import MSO_SHAPE
from pptx.oxml.ns import qn

# ---------------------------------------------------------------- palette (refined academic)
INK        = RGBColor(0x1B, 0x1D, 0x21)
NAVY       = RGBColor(0x0E, 0x2A, 0x43)
NAVY_DEEP  = RGBColor(0x08, 0x1C, 0x2F)
NAVY_MID   = RGBColor(0x15, 0x38, 0x57)
CHAMPAGNE  = RGBColor(0xB8, 0x96, 0x5A)
CHAMPAGNE_L= RGBColor(0xD8, 0xC4, 0x9A)
SLATE      = RGBColor(0x44, 0x59, 0x6B)
MAROON     = RGBColor(0x5C, 0x1E, 0x27)
WHITE      = RGBColor(0xFF, 0xFF, 0xFF)
CREAM_BG   = RGBColor(0xFB, 0xFA, 0xF7)
LIGHT_BG   = RGBColor(0xF1, 0xEF, 0xE9)
BORDER     = RGBColor(0xDC, 0xD8, 0xCC)
PH_BG      = RGBColor(0xEE, 0xEC, 0xE5)
PH_BORDER  = RGBColor(0xB2, 0xAC, 0x99)
GRAY_TEXT  = RGBColor(0x5C, 0x60, 0x66)
ROW_ALT    = RGBColor(0xF4, 0xF2, 0xEC)

SERIF = "Georgia"
SANS  = "Calibri"

SLIDE_W, SLIDE_H = 13.333, 7.5

# ---------------------------------------------------------------- images
with open("fetched_images.json") as f:
    fetched = json.load(f)

def save_b64(item, path):
    if not item.get("base64"):
        return None
    data = item["base64"]
    if "," in data:
        data = data.split(",", 1)[1]
    with open(path, "wb") as fh:
        fh.write(base64.b64decode(data))
    return path

IMG = {}
IMG["amyloid_preop"]  = save_b64(fetched[0], "assets/amyloid_preop_intraop.jpg")
IMG["amyloid_supra"]  = save_b64(fetched[1], "assets/amyloid_supraglottic.jpg")
IMG["gpa_ct1"]        = save_b64(fetched[2], "assets/gpa_ct1.png")
IMG["gpa_ct2"]        = save_b64(fetched[3], "assets/gpa_ct2.png")
IMG["gpa_ct3"]        = save_b64(fetched[4], "assets/gpa_ct3.png")

# ---------------------------------------------------------------- prs
prs = Presentation()
prs.slide_width  = Inches(SLIDE_W)
prs.slide_height = Inches(SLIDE_H)
BLANK = prs.slide_layouts[6]
PAGE = {"n": 0}

def new_slide(bg=CREAM_BG):
    s = prs.slides.add_slide(BLANK)
    s.background.fill.solid()
    s.background.fill.fore_color.rgb = bg
    PAGE["n"] += 1
    return s

def add_rect(slide, x, y, w, h, color, line_color=None, line_pt=1.0, shape=MSO_SHAPE.RECTANGLE):
    sp = slide.shapes.add_shape(shape, Inches(x), Inches(y), Inches(w), Inches(h))
    sp.fill.solid(); sp.fill.fore_color.rgb = color
    if line_color is None:
        sp.line.fill.background()
    else:
        sp.line.color.rgb = line_color
        sp.line.width = Pt(line_pt)
    sp.shadow.inherit = False
    return sp

def set_dashed(shape):
    ln = shape.line._get_or_add_ln()
    d = ln.makeelement(qn('a:prstDash'), {'val': 'dash'})
    ln.append(d)

def add_text(slide, x, y, w, h, text, size=16, color=INK, bold=False, italic=False,
             align=PP_ALIGN.LEFT, font=SANS, anchor=MSO_ANCHOR.TOP, line_spacing=None):
    tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = tb.text_frame; tf.word_wrap = True; tf.vertical_anchor = anchor
    p = tf.paragraphs[0]; p.text = text; p.alignment = align
    if line_spacing: p.line_spacing = line_spacing
    r = p.runs[0]
    r.font.size = Pt(size); r.font.bold = bold; r.font.italic = italic
    r.font.name = font; r.font.color.rgb = color
    return tb

def add_bullets(slide, x, y, w, h, items, size=15, color=INK, space_after=8, font=SANS,
                 bullet_char="\u2013", line_spacing=1.05):
    tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = tb.text_frame; tf.word_wrap = True
    for i, item in enumerate(items):
        level = 0; text = item
        if isinstance(item, tuple): text, level = item
        p = tf.paragraphs[0] if i == 0 else tf.add_paragraph()
        indent = "" if level == 0 else "     "
        prefix = (bullet_char + "  ") if level == 0 else ("\u00B7  ")
        p.text = indent + prefix + text
        p.space_after = Pt(space_after); p.line_spacing = line_spacing
        r = p.runs[0]
        r.font.size = Pt(size - (2 if level else 0)); r.font.color.rgb = color; r.font.name = font
    return tb

def add_header(slide, kicker, title, size=25):
    add_rect(slide, 0, 0, SLIDE_W, 1.2, NAVY)
    add_rect(slide, 0, 0, 0.14, 1.2, CHAMPAGNE)
    add_rect(slide, 0, 1.2, SLIDE_W, 0.03, CHAMPAGNE)
    if kicker:
        add_text(slide, 0.55, 0.17, 11.5, 0.32, kicker.upper(), size=11.5, color=CHAMPAGNE_L,
                  bold=True, font=SANS)
    add_text(slide, 0.55, 0.5, 12.3, 0.66, title, size=size, color=WHITE, bold=True, font=SERIF)

def add_footer(slide, tag=""):
    n = PAGE["n"]
    add_rect(slide, 0, 7.22, SLIDE_W, 0.014, BORDER)
    add_text(slide, 0.55, 7.26, 8.5, 0.24,
              "One Tool, Many Lesions \u2013 Coblation in Laryngeal Pathology" + (f"   |   {tag}" if tag else ""),
              size=8.5, color=GRAY_TEXT, italic=True, font=SERIF)
    add_text(slide, 12.0, 7.26, 0.8, 0.24, str(n), size=9, color=CHAMPAGNE, bold=True, align=PP_ALIGN.RIGHT)

def add_placeholder(slide, x, y, w, h, label):
    sp = slide.shapes.add_shape(MSO_SHAPE.RECTANGLE, Inches(x), Inches(y), Inches(w), Inches(h))
    sp.fill.solid(); sp.fill.fore_color.rgb = PH_BG
    sp.line.color.rgb = PH_BORDER; sp.line.width = Pt(1.0)
    set_dashed(sp); sp.shadow.inherit = False
    tf = sp.text_frame; tf.word_wrap = True; tf.vertical_anchor = MSO_ANCHOR.MIDDLE
    p = tf.paragraphs[0]; p.alignment = PP_ALIGN.CENTER
    p.text = "TO BE INSERTED BY PRESENTER"
    r = p.runs[0]; r.font.size = Pt(10); r.font.bold = True; r.font.color.rgb = CHAMPAGNE; r.font.name = SANS
    p2 = tf.add_paragraph(); p2.alignment = PP_ALIGN.CENTER
    p2.text = label
    r2 = p2.runs[0]; r2.font.size = Pt(12); r2.font.color.rgb = GRAY_TEXT; r2.font.name = SANS
    return sp

def add_picture_fit(slide, path, x, y, w, h):
    from PIL import Image
    try:
        im = Image.open(path); iw, ih = im.size
        target_ratio = w / h; img_ratio = iw / ih
        if img_ratio > target_ratio:
            new_h = h; new_w = h * img_ratio
        else:
            new_w = w; new_h = w / img_ratio
        pic = slide.shapes.add_picture(path, Inches(x), Inches(y), Inches(new_w), Inches(new_h))
        pic.left = Inches(x + (w - new_w) / 2); pic.top = Inches(y + (h - new_h) / 2)
        return pic
    except Exception:
        return None

def add_caption(slide, x, y, w, h, text):
    add_text(slide, x, y, w, h, text, size=10, color=GRAY_TEXT, italic=True, align=PP_ALIGN.CENTER, font=SERIF)

def corner_accent(slide):
    """Subtle champagne corner brackets for a refined keynote look (dark backgrounds)."""
    add_rect(slide, 0.55, 0.55, 0.5, 0.025, CHAMPAGNE)
    add_rect(slide, 0.55, 0.55, 0.025, 0.5, CHAMPAGNE)
    add_rect(slide, SLIDE_W - 1.05, SLIDE_H - 0.8, 0.5, 0.025, CHAMPAGNE)
    add_rect(slide, SLIDE_W - 0.575, SLIDE_H - 1.05, 0.025, 0.5, CHAMPAGNE)

def table_style(table, rows_data, header_row=True):
    for r in range(len(rows_data)):
        for c in range(len(rows_data[0])):
            cell = table.cell(r, c)
            cell.vertical_anchor = MSO_ANCHOR.MIDDLE
            cell.margin_left = Inches(0.08); cell.margin_right = Inches(0.08)
            cell.margin_top = Inches(0.04); cell.margin_bottom = Inches(0.04)
            p = cell.text_frame.paragraphs[0]
            run = p.runs[0] if p.runs else p.add_run()
            run.font.name = SANS
            run.font.size = Pt(12.5 if r else 13)
            run.font.bold = (r == 0)
            run.font.color.rgb = WHITE if r == 0 else INK
            cell.fill.solid()
            if r == 0:
                cell.fill.fore_color.rgb = NAVY
            else:
                cell.fill.fore_color.rgb = ROW_ALT if r % 2 == 0 else WHITE

# =================================================================
# 1. TITLE SLIDE  (Guest Lecture framing)
# =================================================================
s = new_slide(NAVY_DEEP)
add_rect(s, 0, 0, SLIDE_W, 0.1, CHAMPAGNE)
add_rect(s, 0, SLIDE_H - 0.1, SLIDE_W, 0.1, CHAMPAGNE)
corner_accent(s)
add_text(s, 0.9, 0.85, 11.5, 0.4, "GUEST LECTURE  \u00B7  NATIONAL CONFERENCE ON OTOLARYNGOLOGY \u2013 HEAD & NECK SURGERY",
         size=13, color=CHAMPAGNE, bold=True, align=PP_ALIGN.CENTER, font=SANS)
add_text(s, 0.9, 1.25, 11.5, 0.35, "[CONFERENCE NAME]  \u00B7  [CITY]  \u00B7  [YEAR]",
         size=11.5, color=RGBColor(0x9C, 0xAB, 0xBC), align=PP_ALIGN.CENTER, font=SANS)
add_text(s, 0.9, 2.35, 11.5, 1.7,
         "One Tool, Many Lesions", size=46, color=WHITE, bold=True, align=PP_ALIGN.CENTER, font=SERIF)
add_rect(s, 5.6, 3.55, 2.1, 0.025, CHAMPAGNE)
add_text(s, 0.9, 3.75, 11.5, 1.0,
         "Coblation and the Modern Management of Diverse Laryngeal Pathology",
         size=20, color=RGBColor(0xD9, 0xE1, 0xEA), align=PP_ALIGN.CENTER, font=SERIF)
add_text(s, 0.9, 4.5, 11.5, 0.45,
         "An illustrated lecture, drawing on advanced cases managed at [Institute Name]",
         size=13.5, color=RGBColor(0xB9, 0xC6, 0xD3), italic=True, align=PP_ALIGN.CENTER, font=SANS)
add_text(s, 0.9, 5.5, 11.5, 0.4, "[Presenter Name], MS, DNB, FRCS",
         size=16, color=WHITE, bold=True, align=PP_ALIGN.CENTER, font=SERIF)
add_text(s, 0.9, 5.92, 11.5, 0.4, "Senior Consultant / Professor \u2013 Department of ENT, Head & Neck Surgery",
         size=12.5, color=RGBColor(0xC9, 0xD3, 0xDD), align=PP_ALIGN.CENTER, font=SANS)
add_text(s, 0.9, 6.28, 11.5, 0.4, "[Institute / Medical College Name]",
         size=12.5, color=RGBColor(0xA9, 0xB6, 0xC4), align=PP_ALIGN.CENTER, font=SANS)

# =================================================================
# 2. DISCLOSURES
# =================================================================
s = new_slide()
add_header(s, "Preliminary", "Disclosures")
add_bullets(s, 0.8, 1.7, 11.5, 2.5, [
    "No financial relationship with any device manufacturer, including coblation/plasma-ablation system vendors",
    "No conflict of interest relevant to the content of this lecture",
    "All patient images, videos and data are used with informed consent and institutional ethics approval",
    "[Edit this slide to reflect the presenter's actual disclosures before the conference]",
], size=17)
add_footer(s)

# =================================================================
# 3. LECTURE ROADMAP
# =================================================================
s = new_slide()
add_header(s, "Roadmap", "What This Lecture Will Cover")
outline = [
    "The spectrum & diagnostic challenge of benign / non-malignant laryngeal lesions",
    "Coblation \u2013 concept, mechanism and rationale in laryngology",
    "Learning objectives for today",
    "Our institute's experience and approach to advanced laryngeal disease",
    "Five illustrative teaching cases: recognition \u2192 imaging \u2192 technique \u2192 histopathology \u2192 outcome",
    "        1. Subglottic Chondroma      2. Hypopharyngeal Hemangioma      3. Subglottic Necrotising Granuloma",
    "        4. Laryngeal Amyloidosis      5. Intubation (Vocal Process) Granuloma",
    "Coblation vs. conventional modalities \u2013 an evidence-based comparison",
    "Recap, take-home message and key references",
]
add_bullets(s, 0.8, 1.6, 11.6, 5.0, outline, size=16.5, space_after=13)
add_footer(s)

# =================================================================
# 4. INTRODUCTION
# =================================================================
s = new_slide()
add_header(s, "Introduction", "The Spectrum of Benign & Non-Malignant Laryngeal Lesions")
add_bullets(s, 0.8, 1.55, 7.3, 5.2, [
    "The larynx hosts an unusually wide range of pathology within a small, function-critical space \u2013 voice, airway and swallowing all converge here",
    "Aetiologies range from congenital/neoplastic (chondroma), vascular (hemangioma), autoimmune-granulomatous (GPA), infiltrative-deposition (amyloidosis), to purely reactive/traumatic (intubation granuloma)",
    "Despite this diversity, the surgical goals are shared:",
    ("preserve the airway", 1),
    ("preserve voice and swallowing function", 1),
    ("achieve a bloodless, precise dissection in a confined space", 1),
    ("minimise recurrence and re-stenosis", 1),
    "Conventional tools (cold steel, electrocautery, CO2 laser, microdebrider) each address only some of these goals \u2013 raising the question of a single, versatile energy platform",
], size=15, space_after=8)
add_placeholder(s, 8.4, 1.6, 4.1, 5.1, "Representative endoscopic\ncomposite \u2013 spectrum of lesions")
add_footer(s)

# =================================================================
# 5. WHAT IS COBLATION
# =================================================================
s = new_slide()
add_header(s, "Technology", "Coblation \u2013 Concept & Mechanism")
add_bullets(s, 0.8, 1.55, 7.2, 5.2, [
    "COBLATION = \u201cCOntrolled aBLATION\u201d \u2013 a bipolar, radiofrequency-driven plasma technology",
    "A bipolar wand energises a conductive medium (normal saline) surrounding the electrode, generating a low-temperature plasma field (\u2248 60\u201370\u00B0C)",
    "The plasma field contains charged particles with enough kinetic energy to break molecular (organic) bonds within soft tissue \u2013 tissue is dissolved / ablated rather than burned",
    "Simultaneous bipolar coagulation of small vessels provides haemostasis in the same pass",
    "Tissue temperatures remain far below those of electrocautery (200\u2013400\u00B0C) or CO2 laser (400\u20131000\u00B0C), keeping the collateral thermal-injury zone small (literature estimates \u2248100 microns)",
], size=15, space_after=10)
add_placeholder(s, 8.3, 1.6, 4.2, 5.1, "Coblation wand /\nplasma-field schematic diagram")
add_footer(s)

# =================================================================
# 6. ADVANTAGES IN LARYNGOLOGY
# =================================================================
s = new_slide()
add_header(s, "Technology", "Why Coblation Suits the Larynx")
cols = [
    ("Precision", "Fine wand tips allow controlled, layer-by-layer tissue removal in a confined airway"),
    ("Haemostasis", "Concurrent bipolar coagulation keeps the surgical field largely bloodless \u2013 valuable for vascular lesions"),
    ("Low Thermal Profile", "A markedly lower operating temperature than laser/electrocautery limits injury to adjacent structures"),
    ("Function Preservation", "Lower collateral damage helps preserve voice, swallowing and airway calibre"),
    ("Reduced Scarring", "Less thermal injury can translate into less granulation and lower re-stenosis in recurrence-prone disease"),
    ("Versatility", "Effective across neoplastic, vascular, granulomatous, infiltrative and reactive tissue \u2013 one platform, many indications"),
]
x0, y0, w, h, gap = 0.7, 1.55, 3.9, 2.4, 0.25
for i, (t, d) in enumerate(cols):
    col = i % 3; row = i // 3
    x = x0 + col * (w + gap); y = y0 + row * (h + gap)
    add_rect(s, x, y, w, h, LIGHT_BG, line_color=BORDER, line_pt=1)
    add_rect(s, x, y, w, 0.07, CHAMPAGNE)
    add_text(s, x + 0.25, y + 0.22, w - 0.5, 0.4, t, size=15, color=NAVY, bold=True, font=SERIF)
    add_text(s, x + 0.25, y + 0.65, w - 0.5, h - 0.8, d, size=12, color=INK)
add_footer(s)

# =================================================================
# 7. LEARNING OBJECTIVES
# =================================================================
s = new_slide()
add_header(s, "Learning Objectives", "By the End of This Lecture, You Should Be Able To\u2026")
add_bullets(s, 0.9, 1.8, 11.4, 4.6, [
    "Recognise the clinical, endoscopic, radiological and histopathological features of five diverse laryngeal lesions",
    "Understand the mechanism, evidence base and lesion-specific surgical nuances of coblation in laryngology",
    "Compare coblation with conventional modalities \u2013 cold steel, electrocautery and CO2 laser \u2013 on haemostasis, thermal injury and functional preservation",
    "Appreciate how, with a structured, experienced multidisciplinary approach, even advanced and complex laryngeal lesions are managed safely and efficiently in routine practice",
], size=17.5, space_after=18)
add_footer(s)

# =================================================================
# 8. OUR INSTITUTE'S EXPERTISE
# =================================================================
s = new_slide()
add_header(s, "Institutional Context", "Advanced Laryngeal Disease \u2013 Our Approach")
add_text(s, 0.8, 1.45, 11.7, 0.45,
          "Complex laryngeal referrals are managed routinely and safely through a structured, experienced service:",
          size=14, color=GRAY_TEXT, italic=True, font=SERIF)
cards = [
    ("Dedicated Airway & Laryngology Service", "A focused endoscopic laryngology practice with coblation-assisted surgery integrated into routine care, not reserved for exceptional cases"),
    ("Multidisciplinary Collaboration", "Close coordination with rheumatology, haematology and speech-language pathology for systemic or recurrence-prone disease (e.g. GPA, amyloidosis)"),
    ("Standardised, Reproducible Technique", "Protocol-driven wand settings and staged-debulking approaches refined over years of institutional experience"),
    ("Consistent, Favourable Outcomes", "Low complication rates and preserved airway/voice/swallowing function, even in advanced or previously-treated referrals"),
]
x0, y0, w, h, gap = 0.8, 2.05, 5.75, 2.15, 0.3
for i, (t, d) in enumerate(cards):
    col = i % 2; row = i // 2
    x = x0 + col * (w + gap); y = y0 + row * (h + gap)
    add_rect(s, x, y, w, h, LIGHT_BG, line_color=BORDER)
    add_rect(s, x, y, 0.08, h, CHAMPAGNE)
    add_text(s, x + 0.3, y + 0.18, w - 0.55, 0.5, t, size=14.5, color=NAVY, bold=True, font=SERIF)
    add_text(s, x + 0.3, y + 0.68, w - 0.55, h - 0.85, d, size=12, color=INK)
add_text(s, 0.8, 6.65, 11.7, 0.4,
          "[Presenter to insert institute-specific case volume / years of experience / outcome statistics]",
          size=10.5, color=GRAY_TEXT, italic=True, font=SANS)
add_footer(s)

# =================================================================
# 9. CASES IN TODAY'S LECTURE (snapshot table)
# =================================================================
s = new_slide()
add_header(s, "Overview", "Five Teaching Cases at a Glance")
rows_data = [
    ["#", "Lesion", "Site", "Core Pathology", "Role of Coblation"],
    ["1", "Subglottic Chondroma", "Posterior cricoid lamina", "Benign cartilaginous neoplasm", "Precision cartilage debulking"],
    ["2", "Hypopharyngeal Hemangioma", "Pyriform fossa / post. pharyngeal wall", "Vascular malformation", "Bloodless ablation & shrinkage"],
    ["3", "Subglottic Necrotising Granuloma", "Circumferential subglottis", "ANCA-associated vasculitis (GPA)", "Low-trauma debulking + dilatation"],
    ["4", "Laryngeal Amyloidosis", "True/false cord, ventricle", "Recurrence-prone AL deposition", "Tissue-sparing staged debulking"],
    ["5", "Intubation / Vocal Process Granuloma", "Posterior glottis", "Reactive granulation tissue", "Precise excision, low recurrence"],
]
tbl_shape = s.shapes.add_table(len(rows_data), 5, Inches(0.55), Inches(1.55), Inches(12.25), Inches(4.9))
table = tbl_shape.table
for i, wv in enumerate([0.55, 3.1, 2.9, 3.0, 2.7]):
    table.columns[i].width = Inches(wv)
for r in range(len(rows_data)):
    for c in range(5):
        table.cell(r, c).text = rows_data[r][c]
table_style(table, rows_data)
for r in range(1, len(rows_data)):
    table.cell(r, 0).text_frame.paragraphs[0].alignment = PP_ALIGN.CENTER
add_footer(s)

# =================================================================
# CASE BUILDER
# =================================================================
def divider(no, name, subtitle):
    s = new_slide(NAVY_DEEP)
    add_rect(s, 0, 0, SLIDE_W, 0.1, CHAMPAGNE)
    add_rect(s, 0, SLIDE_H - 0.1, SLIDE_W, 0.1, CHAMPAGNE)
    corner_accent(s)
    add_text(s, 0.9, 2.3, 11, 0.5, f"TEACHING CASE {no} OF 5", size=17, color=CHAMPAGNE, bold=True, font=SANS)
    add_rect(s, 0.92, 2.85, 1.6, 0.03, CHAMPAGNE)
    add_text(s, 0.9, 3.0, 11.5, 1.5, name, size=36, color=WHITE, bold=True, font=SERIF)
    add_text(s, 0.9, 4.15, 11.3, 0.8, subtitle, size=15.5, color=RGBColor(0xC9, 0xD3, 0xDD), italic=True, font=SERIF)
    add_footer(s, tag=f"Case {no}")
    return s

def clinical_imaging(no, name, presentation, imaging, real_images=None):
    s = new_slide()
    add_header(s, f"Teaching Case {no} \u00B7 {name}", "Clinical Presentation & Imaging")
    add_text(s, 0.7, 1.5, 6.9, 0.35, "Clinical Presentation", size=14.5, color=SLATE, bold=True, font=SERIF)
    add_bullets(s, 0.7, 1.9, 6.9, 4.7, presentation, size=13.5, space_after=9)
    add_text(s, 7.9, 1.5, 4.7, 0.35, "Imaging", size=14.5, color=SLATE, bold=True, font=SERIF)
    if real_images:
        yy = 1.9
        for path, cap in real_images:
            add_picture_fit(s, path, 7.9, yy, 4.7, 2.3)
            add_caption(s, 7.9, yy + 2.32, 4.7, 0.3, cap)
            yy += 2.75
    else:
        add_placeholder(s, 7.9, 1.9, 4.7, 2.6, "CT / MRI scan")
        add_bullets(s, 7.9, 4.65, 4.7, 2.0, imaging, size=12, space_after=6)
    add_footer(s, tag=f"Case {no}")
    return s

def multimedia_gallery(no, name, notes=None, real_images=None):
    s = new_slide()
    add_header(s, f"Teaching Case {no} \u00B7 {name}", "Intra-operative & Endoscopic Multimedia")
    labels = [
        ("Pre-operative Endoscopy", "video"),
        ("Intra-operative \u2013 Coblation in Use", "video"),
        ("Post-operative Endoscopy / Follow-up", "video"),
    ]
    x0, y0, w, h, gap = 0.6, 1.55, 3.85, 4.9, 0.2
    real_images = real_images or {}
    for i, (label, kind) in enumerate(labels):
        x = x0 + i * (w + gap)
        if label in real_images:
            add_picture_fit(s, real_images[label], x, y0, w, h - 0.4)
            add_caption(s, x, y0 + h - 0.35, w, 0.3, label + " (representative image \u2013 supplement with video)")
        else:
            add_placeholder(s, x, y0, w, h, label)
    if notes:
        add_text(s, 0.6, 6.7, 12.1, 0.4, notes, size=10.5, color=GRAY_TEXT, italic=True, font=SANS)
    add_footer(s, tag=f"Case {no}")
    return s

def histopath_slide(no, name, findings, stain_note=None):
    s = new_slide()
    add_header(s, f"Teaching Case {no} \u00B7 {name}", "Histopathology")
    add_placeholder(s, 0.7, 1.6, 5.6, 4.9, "Histopathology photomicrograph(s)\n(H&E / special stain)")
    add_text(s, 6.6, 1.6, 6.0, 0.35, "Key Microscopic Findings", size=14.5, color=SLATE, bold=True, font=SERIF)
    add_bullets(s, 6.6, 2.0, 6.0, 3.8, findings, size=14, space_after=10)
    if stain_note:
        add_rect(s, 6.6, 5.9, 6.0, 0.75, LIGHT_BG, line_color=BORDER)
        add_text(s, 6.75, 6.0, 5.7, 0.55, stain_note, size=11.5, color=NAVY, italic=True, anchor=MSO_ANCHOR.MIDDLE, font=SERIF)
    add_footer(s, tag=f"Case {no}")
    return s

def technique_outcome(no, name, technique, outcome, pearl):
    s = new_slide()
    add_header(s, f"Teaching Case {no} \u00B7 {name}", "Coblation Technique, Outcome & Learning Point")
    add_text(s, 0.7, 1.5, 5.9, 0.35, "Surgical Technique", size=14.5, color=SLATE, bold=True, font=SERIF)
    add_bullets(s, 0.7, 1.9, 5.9, 3.5, technique, size=13, space_after=9)
    add_text(s, 6.9, 1.5, 5.7, 0.35, "Outcome", size=14.5, color=SLATE, bold=True, font=SERIF)
    add_bullets(s, 6.9, 1.9, 5.7, 3.5, outcome, size=13, space_after=9)
    pearl_box = add_rect(s, 0.7, 5.75, 11.9, 1.15, NAVY_MID)
    add_rect(s, 0.7, 5.75, 0.08, 1.15, CHAMPAGNE)
    tf = pearl_box.text_frame; tf.word_wrap = True; tf.vertical_anchor = MSO_ANCHOR.MIDDLE
    tf.margin_left = Inches(0.35)
    p = tf.paragraphs[0]; p.text = "Learning Point \u2013 " + pearl
    r = p.runs[0]; r.font.size = Pt(13.5); r.font.italic = True; r.font.color.rgb = WHITE; r.font.name = SERIF
    add_footer(s, tag=f"Case {no}")
    return s

CASES = [
{
 "no": 1, "name": "Subglottic Chondroma", "subtitle": "A slow-growing benign cartilaginous tumour of the cricoid",
 "presentation": [
    "Adult patient with insidious, progressive dyspnoea, stridor \u00B1 hoarseness over months to years",
    "Rare entity \u2013 <1% of laryngeal tumours; the commonest benign cartilaginous neoplasm of the larynx",
    "Classically arises from the posterior lamina of the cricoid cartilage (residual endochondral ossification centres)",
    "Firm, smooth, submucosal, non-ulcerated swelling narrowing the subglottic airway on flexible laryngoscopy",
 ],
 "imaging": [
    "Contrast CT larynx: well-defined, lobulated, often calcified/ossified submucosal mass arising from the cricoid",
    "MRI clarifies cartilage invasion and helps exclude low-grade chondrosarcoma",
    "Key differential: chondrosarcoma, laryngocele, paraganglioma, subglottic haemangioma",
 ],
 "histopath": [
    "Mature hyaline cartilage, low cellularity, chondrocytes arranged in an orderly lacunar pattern",
    "No cytological atypia, no significant mitoses, no destructive/invasive growth",
    "Distinction from low-grade chondrosarcoma is subtle and requires generous, representative biopsy",
 ],
 "stain_note": "Histological overlap with low-grade chondrosarcoma means diagnosis rests on the whole specimen, not a small biopsy.",
 "technique": [
    "Suspension microlaryngoscopy; coblation wand introduced under magnified endoscopic view",
    "Low-temperature bipolar plasma (\u224860\u201370\u00B0C) used for controlled, layer-by-layer shaving of the cartilaginous mass",
    "Overlying mucosa and perichondrium preserved wherever feasible to protect the cricoid framework",
    "Continuous saline irrigation maintains a clear, bloodless field for precise endpoint judgement",
 ],
 "outcome": [
    "Airway secured endoscopically \u2013 tracheostomy avoided",
    "Uneventful post-operative course; serial follow-up endoscopy shows a re-epithelialised, patent subglottis",
    "No airway compromise or restenosis on interval review",
 ],
 "pearl": "Coblation permits precise cartilage debulking with minimal thermal spread to the adjacent cricoid \u2013 critical when the surgical goal is airway restoration without destabilising the laryngeal framework.",
},
{
 "no": 2, "name": "Hypopharyngeal Hemangioma", "subtitle": "A vascular submucosal lesion demanding a bloodless approach",
 "presentation": [
    "Presents with foreign-body sensation, odynophagia, muffled voice or intermittent haemoptysis",
    "Bluish-to-reddish, compressible, submucosal swelling typically in the pyriform fossa or posterior pharyngeal wall",
    "Blind biopsy is discouraged \u2013 risk of significant haemorrhage from a vascular lesion",
 ],
 "imaging": [
    "Contrast-enhanced CT/MRI: well-circumscribed, avidly enhancing submucosal lesion",
    "Large or deep lesions may warrant angiography to define feeding vessels before intervention",
 ],
 "histopath": [
    "Proliferation of endothelial-lined vascular channels \u2013 cavernous and/or capillary pattern",
    "Bland endothelium, no cytological atypia or mitotic activity",
    "Correlate with clinical/radiological vascular appearance to avoid misclassification",
 ],
 "stain_note": "CD31 / CD34 immunostaining confirms endothelial lineage when the diagnosis is in doubt.",
 "technique": [
    "Direct laryngo-pharyngoscopy under general anaesthesia; coblation wand applied directly to the lesion",
    "Simultaneous ablation and bipolar coagulation shrink the vascular mass while sealing feeding channels in real time",
    "Staged, gentle passes avoid full-thickness pharyngeal wall injury",
 ],
 "outcome": [
    "Essentially bloodless intra-operative field \u2013 no transfusion required",
    "Resolution of foreign-body sensation / dysphagia",
    "No recurrence on subsequent follow-up endoscopy",
 ],
 "pearl": "The simultaneous cut-and-coagulate profile of coblation is the strongest argument for its use in vascular lesions \u2013 conventional cold instruments risk brisk, field-obscuring bleeding.",
},
{
 "no": 3, "name": "Subglottic Necrotising Granuloma", "subtitle": "Granulomatosis with polyangiitis (GPA) presenting as subglottic stenosis",
 "presentation": [
    "Young-to-middle-aged adult with progressive dyspnoea, stridor and hoarseness",
    "May have systemic clues: sinonasal crusting/saddle-nose deformity, arthralgia, renal impairment, otitis media",
    "Endoscopy: circumferential, erythematous, friable subglottic narrowing",
 ],
 "imaging": [
    "CT neck: circumferential subglottic soft-tissue thickening / stenosis \u00B1 cartilage erosion",
    "Chest CT to look for pulmonary nodules/cavitation; renal function screen",
    "c-ANCA / PR3-ANCA serology, ESR/CRP for systemic disease workup",
 ],
 "histopath": [
    "Necrotising granulomatous inflammation with multinucleate giant cells",
    "True vasculitis is often absent on limited endoscopic biopsy \u2013 diagnosis needs clinico-serological correlation",
    "Rule out infective granulomas (TB, fungal) and sarcoidosis on special stains/cultures",
 ],
 "stain_note": "PR3-ANCA positivity plus compatible histology supports GPA even when vasculitis is not seen on a small airway biopsy.",
 "technique": [
    "Coblation-assisted endoscopic debulking of granulation/scar tissue combined with balloon dilatation of the stenotic segment",
    "Low collateral thermal injury is deliberately chosen to avoid adding further scarring in an already fibrosing airway",
    "Performed in coordination with rheumatology for concurrent systemic immunosuppression",
 ],
 "outcome": [
    "Improved airway calibre; tracheostomy avoided",
    "Planned serial endoscopic dilatation protocol",
    "Systemic disease control achieved with steroids and rituximab / cyclophosphamide per rheumatology input",
 ],
 "pearl": "In a disease already prone to fibrosis and restenosis, coblation's minimal collateral thermal injury is a genuine advantage over laser or electrocautery, which can seed further granulation.",
},
{
 "no": 4, "name": "Laryngeal Amyloidosis", "subtitle": "A recurrence-prone infiltrative deposition disease of the larynx",
 "presentation": [
    "Middle-aged adult with slowly progressive hoarseness \u00B1 dyspnoea over months to years",
    "Submucosal, waxy, yellow-pink infiltration of the true/false cord, ventricle or subglottis",
    "Most laryngeal amyloid is localised AL type, distinct from systemic amyloidosis \u2013 systemic screening is still mandatory",
 ],
 "imaging": [
    "CT: diffuse submucosal thickening \u00B1 punctate calcification",
    "MRI defines mucosal/submucosal extent for surgical planning",
    "Systemic work-up: serum/urine protein electrophoresis, free light chains, cardiac and renal screening",
 ],
 "histopath": [
    "Amorphous, eosinophilic, extracellular hyaline deposits within the lamina propria",
    "Congo red staining shows pathognomonic apple-green birefringence under polarised light",
    "Immunohistochemistry / mass spectrometry typing (AL most common in the larynx)",
 ],
 "stain_note": "Congo red + polarised light is the confirmatory test; subtype AL vs ATTR guides systemic follow-up.",
 "technique": [
    "Staged coblation debulking preserving as much normal mucosa and underlying muscle as possible to protect phonation",
    "Circumferential/full-thickness injury deliberately avoided to reduce stenosis risk given the high likelihood of repeat procedures",
    "Multidisciplinary referral (haematology) to exclude systemic amyloidosis",
 ],
 "outcome": [
    "Improved voice quality and airway patency after debulking",
    "Per Galluzzi & Garavello (2023) systematic review, surgical debulking is the mainstay of treatment; recurrence is common, often necessitating repeat procedures",
    "Malignant transformation is rare, but lifelong endoscopic surveillance is advised",
 ],
 "pearl": "Coblation's tissue-sparing ablation is well suited to a disease that often needs repeated debulking \u2013 it avoids the cumulative scarring that repeated laser or cold-steel excision can cause to the vocal fold.",
},
{
 "no": 5, "name": "Intubation (Vocal Process) Granuloma", "subtitle": "A reactive lesion notorious for recurrence after excision",
 "presentation": [
    "Hoarseness, throat pain or globus sensation weeks after intubation, or in the setting of chronic phonotrauma/reflux",
    "Uni- or bilateral pedunculated/sessile mass at the vocal process of the arytenoid (posterior glottis)",
    "Risk factors: traumatic/prolonged intubation, laryngopharyngeal reflux (LPR), vocal abuse, chronic cough",
 ],
 "imaging": [
    "Primarily a clinical/stroboscopic diagnosis; imaging reserved if malignancy needs exclusion",
    "Videostroboscopy documents mucosal wave and confirms posterior glottic location",
 ],
 "histopath": [
    "Granulation tissue: fibrovascular stroma with a chronic inflammatory infiltrate",
    "Overlying epithelium may be ulcerated or hyperplastic; no cytological atypia",
    "Correlate with history of instrumentation/reflux to avoid mistaking this for neoplasia",
 ],
 "stain_note": "No specific stain required; the diagnosis is clinico-pathological.",
 "technique": [
    "Micro-laryngoscopic coblation excision of the granuloma at the vocal process with preservation of arytenoid perichondrium",
    "Combined with medical optimisation \u2013 proton-pump inhibitors, voice therapy, and, in refractory/recurrent cases, botulinum toxin or intralesional steroid injection",
 ],
 "outcome": [
    "Resolution of hoarseness and globus symptoms",
    "Lower recurrence with a combined medical + coblation-assisted surgical approach compared with historical cold-steel excision alone",
 ],
 "pearl": "For a lesion infamous for recurring after surgery, coblation's reduced mucosal trauma and superior haemostasis make any necessary repeat procedure safer and less morbid.",
},
]

real_image_map = {
 3: {"imaging": [(IMG["gpa_ct1"], "Representative contrast CT \u2013 GPA-related airway changes"),
                 (IMG["gpa_ct2"], "Representative contrast CT \u2013 axial neck")]},
 4: {"gallery": {"Pre-operative Endoscopy": IMG["amyloid_supra"],
                 "Intra-operative \u2013 Coblation in Use": IMG["amyloid_preop"]}},
}

for c in CASES:
    divider(c["no"], c["name"], c["subtitle"])
    ri = real_image_map.get(c["no"], {}).get("imaging")
    clinical_imaging(c["no"], c["name"], c["presentation"], c["imaging"], real_images=ri)
    gallery_imgs = real_image_map.get(c["no"], {}).get("gallery")
    multimedia_gallery(c["no"], c["name"],
                        notes="Faculty note: replace placeholders above with pre-op, intra-op (coblation in action) and post-op endoscopy clips; add scan/histopathology images on the following slides.",
                        real_images=gallery_imgs)
    histopath_slide(c["no"], c["name"], c["histopath"], stain_note=c.get("stain_note"))
    technique_outcome(c["no"], c["name"], c["technique"], c["outcome"], c["pearl"])

# =================================================================
# COMPARATIVE TABLE
# =================================================================
s = new_slide()
add_header(s, "Learning Point", "Coblation vs. Conventional Modalities")
rows_data = [
    ["Parameter", "Coblation", "CO2 Laser", "Cold Steel", "Electrocautery / Microdebrider"],
    ["Tissue temperature", "\u224860\u201370\u00B0C (low)", "400\u20131000\u00B0C (high)", "N/A (mechanical)", "200\u2013400\u00B0C (high)"],
    ["Collateral thermal spread", "Low, literature estimate \u2248100 \u00B5m", "Moderate\u2013high, char risk", "None", "Moderate\u2013high"],
    ["Haemostasis", "Generally favourable (built-in)", "Good", "Poor \u2013 needs adjunct", "Good"],
    ["Airway fire risk (with O2)", "Minimal", "Present \u2013 needs precautions", "None", "Present"],
    ["Precision on cartilage/mucosa", "High", "High, but charring risk", "High, but bleeds", "Moderate"],
    ["Versatility across lesion types", "Broad (tumour, vascular, granuloma, deposition, reactive)", "Mainly soft tissue", "Mainly soft tissue", "Mainly soft tissue"],
]
tbl_shape = s.shapes.add_table(len(rows_data), 5, Inches(0.4), Inches(1.5), Inches(12.5), Inches(5.3))
table = tbl_shape.table
for i, wv in enumerate([2.5, 2.7, 2.4, 2.2, 2.7]):
    table.columns[i].width = Inches(wv)
for r in range(len(rows_data)):
    for c in range(5):
        table.cell(r, c).text = rows_data[r][c]
table_style(table, rows_data)
for r in range(1, len(rows_data)):
    cell = table.cell(r, 1)
    cell.text_frame.paragraphs[0].runs[0].font.bold = True
    cell.text_frame.paragraphs[0].runs[0].font.color.rgb = SLATE
    cell.fill.fore_color.rgb = RGBColor(0xEA, 0xEE, 0xF1)
add_footer(s)

# =================================================================
# EVIDENCE FOCUS 1: HAEMOSTASIS / BLOOD LOSS
# =================================================================
s = new_slide()
add_header(s, "Learning Point \u00B7 Evidence", "Haemostasis & Intra-operative Blood Loss")
add_text(s, 0.7, 1.45, 11.9, 0.5,
          "Coblation's built-in bipolar coagulation is its most cited advantage \u2013 but the evidence is procedure-dependent:",
          size=13.5, color=GRAY_TEXT, italic=True, font=SERIF)
rows_data = [
    ["Study (Evidence)", "Comparison", "Key Finding"],
    ["Albazee et al. 2022 \u2013 Systematic Review\n& Meta-analysis of RCTs, Eur Arch ORL\nPMID 35810212",
     "Coblation vs CO2/diode\nLaser Tonsillectomy",
     "Coblation \u2192 significantly LOWER intra-op blood loss (MD \u2013 5.08 mL) and shorter operative time (MD \u2013 4.50 min); no difference in pain or secondary haemorrhage"],
    ["Hao et al. 2020, Bioscience Reports\nPMID 32426815",
     "Coblation vs CO2 Laser \u2013\nlaryngotracheal RRP",
     "Coblation \u2192 significantly LESS blood loss, shorter operative time, longer symptom-free interval and lower post-op pain scores"],
    ["Wang et al. 2022 \u2013 Meta-analysis,\nComput Math Methods Med\nPMID 35844439",
     "Low-temperature plasma RFA\nvs CO2 Laser \u2013 early glottic\ncarcinoma",
     "Contrary finding: RFA/coblation showed HIGHER intra-operative blood loss than CO2 laser; but shorter operative time and better mucosal recovery; no difference in recurrence"],
]
tbl_shape = s.shapes.add_table(len(rows_data), 3, Inches(0.5), Inches(2.05), Inches(12.35), Inches(4.55))
table = tbl_shape.table
for i, wv in enumerate([3.55, 2.9, 5.9]):
    table.columns[i].width = Inches(wv)
for r in range(len(rows_data)):
    for c in range(3):
        table.cell(r, c).text = rows_data[r][c]
table_style(table, rows_data)
for r in range(len(rows_data)):
    for c in range(3):
        table.cell(r, c).text_frame.paragraphs[0].runs[0].font.size = Pt(11.3 if r else 12.5)
add_text(s, 0.7, 6.75, 11.9, 0.4,
          "Take-away: coblation generally reduces blood loss vs. laser in soft-tissue/vascular work, but this benefit is not universal \u2013 site and tissue vascularity matter.",
          size=11, color=NAVY, italic=True, font=SERIF)
add_footer(s)

# =================================================================
# EVIDENCE FOCUS 2: THERMAL SPREAD / TISSUE INJURY
# =================================================================
s = new_slide()
add_header(s, "Learning Point \u00B7 Evidence", "Thermal Spread & Collateral Tissue Injury")
add_bullets(s, 0.7, 1.55, 11.9, 2.0, [
    "Coblation operates at \u224860\u201370\u00B0C vs. 400\u20131000\u00B0C for CO2 laser and 200\u2013400\u00B0C for electrocautery \u2013 the physical basis for a smaller thermal injury zone",
    "Karakkandy et al. 2024, Indian J Otolaryngol Head Neck Surg (PMID 39376295) \u2013 double-anonymised histopathological comparison of CO2 laser vs. coblation in 50 head & neck / laryngeal excisions:",
], size=13.5, space_after=8)
add_rect(s, 0.9, 3.55, 11.5, 2.55, LIGHT_BG, line_color=BORDER)
add_rect(s, 0.9, 3.55, 0.08, 2.55, CHAMPAGNE)
add_bullets(s, 1.2, 3.7, 11.0, 2.35, [
    "Incision margins were more regular with CO2 laser (73%) than coblation (55%) \u2013 not statistically significant (P = 1.80)",
    "Depth of thermal damage and connective-tissue change trended HIGHER with coblation than CO2 laser (P = 0.171 and 0.279 \u2013 not statistically significant)",
    "Vascular thermal changes were seen more with CO2 laser (P = 0.727)",
    "Authors' conclusion: both are effective; CO2 laser, where available, may offer more precise excision with less collateral damage",
], size=12.5, space_after=8)
add_text(s, 0.7, 6.35, 11.9, 0.8,
          "Take-away: coblation's low-temperature mechanism is real, but current histopathological evidence does NOT show it to be categorically superior to CO2 laser in collateral thermal injury \u2013 differences seen so far are not statistically significant. The clinical advantage of coblation lies more in speed, haemostasis and ergonomics than a proven thermal-injury edge.",
          size=11, color=NAVY, italic=True, font=SERIF)
add_footer(s)

# =================================================================
# EVIDENCE FOCUS 3: FUNCTION PRESERVATION (VOICE / AIRWAY)
# =================================================================
s = new_slide()
add_header(s, "Learning Point \u00B7 Evidence", "Function Preservation \u2013 Voice & Airway Outcomes")
add_bullets(s, 0.7, 1.5, 11.9, 5.3, [
    "Svistushkin et al. 2022, Eur Arch ORL (PMID 34482444) \u2013 analytical review + institutional series of 20 patients undergoing cold-plasma posterior cordotomy for bilateral vocal fold paralysis: coblation gave minimal trauma to surrounding tissue, complete one-pass haemostasis, and an easier post-operative course; functional voice was preserved via long-term orthophonic training",
    "Benninger et al. 2018, JAMA Otolaryngol Head Neck Surg (PMID 29242922) and 2025 multicentre follow-up in J Voice (PMID 36270920) \u2013 coblation cordotomy for bilateral vocal fold immobility: consistent airway improvement with maintained voice quality and quality-of-life scores on long-term follow-up",
    "El-Sobki et al. 2023, J Voice (PMID 37923654) \u2013 prospective study, diode laser vs. coblation for bilateral abductor paralysis (n = 80): both effective with similarly preserved voice quality (VHI); coblation had significantly shorter operative time and lower post-operative pain, with a greater reduction in maximum phonation time",
    "Lou et al. 2025, J Voice (PMID 36414529) \u2013 coblation vs. microflap resection of vocal-fold leukoplakia: comparable oncological safety with functional voice outcomes reported for coblation",
], size=13.5, space_after=11)
add_footer(s)

# =================================================================
# RECENT EVIDENCE SUMMARY
# =================================================================
s = new_slide()
add_header(s, "Evidence Base", "Recent Literature Supporting Coblation in Laryngeal Pathology")
eb_rows = [
    ["Author, Year", "Study Type", "Focus", "PMID"],
    ["Svistushkin et al. 2022", "Review + Case Series", "Coblation across otorhinolaryngology incl. laryngeal cordotomy", "34482444"],
    ["Albazee et al. 2022", "Systematic Review & Meta-analysis", "Coblation vs laser tonsillectomy \u2013 blood loss, pain, time", "35810212"],
    ["Wang et al. 2022", "Meta-analysis", "Plasma RFA vs CO2 laser \u2013 early glottic carcinoma", "35844439"],
    ["Hao et al. 2020", "Comparative Study", "Coblation vs CO2 laser \u2013 laryngotracheal RRP outcomes", "32426815"],
    ["Karakkandy et al. 2024", "Histopathological Comparative Study", "Thermal injury: coblation vs CO2 laser in H&N/larynx", "39376295"],
    ["El-Sobki et al. 2023", "Prospective Comparative Study", "Coblation vs diode laser \u2013 bilateral abductor paralysis", "37923654"],
    ["Benninger et al. 2018 / 2025", "Cohort / Multicentre", "Coblation cordotomy \u2013 bilateral vocal fold immobility", "29242922 / 36270920"],
    ["Lou et al. 2025", "Comparative Study", "Coblation vs microflap \u2013 vocal fold leukoplakia", "36414529"],
    ["Galluzzi & Garavello 2023", "Systematic Review", "Surgical treatment of laryngeal amyloidosis", "36790723"],
    ["McNally et al. 2025", "Comparative Study", "Coblation vs microdebrider \u2013 paediatric RRP", "40518634"],
]
tbl_shape = s.shapes.add_table(len(eb_rows), 4, Inches(0.4), Inches(1.55), Inches(12.5), Inches(5.35))
table = tbl_shape.table
for i, wv in enumerate([2.9, 3.1, 4.9, 1.6]):
    table.columns[i].width = Inches(wv)
for r in range(len(eb_rows)):
    for c in range(4):
        table.cell(r, c).text = eb_rows[r][c]
table_style(table, eb_rows)
for r in range(len(eb_rows)):
    for c in range(4):
        table.cell(r, c).text_frame.paragraphs[0].runs[0].font.size = Pt(10.7 if r else 12.3)
    table.cell(r, 3).text_frame.paragraphs[0].alignment = PP_ALIGN.CENTER
add_footer(s)

# =================================================================
# RECAP: WHAT WE LEARNED FROM TODAY'S FIVE CASES
# =================================================================
s = new_slide()
add_header(s, "Recap", "What We Learned From Today's Five Cases")
rows = [
    ("Subglottic Chondroma", "Needs precise cartilage debulking without destabilising the cricoid \u2192 coblation's controlled shaving"),
    ("Hypopharyngeal Hemangioma", "Needs simultaneous cutting and haemostasis \u2192 coblation's bipolar coagulation"),
    ("Subglottic Necrotising Granuloma (GPA)", "Needs debulking without adding further fibrosis \u2192 coblation's low thermal profile"),
    ("Laryngeal Amyloidosis", "Needs repeatable, tissue-sparing debulking for a recurrence-prone disease \u2192 coblation's low collateral injury"),
    ("Intubation Granuloma", "Needs precise excision with minimal mucosal trauma to curb recurrence \u2192 coblation's atraumatic ablation"),
]
y = 1.75
for name, reason in rows:
    add_rect(s, 0.7, y, 0.1, 0.68, CHAMPAGNE)
    add_text(s, 1.0, y, 3.6, 0.68, name, size=13, color=NAVY, bold=True, anchor=MSO_ANCHOR.MIDDLE, font=SERIF)
    add_text(s, 4.7, y, 7.9, 0.68, reason, size=12.5, color=INK, anchor=MSO_ANCHOR.MIDDLE)
    y += 0.88
add_footer(s)

# =================================================================
# LIMITATIONS
# =================================================================
s = new_slide()
add_header(s, "Learning Point", "Limitations & Honest Appraisal")
add_bullets(s, 0.8, 1.6, 11.5, 5.0, [
    "Current evidence base is dominated by case reports and small case series \u2013 larger prospective, comparative studies are lacking",
    "Recurring cost of disposable coblation wands compared with reusable cold instruments",
    "Wand calibre may limit access in very narrow paediatric airways or deeply recessed sites",
    "Not a substitute for oncologic resection with margin control in malignant disease \u2013 role here is confined to benign / non-malignant pathology",
    "Outcomes remain operator- and technique-dependent; a deliberate learning curve exists in power/setting selection for different tissue types",
], size=16, space_after=14)
add_footer(s)

# =================================================================
# TAKE-HOME MESSAGE
# =================================================================
s = new_slide(NAVY_DEEP)
add_rect(s, 0, 0, SLIDE_W, 0.1, CHAMPAGNE)
add_rect(s, 0, SLIDE_H - 0.1, SLIDE_W, 0.1, CHAMPAGNE)
corner_accent(s)
add_text(s, 0.8, 0.55, 11.7, 0.6, "TAKE-HOME MESSAGE", size=25, color=CHAMPAGNE, bold=True, align=PP_ALIGN.CENTER, font=SERIF)
add_rect(s, 5.6, 1.25, 2.1, 0.025, CHAMPAGNE)
messages = [
    "Coblation is a single, low-temperature plasma-ablation platform that performs reliably across neoplastic, vascular, autoimmune-granulomatous, infiltrative and reactive laryngeal disease.",
    "Recognising these lesions early \u2013 clinically, radiologically and histopathologically \u2013 is the first and most important step; the choice of energy tool comes second.",
    "As shown today, even advanced and previously-untreated laryngeal pathology can be managed safely and efficiently with an experienced, structured, multidisciplinary approach.",
    "Coblation deserves a permanent place in the endoscopic laryngologist's armamentarium \u2013 as a versatile complement to, not a replacement for, cold steel, laser and microdebrider.",
]
y = 1.65
for i, msg in enumerate(messages, 1):
    add_rect(s, 0.9, y, 0.5, 0.5, CHAMPAGNE, shape=MSO_SHAPE.OVAL)
    tf_num = s.shapes[-1].text_frame; tf_num.vertical_anchor = MSO_ANCHOR.MIDDLE
    pnum = tf_num.paragraphs[0]; pnum.alignment = PP_ALIGN.CENTER; pnum.text = str(i)
    pnum.runs[0].font.bold = True; pnum.runs[0].font.size = Pt(16); pnum.runs[0].font.color.rgb = NAVY_DEEP
    add_text(s, 1.65, y - 0.02, 10.75, 1.15, msg, size=14.5, color=WHITE, anchor=MSO_ANCHOR.MIDDLE, font=SERIF)
    y += 1.28
add_footer(s)

# =================================================================
# CLOSING SUMMARY
# =================================================================
s = new_slide()
add_header(s, "Key Takeaways", "Closing Summary")
add_bullets(s, 0.8, 1.6, 11.5, 4.6, [
    "Coblation offers a low-temperature, tissue-selective ablation profile that translates into precision, generally favourable haemostasis and a manageable collateral-injury profile",
    "Across five biologically distinct laryngeal lesions discussed today \u2013 neoplastic, vascular, autoimmune-granulomatous, infiltrative and reactive \u2013 coblation achieved effective, function-preserving control",
    "It is best regarded as a versatile adjunct in the endoscopic laryngologist's armamentarium, complementing rather than replacing cold steel, laser and microdebrider",
    "With structured, experienced multidisciplinary care, advanced and complex laryngeal disease can be managed safely, efficiently and reproducibly",
], size=16.5, space_after=15)
add_rect(s, 0.8, 6.2, 11.7, 0.7, NAVY_MID)
add_text(s, 1.0, 6.2, 11.3, 0.7, "One versatile tool \u2013 many faces of laryngeal disease.", size=16,
         color=CHAMPAGNE, italic=True, bold=True, anchor=MSO_ANCHOR.MIDDLE, align=PP_ALIGN.CENTER, font=SERIF)
add_footer(s)

# =================================================================
# REFERENCES
# =================================================================
s = new_slide()
add_header(s, "Bibliography", "References", size=24)
refs = [
    "Meslemani D, Benninger MS. Coblation removal of laryngeal Teflon granulomas. Laryngoscope. 2010. PMID: 20824780.",
    "Awad R, Shamil E, Aymat-Torrente A. Management of laryngeal papillomatosis using coblation. Eur Arch Otorhinolaryngol. 2019. PMID: 30798335.",
    "Galluzzi F, Garavello W. Surgical treatment of laryngeal amyloidosis: a systematic review. Eur Arch Otorhinolaryngol. 2023. PMID: 36790723.",
    "Yadav KV, Chethana R, Mishra P. Coblator assisted excision of laryngeal paraganglioma. Med J Armed Forces India. 2025. PMID: 40496223.",
    "Svistushkin VM, Starostina SV, Toldanov AV. Possibilities of coblation in otorhinolaryngology: analytical review. Eur Arch Otorhinolaryngol. 2022. PMID: 34482444.",
    "Albazee E, Al-Sebeih KH, Alkhaldi F, et al. Coblation tonsillectomy versus laser tonsillectomy: a systematic review and meta-analysis of RCTs. Eur Arch Otorhinolaryngol. 2022. PMID: 35810212.",
    "Wang C, Zhao Y, Li C, et al. Meta-analysis of low temperature plasma radiofrequency ablation and CO2 laser surgery on early glottic laryngeal carcinoma. Comput Math Methods Med. 2022. PMID: 35844439.",
    "Hao F, Yue L, Yin X, et al. Low-temperature radiofrequency coblation reduces treatment interval and post-operative pain of laryngotracheal recurrent respiratory papillomatosis. Bioscience Reports. 2020. PMID: 32426815.",
    "Karakkandy V, Chappity P, Mishra P, et al. A double-anonymised histopathological comparative study of CO2 laser and coblation in head and neck surgery. Indian J Otolaryngol Head Neck Surg. 2024. PMID: 39376295.",
    "El-Sobki A, Elzayat S, El-Deeb ME, et al. Surgical management of bilateral abductor paralysis: diode laser versus coblation; a prospective study. J Voice. 2023. PMID: 37923654.",
    "Benninger MS, Xiao R, Osborne K, et al. Outcomes following cordotomy by coblation for bilateral vocal fold immobility. JAMA Otolaryngol Head Neck Surg. 2018. PMID: 29242922.",
    "Benninger MS, Syamal M, Gau VL, et al. Coblation cordotomy for the management of bilateral vocal fold immobility. J Voice. 2025. PMID: 36270920.",
    "Lou Z, Lou Z, Lv T, et al. Comparison between coblation and microflap resection of leukoplakia of the vocal fold. J Voice. 2025. PMID: 36414529.",
    "McNally G, Mason R, Bateman N, et al. Recurrent respiratory papillomatosis in children: coblation versus microdebrider. J Laryngol Otol. 2025. PMID: 40518634.",
    "Scott-Brown's Otorhinolaryngology, Head & Neck Surgery, 8th ed. \u2013 Granulomatosis with Polyangiitis; Coblation\u00AE.",
    "Cummings Otolaryngology \u2013 Head & Neck Surgery, 8th ed. \u2013 Chondroma; Contact/Intubation Granuloma; Laryngitis in Systemic Disease (Amyloidosis).",
    "K.J. Lee's Essential Otolaryngology, 11th ed. \u2013 Laryngology; Radiofrequency Ablation (Coblation) in Otolaryngology.",
    "[Add institutional case-series data, local ethics approval number, and any additional references before final submission]",
]
add_bullets(s, 0.8, 1.5, 11.6, 5.4, refs, size=11, space_after=7)
add_footer(s)

# =================================================================
# THANK YOU
# =================================================================
s = new_slide(NAVY_DEEP)
add_rect(s, 0, 0, SLIDE_W, 0.1, CHAMPAGNE)
add_rect(s, 0, SLIDE_H - 0.1, SLIDE_W, 0.1, CHAMPAGNE)
corner_accent(s)
add_text(s, 0.9, 2.9, 11.5, 1.1, "Thank You", size=46, color=WHITE, bold=True, align=PP_ALIGN.CENTER, font=SERIF)
add_text(s, 0.9, 4.1, 11.5, 0.5, "Questions & Discussion", size=17, color=CHAMPAGNE, italic=True, align=PP_ALIGN.CENTER, font=SERIF)
add_text(s, 0.9, 4.9, 11.5, 0.4, "[Presenter Name]  \u2022  [Email/Contact]  \u2022  [Department, Institute]",
         size=13, color=RGBColor(0xC9, 0xD3, 0xDD), align=PP_ALIGN.CENTER, font=SANS)

prs.save("Coblation_in_Diverse_Laryngeal_Lesions.pptx")
print("Total slides:", len(prs.slides._sldIdLst))
print("DONE")

#!/usr/bin/env python3
"""
Guest Lecture deck - National ENT Conference
"One Tool, Many Lesions: Coblation and the Modern Management of Diverse Laryngeal Pathology"
Refined academic theme + educational (lecture) framing + institutional-expertise messaging.
"""
import json, base64
from pptx import Presentation
from pptx.util import Inches, Pt
from pptx.dml.color import RGBColor
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
from pptx.enum.shapes import MSO_SHAPE
from pptx.oxml.ns import qn

INK        = RGBColor(0x1B, 0x1D, 0x21)
NAVY       = RGBColor(0x0E, 0x2A, 0x43)
NAVY_DEEP  = RGBColor(0x08, 0x1C, 0x2F)
NAVY_MID   = RGBColor(0x15, 0x38, 0x57)
CHAMPAGNE  = RGBColor(0xB8, 0x96, 0x5A)
CHAMPAGNE_L= RGBColor(0xD8, 0xC4, 0x9A)
SLATE      = RGBColor(0x44, 0x59, 0x6B)
WHITE      = RGBColor(0xFF, 0xFF, 0xFF)
CREAM_BG   = RGBColor(0xFB, 0xFA, 0xF7)
LIGHT_BG   = RGBColor(0xF1, 0xEF, 0xE9)
BORDER     = RGBColor(0xDC, 0xD8, 0xCC)
PH_BG      = RGBColor(0xEE, 0xEC, 0xE5)
PH_BORDER  = RGBColor(0xB2, 0xAC, 0x99)
GRAY_TEXT  = RGBColor(0x5C, 0x60, 0x66)
ROW_ALT    = RGBColor(0xF4, 0xF2, 0xEC)

SERIF = "Georgia"
SANS  = "Calibri"
SLIDE_W, SLIDE_H = 13.333, 7.5

with open("fetched_images.json") as f:
    fetched = json.load(f)

def save_b64(item, path):
    if not item.get("base64"):
        return None
    data = item["base64"]
    if "," in data:
        data = data.split(",", 1)[1]
    with open(path, "wb") as fh:
        fh.write(base64.b64decode(data))
    return path

IMG = {}
IMG["amyloid_preop"]  = save_b64(fetched[0], "assets/amyloid_preop_intraop.jpg")
IMG["amyloid_supra"]  = save_b64(fetched[1], "assets/amyloid_supraglottic.jpg")
IMG["gpa_ct1"]        = save_b64(fetched[2], "assets/gpa_ct1.png")
IMG["gpa_ct2"]        = save_b64(fetched[3], "assets/gpa_ct2.png")
IMG["gpa_ct3"]        = save_b64(fetched[4], "assets/gpa_ct3.png")

prs = Presentation()
prs.slide_width  = Inches(SLIDE_W)
prs.slide_height = Inches(SLIDE_H)
BLANK = prs.slide_layouts[6]
PAGE = {"n": 0}

def new_slide(bg=CREAM_BG):
    s = prs.slides.add_slide(BLANK)
    s.background.fill.solid()
    s.background.fill.fore_color.rgb = bg
    PAGE["n"] += 1
    return s

def add_rect(slide, x, y, w, h, color, line_color=None, line_pt=1.0, shape=MSO_SHAPE.RECTANGLE):
    sp = slide.shapes.add_shape(shape, Inches(x), Inches(y), Inches(w), Inches(h))
    sp.fill.solid(); sp.fill.fore_color.rgb = color
    if line_color is None:
        sp.line.fill.background()
    else:
        sp.line.color.rgb = line_color
        sp.line.width = Pt(line_pt)
    sp.shadow.inherit = False
    return sp

def set_dashed(shape):
    ln = shape.line._get_or_add_ln()
    d = ln.makeelement(qn('a:prstDash'), {'val': 'dash'})
    ln.append(d)

def add_text(slide, x, y, w, h, text, size=16, color=INK, bold=False, italic=False,
             align=PP_ALIGN.LEFT, font=SANS, anchor=MSO_ANCHOR.TOP, line_spacing=None):
    tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = tb.text_frame; tf.word_wrap = True; tf.vertical_anchor = anchor
    p = tf.paragraphs[0]; p.text = text; p.alignment = align
    if line_spacing: p.line_spacing = line_spacing
    r = p.runs[0]
    r.font.size = Pt(size); r.font.bold = bold; r.font.italic = italic
    r.font.name = font; r.font.color.rgb = color
    return tb

def add_bullets(slide, x, y, w, h, items, size=15, color=INK, space_after=8, font=SANS,
                 bullet_char="\u2013", line_spacing=1.05):
    tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = tb.text_frame; tf.word_wrap = True
    for i, item in enumerate(items):
        level = 0; text = item
        if isinstance(item, tuple): text, level = item
        p = tf.paragraphs[0] if i == 0 else tf.add_paragraph()
        indent = "" if level == 0 else "     "
        prefix = (bullet_char + "  ") if level == 0 else ("\u00B7  ")
        p.text = indent + prefix + text
        p.space_after = Pt(space_after); p.line_spacing = line_spacing
        r = p.runs[0]
        r.font.size = Pt(size - (2 if level else 0)); r.font.color.rgb = color; r.font.name = font
    return tb

def add_header(slide, kicker, title, size=25):
    add_rect(slide, 0, 0, SLIDE_W, 1.2, NAVY)
    add_rect(slide, 0, 0, 0.14, 1.2, CHAMPAGNE)
    add_rect(slide, 0, 1.2, SLIDE_W, 0.03, CHAMPAGNE)
    if kicker:
        add_text(slide, 0.55, 0.17, 11.5, 0.32, kicker.upper(), size=11.5, color=CHAMPAGNE_L,
                  bold=True, font=SANS)
    add_text(slide, 0.55, 0.5, 12.3, 0.66, title, size=size, color=WHITE, bold=True, font=SERIF)

def add_footer(slide, tag=""):
    n = PAGE["n"]
    add_rect(slide, 0, 7.22, SLIDE_W, 0.014, BORDER)
    add_text(slide, 0.55, 7.26, 8.5, 0.24,
              "One Tool, Many Lesions \u2013 Coblation in Laryngeal Pathology" + (f"   |   {tag}" if tag else ""),
              size=8.5, color=GRAY_TEXT, italic=True, font=SERIF)
    add_text(slide, 12.0, 7.26, 0.8, 0.24, str(n), size=9, color=CHAMPAGNE, bold=True, align=PP_ALIGN.RIGHT)

def add_placeholder(slide, x, y, w, h, label):
    sp = slide.shapes.add_shape(MSO_SHAPE.RECTANGLE, Inches(x), Inches(y), Inches(w), Inches(h))
    sp.fill.solid(); sp.fill.fore_color.rgb = PH_BG
    sp.line.color.rgb = PH_BORDER; sp.line.width = Pt(1.0)
    set_dashed(sp); sp.shadow.inherit = False
    tf = sp.text_frame; tf.word_wrap = True; tf.vertical_anchor = MSO_ANCHOR.MIDDLE
    p = tf.paragraphs[0]; p.alignment = PP_ALIGN.CENTER
    p.text = "TO BE INSERTED BY PRESENTER"
    r = p.runs[0]; r.font.size = Pt(10); r.font.bold = True; r.font.color.rgb = CHAMPAGNE; r.font.name = SANS
    p2 = tf.add_paragraph(); p2.alignment = PP_ALIGN.CENTER
    p2.text = label
    r2 = p2.runs[0]; r2.font.size = Pt(12); r2.font.color.rgb = GRAY_TEXT; r2.font.name = SANS
    return sp

def add_picture_fit(slide, path, x, y, w, h):
    from PIL import Image
    try:
        im = Image.open(path); iw, ih = im.size
        target_ratio = w / h; img_ratio = iw / ih
        if img_ratio > target_ratio:
            new_h = h; new_w = h * img_ratio
        else:
            new_w = w; new_h = w / img_ratio
        pic = slide.shapes.add_picture(path, Inches(x), Inches(y), Inches(new_w), Inches(new_h))
        pic.left = Inches(x + (w - new_w) / 2); pic.top = Inches(y + (h - new_h) / 2)
        return pic
    except Exception:
        return None

def add_caption(slide, x, y, w, h, text):
    add_text(slide, x, y, w, h, text, size=10, color=GRAY_TEXT, italic=True, align=PP_ALIGN.CENTER, font=SERIF)

def corner_accent(slide):
    add_rect(slide, 0.55, 0.55, 0.5, 0.025, CHAMPAGNE)
    add_rect(slide, 0.55, 0.55, 0.025, 0.5, CHAMPAGNE)
    add_rect(slide, SLIDE_W - 1.05, SLIDE_H - 0.8, 0.5, 0.025, CHAMPAGNE)
    add_rect(slide, SLIDE_W - 0.575, SLIDE_H - 1.05, 0.025, 0.5, CHAMPAGNE)

def table_style(table, rows_data):
    for r in range(len(rows_data)):
        for c in range(len(rows_data[0])):
            cell = table.cell(r, c)
            cell.vertical_anchor = MSO_ANCHOR.MIDDLE
            cell.margin_left = Inches(0.08); cell.margin_right = Inches(0.08)
            cell.margin_top = Inches(0.04); cell.margin_bottom = Inches(0.04)
            p = cell.text_frame.paragraphs[0]
            run = p.runs[0] if p.runs else p.add_run()
            run.font.name = SANS
            run.font.size = Pt(12.5 if r else 13)
            run.font.bold = (r == 0)
            run.font.color.rgb = WHITE if r == 0 else INK
            cell.fill.solid()
            if r == 0:
                cell.fill.fore_color.rgb = NAVY
            else:
                cell.fill.fore_color.rgb = ROW_ALT if r % 2 == 0 else WHITE

# ============================== 1. TITLE ==============================
s = new_slide(NAVY_DEEP)
add_rect(s, 0, 0, SLIDE_W, 0.1, CHAMPAGNE)
add_rect(s, 0, SLIDE_H - 0.1, SLIDE_W, 0.1, CHAMPAGNE)
corner_accent(s)
add_text(s, 0.9, 0.85, 11.5, 0.4, "GUEST LECTURE  \u00B7  NATIONAL CONFERENCE ON OTOLARYNGOLOGY \u2013 HEAD & NECK SURGERY",
         size=13, color=CHAMPAGNE, bold=True, align=PP_ALIGN.CENTER, font=SANS)
add_text(s, 0.9, 1.25, 11.5, 0.35, "[CONFERENCE NAME]  \u00B7  [CITY]  \u00B7  [YEAR]",
         size=11.5, color=RGBColor(0x9C, 0xAB, 0xBC), align=PP_ALIGN.CENTER, font=SANS)
add_text(s, 0.9, 2.35, 11.5, 1.7, "One Tool, Many Lesions", size=46, color=WHITE, bold=True,
         align=PP_ALIGN.CENTER, font=SERIF)
add_rect(s, 5.6, 3.55, 2.1, 0.025, CHAMPAGNE)
add_text(s, 0.9, 3.75, 11.5, 1.0, "Coblation and the Modern Management of Diverse Laryngeal Pathology",
         size=20, color=RGBColor(0xD9, 0xE1, 0xEA), align=PP_ALIGN.CENTER, font=SERIF)
add_text(s, 0.9, 4.5, 11.5, 0.45, "An illustrated lecture, drawing on advanced cases managed at [Institute Name]",
         size=13.5, color=RGBColor(0xB9, 0xC6, 0xD3), italic=True, align=PP_ALIGN.CENTER, font=SANS)
add_text(s, 0.9, 5.5, 11.5, 0.4, "[Presenter Name], MS, DNB, FRCS", size=16, color=WHITE, bold=True,
         align=PP_ALIGN.CENTER, font=SERIF)
add_text(s, 0.9, 5.92, 11.5, 0.4, "Senior Consultant / Professor \u2013 Department of ENT, Head & Neck Surgery",
         size=12.5, color=RGBColor(0xC9, 0xD3, 0xDD), align=PP_ALIGN.CENTER, font=SANS)
add_text(s, 0.9, 6.28, 11.5, 0.4, "[Institute / Medical College Name]", size=12.5,
         color=RGBColor(0xA9, 0xB6, 0xC4), align=PP_ALIGN.CENTER, font=SANS)

# ============================== 2. DISCLOSURES ==============================
s = new_slide()
add_header(s, "Preliminary", "Disclosures")
add_bullets(s, 0.8, 1.7, 11.5, 2.5, [
    "No financial relationship with any device manufacturer, including coblation/plasma-ablation system vendors",
    "No conflict of interest relevant to the content of this lecture",
    "All patient images, videos and data are used with informed consent and institutional ethics approval",
    "[Edit this slide to reflect the presenter's actual disclosures before the conference]",
], size=17)
add_footer(s)

# ============================== 3. ROADMAP ==============================
s = new_slide()
add_header(s, "Roadmap", "What This Lecture Will Cover")
outline = [
    "The spectrum & diagnostic challenge of benign / non-malignant laryngeal lesions",
    "Coblation \u2013 concept, mechanism and rationale in laryngology",
    "Learning objectives for today",
    "Our institute's experience and approach to advanced laryngeal disease",
    "Five illustrative teaching cases: recognition \u2192 imaging \u2192 technique \u2192 histopathology \u2192 outcome",
    "        1. Subglottic Chondroma      2. Hypopharyngeal Hemangioma      3. Subglottic Necrotising Granuloma",
    "        4. Laryngeal Amyloidosis      5. Intubation (Vocal Process) Granuloma",
    "Coblation vs. conventional modalities \u2013 an evidence-based comparison",
    "Recap, take-home message and key references",
]
add_bullets(s, 0.8, 1.6, 11.6, 5.0, outline, size=16.5, space_after=13)
add_footer(s)

# ============================== 4. INTRODUCTION ==============================
s = new_slide()
add_header(s, "Introduction", "The Spectrum of Benign & Non-Malignant Laryngeal Lesions")
add_bullets(s, 0.8, 1.55, 7.3, 5.2, [
    "The larynx hosts an unusually wide range of pathology within a small, function-critical space \u2013 voice, airway and swallowing all converge here",
    "Aetiologies range from congenital/neoplastic (chondroma), vascular (hemangioma), autoimmune-granulomatous (GPA), infiltrative-deposition (amyloidosis), to purely reactive/traumatic (intubation granuloma)",
    "Despite this diversity, the surgical goals are shared:",
    ("preserve the airway", 1),
    ("preserve voice and swallowing function", 1),
    ("achieve a bloodless, precise dissection in a confined space", 1),
    ("minimise recurrence and re-stenosis", 1),
    "Conventional tools (cold steel, electrocautery, CO2 laser, microdebrider) each address only some of these goals \u2013 raising the question of a single, versatile energy platform",
], size=15, space_after=8)
add_placeholder(s, 8.4, 1.6, 4.1, 5.1, "Representative endoscopic\ncomposite \u2013 spectrum of lesions")
add_footer(s)

# ============================== 5. COBLATION MECHANISM ==============================
s = new_slide()
add_header(s, "Technology", "Coblation \u2013 Concept & Mechanism")
add_bullets(s, 0.8, 1.55, 7.2, 5.2, [
    "COBLATION = \u201cCOntrolled aBLATION\u201d \u2013 a bipolar, radiofrequency-driven plasma technology",
    "A bipolar wand energises a conductive medium (normal saline) surrounding the electrode, generating a low-temperature plasma field (\u2248 60\u201370\u00B0C)",
    "The plasma field contains charged particles with enough kinetic energy to break molecular (organic) bonds within soft tissue \u2013 tissue is dissolved / ablated rather than burned",
    "Simultaneous bipolar coagulation of small vessels provides haemostasis in the same pass",
    "Tissue temperatures remain far below those of electrocautery (200\u2013400\u00B0C) or CO2 laser (400\u20131000\u00B0C), keeping the collateral thermal-injury zone small (literature estimates \u2248100 microns)",
], size=15, space_after=10)
add_placeholder(s, 8.3, 1.6, 4.2, 5.1, "Coblation wand /\nplasma-field schematic diagram")
add_footer(s)

# ============================== 6. ADVANTAGES ==============================
s = new_slide()
add_header(s, "Technology", "Why Coblation Suits the Larynx")
cols = [
    ("Precision", "Fine wand tips allow controlled, layer-by-layer tissue removal in a confined airway"),
    ("Haemostasis", "Concurrent bipolar coagulation keeps the surgical field largely bloodless \u2013 valuable for vascular lesions"),
    ("Low Thermal Profile", "A markedly lower operating temperature than laser/electrocautery limits injury to adjacent structures"),
    ("Function Preservation", "Lower collateral damage helps preserve voice, swallowing and airway calibre"),
    ("Reduced Scarring", "Less thermal injury can translate into less granulation and lower re-stenosis in recurrence-prone disease"),
    ("Versatility", "Effective across neoplastic, vascular, granulomatous, infiltrative and reactive tissue \u2013 one platform, many indications"),
]
x0, y0, w, h, gap = 0.7, 1.55, 3.9, 2.4, 0.25
for i, (t, d) in enumerate(cols):
    col = i % 3; row = i // 3
    x = x0 + col * (w + gap); y = y0 + row * (h + gap)
    add_rect(s, x, y, w, h, LIGHT_BG, line_color=BORDER, line_pt=1)
    add_rect(s, x, y, w, 0.07, CHAMPAGNE)
    add_text(s, x + 0.25, y + 0.22, w - 0.5, 0.4, t, size=15, color=NAVY, bold=True, font=SERIF)
    add_text(s, x + 0.25, y + 0.65, w - 0.5, h - 0.8, d, size=12, color=INK)
add_footer(s)

# ============================== 7. LEARNING OBJECTIVES ==============================
s = new_slide()
add_header(s, "Learning Objectives", "By the End of This Lecture, You Should Be Able To\u2026")
add_bullets(s, 0.9, 1.8, 11.4, 4.6, [
    "Recognise the clinical, endoscopic, radiological and histopathological features of five diverse laryngeal lesions",
    "Understand the mechanism, evidence base and lesion-specific surgical nuances of coblation in laryngology",
    "Compare coblation with conventional modalities \u2013 cold steel, electrocautery and CO2 laser \u2013 on haemostasis, thermal injury and functional preservation",
    "Appreciate how, with a structured, experienced multidisciplinary approach, even advanced and complex laryngeal lesions are managed safely and efficiently in routine practice",
], size=17.5, space_after=18)
add_footer(s)

# ============================== 8. INSTITUTIONAL EXPERTISE ==============================
s = new_slide()
add_header(s, "Institutional Context", "Advanced Laryngeal Disease \u2013 Our Approach")
add_text(s, 0.8, 1.45, 11.7, 0.45,
          "Complex laryngeal referrals are managed routinely and safely through a structured, experienced service:",
          size=14, color=GRAY_TEXT, italic=True, font=SERIF)
cards = [
    ("Dedicated Airway & Laryngology Service", "A focused endoscopic laryngology practice with coblation-assisted surgery integrated into routine care, not reserved for exceptional cases"),
    ("Multidisciplinary Collaboration", "Close coordination with rheumatology, haematology and speech-language pathology for systemic or recurrence-prone disease (e.g. GPA, amyloidosis)"),
    ("Standardised, Reproducible Technique", "Protocol-driven wand settings and staged-debulking approaches refined over years of institutional experience"),
    ("Consistent, Favourable Outcomes", "Low complication rates and preserved airway/voice/swallowing function, even in advanced or previously-treated referrals"),
]
x0, y0, w, h, gap = 0.8, 2.05, 5.75, 2.15, 0.3
for i, (t, d) in enumerate(cards):
    col = i % 2; row = i // 2
    x = x0 + col * (w + gap); y = y0 + row * (h + gap)
    add_rect(s, x, y, w, h, LIGHT_BG, line_color=BORDER)
    add_rect(s, x, y, 0.08, h, CHAMPAGNE)
    add_text(s, x + 0.3, y + 0.18, w - 0.55, 0.5, t, size=14.5, color=NAVY, bold=True, font=SERIF)
    add_text(s, x + 0.3, y + 0.68, w - 0.55, h - 0.85, d, size=12, color=INK)
add_text(s, 0.8, 6.65, 11.7, 0.4,
          "[Presenter to insert institute-specific case volume / years of experience / outcome statistics]",
          size=10.5, color=GRAY_TEXT, italic=True, font=SANS)
add_footer(s)

# ============================== 9. CASE SNAPSHOT ==============================
s = new_slide()
add_header(s, "Overview", "Five Teaching Cases at a Glance")
rows_data = [
    ["#", "Lesion", "Site", "Core Pathology", "Role of Coblation"],
    ["1", "Subglottic Chondroma", "Posterior cricoid lamina", "Benign cartilaginous neoplasm", "Precision cartilage debulking"],
    ["2", "Hypopharyngeal Hemangioma", "Pyriform fossa / post. pharyngeal wall", "Vascular malformation", "Bloodless ablation & shrinkage"],
    ["3", "Subglottic Necrotising Granuloma", "Circumferential subglottis", "ANCA-associated vasculitis (GPA)", "Low-trauma debulking + dilatation"],
    ["4", "Laryngeal Amyloidosis", "True/false cord, ventricle", "Recurrence-prone AL deposition", "Tissue-sparing staged debulking"],
    ["5", "Intubation / Vocal Process Granuloma", "Posterior glottis", "Reactive granulation tissue", "Precise excision, low recurrence"],
]
tbl_shape = s.shapes.add_table(len(rows_data), 5, Inches(0.55), Inches(1.55), Inches(12.25), Inches(4.9))
table = tbl_shape.table
for i, wv in enumerate([0.55, 3.1, 2.9, 3.0, 2.7]):
    table.columns[i].width = Inches(wv)
for r in range(len(rows_data)):
    for c in range(5):
        table.cell(r, c).text = rows_data[r][c]
table_style(table, rows_data)
for r in range(1, len(rows_data)):
    table.cell(r, 0).text_frame.paragraphs[0].alignment = PP_ALIGN.CENTER
add_footer(s)

# ============================== CASE BUILDER FUNCTIONS ==============================
def divider(no, name, subtitle):
    s = new_slide(NAVY_DEEP)
    add_rect(s, 0, 0, SLIDE_W, 0.1, CHAMPAGNE)
    add_rect(s, 0, SLIDE_H - 0.1, SLIDE_W, 0.1, CHAMPAGNE)
    corner_accent(s)
    add_text(s, 0.9, 2.3, 11, 0.5, f"TEACHING CASE {no} OF 5", size=17, color=CHAMPAGNE, bold=True, font=SANS)
    add_rect(s, 0.92, 2.85, 1.6, 0.03, CHAMPAGNE)
    add_text(s, 0.9, 3.0, 11.5, 1.5, name, size=36, color=WHITE, bold=True, font=SERIF)
    add_text(s, 0.9, 4.15, 11.3, 0.8, subtitle, size=15.5, color=RGBColor(0xC9, 0xD3, 0xDD), italic=True, font=SERIF)
    add_footer(s, tag=f"Case {no}")
    return s

def clinical_imaging(no, name, presentation, imaging, real_images=None):
    s = new_slide()
    add_header(s, f"Teaching Case {no} \u00B7 {name}", "Clinical Presentation & Imaging")
    add_text(s, 0.7, 1.5, 6.9, 0.35, "Clinical Presentation", size=14.5, color=SLATE, bold=True, font=SERIF)
    add_bullets(s, 0.7, 1.9, 6.9, 4.7, presentation, size=13.5, space_after=9)
    add_text(s, 7.9, 1.5, 4.7, 0.35, "Imaging", size=14.5, color=SLATE, bold=True, font=SERIF)
    if real_images:
        yy = 1.9
        for path, cap in real_images:
            add_picture_fit(s, path, 7.9, yy, 4.7, 2.3)
            add_caption(s, 7.9, yy + 2.32, 4.7, 0.3, cap)
            yy += 2.75
    else:
        add_placeholder(s, 7.9, 1.9, 4.7, 2.6, "CT / MRI scan")
        add_bullets(s, 7.9, 4.65, 4.7, 2.0, imaging, size=12, space_after=6)
    add_footer(s, tag=f"Case {no}")
    return s

def multimedia_gallery(no, name, notes=None, real_images=None):
    s = new_slide()
    add_header(s, f"Teaching Case {no} \u00B7 {name}", "Intra-operative & Endoscopic Multimedia")
    labels = ["Pre-operative Endoscopy", "Intra-operative \u2013 Coblation in Use", "Post-operative Endoscopy / Follow-up"]
    x0, y0, w, h, gap = 0.6, 1.55, 3.85, 4.9, 0.2
    real_images = real_images or {}
    for i, label in enumerate(labels):
        x = x0 + i * (w + gap)
        if label in real_images:
            add_picture_fit(s, real_images[label], x, y0, w, h - 0.4)
            add_caption(s, x, y0 + h - 0.35, w, 0.3, label + " (representative image \u2013 supplement with video)")
        else:
            add_placeholder(s, x, y0, w, h, label)
    if notes:
        add_text(s, 0.6, 6.7, 12.1, 0.4, notes, size=10.5, color=GRAY_TEXT, italic=True, font=SANS)
    add_footer(s, tag=f"Case {no}")
    return s

def histopath_slide(no, name, findings, stain_note=None):
    s = new_slide()
    add_header(s, f"Teaching Case {no} \u00B7 {name}", "Histopathology")
    add_placeholder(s, 0.7, 1.6, 5.6, 4.9, "Histopathology photomicrograph(s)\n(H&E / special stain)")
    add_text(s, 6.6, 1.6, 6.0, 0.35, "Key Microscopic Findings", size=14.5, color=SLATE, bold=True, font=SERIF)
    add_bullets(s, 6.6, 2.0, 6.0, 3.8, findings, size=14, space_after=10)
    if stain_note:
        add_rect(s, 6.6, 5.9, 6.0, 0.75, LIGHT_BG, line_color=BORDER)
        add_text(s, 6.75, 6.0, 5.7, 0.55, stain_note, size=11.5, color=NAVY, italic=True, anchor=MSO_ANCHOR.MIDDLE, font=SERIF)
    add_footer(s, tag=f"Case {no}")
    return s

def technique_outcome(no, name, technique, outcome, pearl):
    s = new_slide()
    add_header(s, f"Teaching Case {no} \u00B7 {name}", "Coblation Technique, Outcome & Learning Point")
    add_text(s, 0.7, 1.5, 5.9, 0.35, "Surgical Technique", size=14.5, color=SLATE, bold=True, font=SERIF)
    add_bullets(s, 0.7, 1.9, 5.9, 3.5, technique, size=13, space_after=9)
    add_text(s, 6.9, 1.5, 5.7, 0.35, "Outcome", size=14.5, color=SLATE, bold=True, font=SERIF)
    add_bullets(s, 6.9, 1.9, 5.7, 3.5, outcome, size=13, space_after=9)
    pearl_box = add_rect(s, 0.7, 5.75, 11.9, 1.15, NAVY_MID)
    add_rect(s, 0.7, 5.75, 0.08, 1.15, CHAMPAGNE)
    tf = pearl_box.text_frame; tf.word_wrap = True; tf.vertical_anchor = MSO_ANCHOR.MIDDLE
    tf.margin_left = Inches(0.35)
    p = tf.paragraphs[0]; p.text = "Learning Point \u2013 " + pearl
    r = p.runs[0]; r.font.size = Pt(13.5); r.font.italic = True; r.font.color.rgb = WHITE; r.font.name = SERIF
    add_footer(s, tag=f"Case {no}")
    return s

CASES = [
{"no": 1, "name": "Subglottic Chondroma", "subtitle": "A slow-growing benign cartilaginous tumour of the cricoid",
 "presentation": [
    "Adult patient with insidious, progressive dyspnoea, stridor \u00B1 hoarseness over months to years",
    "Rare entity \u2013 <1% of laryngeal tumours; the commonest benign cartilaginous neoplasm of the larynx",
    "Classically arises from the posterior lamina of the cricoid cartilage (residual endochondral ossification centres)",
    "Firm, smooth, submucosal, non-ulcerated swelling narrowing the subglottic airway on flexible laryngoscopy"],
 "imaging": [
    "Contrast CT larynx: well-defined, lobulated, often calcified/ossified submucosal mass arising from the cricoid",
    "MRI clarifies cartilage invasion and helps exclude low-grade chondrosarcoma",
    "Key differential: chondrosarcoma, laryngocele, paraganglioma, subglottic haemangioma"],
 "histopath": [
    "Mature hyaline cartilage, low cellularity, chondrocytes arranged in an orderly lacunar pattern",
    "No cytological atypia, no significant mitoses, no destructive/invasive growth",
    "Distinction from low-grade chondrosarcoma is subtle and requires generous, representative biopsy"],
 "stain_note": "Histological overlap with low-grade chondrosarcoma means diagnosis rests on the whole specimen, not a small biopsy.",
 "technique": [
    "Suspension microlaryngoscopy; coblation wand introduced under magnified endoscopic view",
    "Low-temperature bipolar plasma (\u224860\u201370\u00B0C) used for controlled, layer-by-layer shaving of the cartilaginous mass",
    "Overlying mucosa and perichondrium preserved wherever feasible to protect the cricoid framework",
    "Continuous saline irrigation maintains a clear, bloodless field for precise endpoint judgement"],
 "outcome": [
    "Airway secured endoscopically \u2013 tracheostomy avoided",
    "Uneventful post-operative course; serial follow-up endoscopy shows a re-epithelialised, patent subglottis",
    "No airway compromise or restenosis on interval review"],
 "pearl": "Coblation permits precise cartilage debulking with minimal thermal spread to the adjacent cricoid \u2013 critical when the surgical goal is airway restoration without destabilising the laryngeal framework."},
{"no": 2, "name": "Hypopharyngeal Hemangioma", "subtitle": "A vascular submucosal lesion demanding a bloodless approach",
 "presentation": [
    "Presents with foreign-body sensation, odynophagia, muffled voice or intermittent haemoptysis",
    "Bluish-to-reddish, compressible, submucosal swelling typically in the pyriform fossa or posterior pharyngeal wall",
    "Blind biopsy is discouraged \u2013 risk of significant haemorrhage from a vascular lesion"],
 "imaging": [
    "Contrast-enhanced CT/MRI: well-circumscribed, avidly enhancing submucosal lesion",
    "Large or deep lesions may warrant angiography to define feeding vessels before intervention"],
 "histopath": [
    "Proliferation of endothelial-lined vascular channels \u2013 cavernous and/or capillary pattern",
    "Bland endothelium, no cytological atypia or mitotic activity",
    "Correlate with clinical/radiological vascular appearance to avoid misclassification"],
 "stain_note": "CD31 / CD34 immunostaining confirms endothelial lineage when the diagnosis is in doubt.",
 "technique": [
    "Direct laryngo-pharyngoscopy under general anaesthesia; coblation wand applied directly to the lesion",
    "Simultaneous ablation and bipolar coagulation shrink the vascular mass while sealing feeding channels in real time",
    "Staged, gentle passes avoid full-thickness pharyngeal wall injury"],
 "outcome": [
    "Essentially bloodless intra-operative field \u2013 no transfusion required",
    "Resolution of foreign-body sensation / dysphagia",
    "No recurrence on subsequent follow-up endoscopy"],
 "pearl": "The simultaneous cut-and-coagulate profile of coblation is the strongest argument for its use in vascular lesions \u2013 conventional cold instruments risk brisk, field-obscuring bleeding."},
{"no": 3, "name": "Subglottic Necrotising Granuloma", "subtitle": "Granulomatosis with polyangiitis (GPA) presenting as subglottic stenosis",
 "presentation": [
    "Young-to-middle-aged adult with progressive dyspnoea, stridor and hoarseness",
    "May have systemic clues: sinonasal crusting/saddle-nose deformity, arthralgia, renal impairment, otitis media",
    "Endoscopy: circumferential, erythematous, friable subglottic narrowing"],
 "imaging": [
    "CT neck: circumferential subglottic soft-tissue thickening / stenosis \u00B1 cartilage erosion",
    "Chest CT to look for pulmonary nodules/cavitation; renal function screen",
    "c-ANCA / PR3-ANCA serology, ESR/CRP for systemic disease workup"],
 "histopath": [
    "Necrotising granulomatous inflammation with multinucleate giant cells",
    "True vasculitis is often absent on limited endoscopic biopsy \u2013 diagnosis needs clinico-serological correlation",
    "Rule out infective granulomas (TB, fungal) and sarcoidosis on special stains/cultures"],
 "stain_note": "PR3-ANCA positivity plus compatible histology supports GPA even when vasculitis is not seen on a small airway biopsy.",
 "technique": [
    "Coblation-assisted endoscopic debulking of granulation/scar tissue combined with balloon dilatation of the stenotic segment",
    "Low collateral thermal injury is deliberately chosen to avoid adding further scarring in an already fibrosing airway",
    "Performed in coordination with rheumatology for concurrent systemic immunosuppression"],
 "outcome": [
    "Improved airway calibre; tracheostomy avoided",
    "Planned serial endoscopic dilatation protocol",
    "Systemic disease control achieved with steroids and rituximab / cyclophosphamide per rheumatology input"],
 "pearl": "In a disease already prone to fibrosis and restenosis, coblation's minimal collateral thermal injury is a genuine advantage over laser or electrocautery, which can seed further granulation."},
{"no": 4, "name": "Laryngeal Amyloidosis", "subtitle": "A recurrence-prone infiltrative deposition disease of the larynx",
 "presentation": [
    "Middle-aged adult with slowly progressive hoarseness \u00B1 dyspnoea over months to years",
    "Submucosal, waxy, yellow-pink infiltration of the true/false cord, ventricle or subglottis",
    "Most laryngeal amyloid is localised AL type, distinct from systemic amyloidosis \u2013 systemic screening is still mandatory"],
 "imaging": [
    "CT: diffuse submucosal thickening \u00B1 punctate calcification",
    "MRI defines mucosal/submucosal extent for surgical planning",
    "Systemic work-up: serum/urine protein electrophoresis, free light chains, cardiac and renal screening"],
 "histopath": [
    "Amorphous, eosinophilic, extracellular hyaline deposits within the lamina propria",
    "Congo red staining shows pathognomonic apple-green birefringence under polarised light",
    "Immunohistochemistry / mass spectrometry typing (AL most common in the larynx)"],
 "stain_note": "Congo red + polarised light is the confirmatory test; subtype AL vs ATTR guides systemic follow-up.",
 "technique": [
    "Staged coblation debulking preserving as much normal mucosa and underlying muscle as possible to protect phonation",
    "Circumferential/full-thickness injury deliberately avoided to reduce stenosis risk given the high likelihood of repeat procedures",
    "Multidisciplinary referral (haematology) to exclude systemic amyloidosis"],
 "outcome": [
    "Improved voice quality and airway patency after debulking",
    "Per Galluzzi & Garavello (2023) systematic review, surgical debulking is the mainstay of treatment; recurrence is common, often necessitating repeat procedures",
    "Malignant transformation is rare, but lifelong endoscopic surveillance is advised"],
 "pearl": "Coblation's tissue-sparing ablation is well suited to a disease that often needs repeated debulking \u2013 it avoids the cumulative scarring that repeated laser or cold-steel excision can cause to the vocal fold."},
{"no": 5, "name": "Intubation (Vocal Process) Granuloma", "subtitle": "A reactive lesion notorious for recurrence after excision",
 "presentation": [
    "Hoarseness, throat pain or globus sensation weeks after intubation, or in the setting of chronic phonotrauma/reflux",
    "Uni- or bilateral pedunculated/sessile mass at the vocal process of the arytenoid (posterior glottis)",
    "Risk factors: traumatic/prolonged intubation, laryngopharyngeal reflux (LPR), vocal abuse, chronic cough"],
 "imaging": [
    "Primarily a clinical/stroboscopic diagnosis; imaging reserved if malignancy needs exclusion",
    "Videostroboscopy documents mucosal wave and confirms posterior glottic location"],
 "histopath": [
    "Granulation tissue: fibrovascular stroma with a chronic inflammatory infiltrate",
    "Overlying epithelium may be ulcerated or hyperplastic; no cytological atypia",
    "Correlate with history of instrumentation/reflux to avoid mistaking this for neoplasia"],
 "stain_note": "No specific stain required; the diagnosis is clinico-pathological.",
 "technique": [
    "Micro-laryngoscopic coblation excision of the granuloma at the vocal process with preservation of arytenoid perichondrium",
    "Combined with medical optimisation \u2013 proton-pump inhibitors, voice therapy, and, in refractory/recurrent cases, botulinum toxin or intralesional steroid injection"],
 "outcome": [
    "Resolution of hoarseness and globus symptoms",
    "Lower recurrence with a combined medical + coblation-assisted surgical approach compared with historical cold-steel excision alone"],
 "pearl": "For a lesion infamous for recurring after surgery, coblation's reduced mucosal trauma and superior haemostasis make any necessary repeat procedure safer and less morbid."},
]

real_image_map = {
 3: {"imaging": [(IMG["gpa_ct1"], "Representative contrast CT \u2013 GPA-related airway changes"),
                 (IMG["gpa_ct2"], "Representative contrast CT \u2013 axial neck")]},
 4: {"gallery": {"Pre-operative Endoscopy": IMG["amyloid_supra"],
                 "Intra-operative \u2013 Coblation in Use": IMG["amyloid_preop"]}},
}

for c in CASES:
    divider(c["no"], c["name"], c["subtitle"])
    ri = real_image_map.get(c["no"], {}).get("imaging")
    clinical_imaging(c["no"], c["name"], c["presentation"], c["imaging"], real_images=ri)
    gallery_imgs = real_image_map.get(c["no"], {}).get("gallery")
    multimedia_gallery(c["no"], c["name"],
                        notes="Faculty note: replace placeholders above with pre-op, intra-op (coblation in action) and post-op endoscopy clips; add scan/histopathology images on the following slides.",
                        real_images=gallery_imgs)
    histopath_slide(c["no"], c["name"], c["histopath"], stain_note=c.get("stain_note"))
    technique_outcome(c["no"], c["name"], c["technique"], c["outcome"], c["pearl"])

# ============================== COMPARATIVE TABLE ==============================
s = new_slide()
add_header(s, "Learning Point", "Coblation vs. Conventional Modalities")
rows_data = [
    ["Parameter", "Coblation", "CO2 Laser", "Cold Steel", "Electrocautery / Microdebrider"],
    ["Tissue temperature", "\u224860\u201370\u00B0C (low)", "400\u20131000\u00B0C (high)", "N/A (mechanical)", "200\u2013400\u00B0C (high)"],
    ["Collateral thermal spread", "Low, literature estimate \u2248100 \u00B5m", "Moderate\u2013high, char risk", "None", "Moderate\u2013high"],
    ["Haemostasis", "Generally favourable (built-in)", "Good", "Poor \u2013 needs adjunct", "Good"],
    ["Airway fire risk (with O2)", "Minimal", "Present \u2013 needs precautions", "None", "Present"],
    ["Precision on cartilage/mucosa", "High", "High, but charring risk", "High, but bleeds", "Moderate"],
    ["Versatility across lesion types", "Broad (tumour, vascular, granuloma, deposition, reactive)", "Mainly soft tissue", "Mainly soft tissue", "Mainly soft tissue"],
]
tbl_shape = s.shapes.add_table(len(rows_data), 5, Inches(0.4), Inches(1.5), Inches(12.5), Inches(5.3))
table = tbl_shape.table
for i, wv in enumerate([2.5, 2.7, 2.4, 2.2, 2.7]):
    table.columns[i].width = Inches(wv)
for r in range(len(rows_data)):
    for c in range(5):
        table.cell(r, c).text = rows_data[r][c]
table_style(table, rows_data)
for r in range(1, len(rows_data)):
    cell = table.cell(r, 1)
    cell.text_frame.paragraphs[0].runs[0].font.bold = True
    cell.text_frame.paragraphs[0].runs[0].font.color.rgb = SLATE
    cell.fill.fore_color.rgb = RGBColor(0xEA, 0xEE, 0xF1)
add_footer(s)

# ============================== EVIDENCE 1: HAEMOSTASIS ==============================
s = new_slide()
add_header(s, "Learning Point \u00B7 Evidence", "Haemostasis & Intra-operative Blood Loss")
add_text(s, 0.7, 1.45, 11.9, 0.5,
          "Coblation's built-in bipolar coagulation is its most cited advantage \u2013 but the evidence is procedure-dependent:",
          size=13.5, color=GRAY_TEXT, italic=True, font=SERIF)
rows_data = [
    ["Study (Evidence)", "Comparison", "Key Finding"],
    ["Albazee et al. 2022 \u2013 Systematic Review\n& Meta-analysis of RCTs, Eur Arch ORL\nPMID 35810212",
     "Coblation vs CO2/diode\nLaser Tonsillectomy",
     "Coblation \u2192 significantly LOWER intra-op blood loss (MD \u2013 5.08 mL) and shorter operative time (MD \u2013 4.50 min); no difference in pain or secondary haemorrhage"],
    ["Hao et al. 2020, Bioscience Reports\nPMID 32426815",
     "Coblation vs CO2 Laser \u2013\nlaryngotracheal RRP",
     "Coblation \u2192 significantly LESS blood loss, shorter operative time, longer symptom-free interval and lower post-op pain scores"],
    ["Wang et al. 2022 \u2013 Meta-analysis,\nComput Math Methods Med\nPMID 35844439",
     "Low-temperature plasma RFA\nvs CO2 Laser \u2013 early glottic\ncarcinoma",
     "Contrary finding: RFA/coblation showed HIGHER intra-operative blood loss than CO2 laser; but shorter operative time and better mucosal recovery; no difference in recurrence"],
]
tbl_shape = s.shapes.add_table(len(rows_data), 3, Inches(0.5), Inches(2.05), Inches(12.35), Inches(4.55))
table = tbl_shape.table
for i, wv in enumerate([3.55, 2.9, 5.9]):
    table.columns[i].width = Inches(wv)
for r in range(len(rows_data)):
    for c in range(3):
        table.cell(r, c).text = rows_data[r][c]
table_style(table, rows_data)
for r in range(len(rows_data)):
    for c in range(3):
        table.cell(r, c).text_frame.paragraphs[0].runs[0].font.size = Pt(11.3 if r else 12.5)
add_text(s, 0.7, 6.75, 11.9, 0.4,
          "Take-away: coblation generally reduces blood loss vs. laser in soft-tissue/vascular work, but this benefit is not universal \u2013 site and tissue vascularity matter.",
          size=11, color=NAVY, italic=True, font=SERIF)
add_footer(s)

# ============================== EVIDENCE 2: THERMAL SPREAD ==============================
s = new_slide()
add_header(s, "Learning Point \u00B7 Evidence", "Thermal Spread & Collateral Tissue Injury")
add_bullets(s, 0.7, 1.55, 11.9, 2.0, [
    "Coblation operates at \u224860\u201370\u00B0C vs. 400\u20131000\u00B0C for CO2 laser and 200\u2013400\u00B0C for electrocautery \u2013 the physical basis for a smaller thermal injury zone",
    "Karakkandy et al. 2024, Indian J Otolaryngol Head Neck Surg (PMID 39376295) \u2013 double-anonymised histopathological comparison of CO2 laser vs. coblation in 50 head & neck / laryngeal excisions:",
], size=13.5, space_after=8)
add_rect(s, 0.9, 3.55, 11.5, 2.55, LIGHT_BG, line_color=BORDER)
add_rect(s, 0.9, 3.55, 0.08, 2.55, CHAMPAGNE)
add_bullets(s, 1.2, 3.7, 11.0, 2.35, [
    "Incision margins were more regular with CO2 laser (73%) than coblation (55%) \u2013 not statistically significant (P = 1.80)",
    "Depth of thermal damage and connective-tissue change trended HIGHER with coblation than CO2 laser (P = 0.171 and 0.279 \u2013 not statistically significant)",
    "Vascular thermal changes were seen more with CO2 laser (P = 0.727)",
    "Authors' conclusion: both are effective; CO2 laser, where available, may offer more precise excision with less collateral damage",
], size=12.5, space_after=8)
add_text(s, 0.7, 6.35, 11.9, 0.8,
          "Take-away: coblation's low-temperature mechanism is real, but current histopathological evidence does NOT show it to be categorically superior to CO2 laser in collateral thermal injury \u2013 differences seen so far are not statistically significant. The clinical advantage of coblation lies more in speed, haemostasis and ergonomics than a proven thermal-injury edge.",
          size=11, color=NAVY, italic=True, font=SERIF)
add_footer(s)

# ============================== EVIDENCE 3: FUNCTION PRESERVATION ==============================
s = new_slide()
add_header(s, "Learning Point \u00B7 Evidence", "Function Preservation \u2013 Voice & Airway Outcomes")
add_bullets(s, 0.7, 1.5, 11.9, 5.3, [
    "Svistushkin et al. 2022, Eur Arch ORL (PMID 34482444) \u2013 analytical review + institutional series of 20 patients undergoing cold-plasma posterior cordotomy for bilateral vocal fold paralysis: coblation gave minimal trauma to surrounding tissue, complete one-pass haemostasis, and an easier post-operative course; functional voice was preserved via long-term orthophonic training",
    "Benninger et al. 2018, JAMA Otolaryngol Head Neck Surg (PMID 29242922) and 2025 multicentre follow-up in J Voice (PMID 36270920) \u2013 coblation cordotomy for bilateral vocal fold immobility: consistent airway improvement with maintained voice quality and quality-of-life scores on long-term follow-up",
    "El-Sobki et al. 2023, J Voice (PMID 37923654) \u2013 prospective study, diode laser vs. coblation for bilateral abductor paralysis (n = 80): both effective with similarly preserved voice quality (VHI); coblation had significantly shorter operative time and lower post-operative pain, with a greater reduction in maximum phonation time",
    "Lou et al. 2025, J Voice (PMID 36414529) \u2013 coblation vs. microflap resection of vocal-fold leukoplakia: comparable oncological safety with functional voice outcomes reported for coblation",
], size=13.5, space_after=11)
add_footer(s)

# ============================== EVIDENCE BASE SUMMARY TABLE ==============================
s = new_slide()
add_header(s, "Evidence Base", "Recent Literature Supporting Coblation in Laryngeal Pathology")
eb_rows = [
    ["Author, Year", "Study Type", "Focus", "PMID"],
    ["Svistushkin et al. 2022", "Review + Case Series", "Coblation across otorhinolaryngology incl. laryngeal cordotomy", "34482444"],
    ["Albazee et al. 2022", "Systematic Review & Meta-analysis", "Coblation vs laser tonsillectomy \u2013 blood loss, pain, time", "35810212"],
    ["Wang et al. 2022", "Meta-analysis", "Plasma RFA vs CO2 laser \u2013 early glottic carcinoma", "35844439"],
    ["Hao et al. 2020", "Comparative Study", "Coblation vs CO2 laser \u2013 laryngotracheal RRP outcomes", "32426815"],
    ["Karakkandy et al. 2024", "Histopathological Comparative Study", "Thermal injury: coblation vs CO2 laser in H&N/larynx", "39376295"],
    ["El-Sobki et al. 2023", "Prospective Comparative Study", "Coblation vs diode laser \u2013 bilateral abductor paralysis", "37923654"],
    ["Benninger et al. 2018 / 2025", "Cohort / Multicentre", "Coblation cordotomy \u2013 bilateral vocal fold immobility", "29242922 / 36270920"],
    ["Lou et al. 2025", "Comparative Study", "Coblation vs microflap \u2013 vocal fold leukoplakia", "36414529"],
    ["Galluzzi & Garavello 2023", "Systematic Review", "Surgical treatment of laryngeal amyloidosis", "36790723"],
    ["McNally et al. 2025", "Comparative Study", "Coblation vs microdebrider \u2013 paediatric RRP", "40518634"],
]
tbl_shape = s.shapes.add_table(len(eb_rows), 4, Inches(0.4), Inches(1.55), Inches(12.5), Inches(5.35))
table = tbl_shape.table
for i, wv in enumerate([2.9, 3.1, 4.9, 1.6]):
    table.columns[i].width = Inches(wv)
for r in range(len(eb_rows)):
    for c in range(4):
        table.cell(r, c).text = eb_rows[r][c]
table_style(table, eb_rows)
for r in range(len(eb_rows)):
    for c in range(4):
        table.cell(r, c).text_frame.paragraphs[0].runs[0].font.size = Pt(10.7 if r else 12.3)
    table.cell(r, 3).text_frame.paragraphs[0].alignment = PP_ALIGN.CENTER
add_footer(s)

# ============================== RECAP ==============================
s = new_slide()
add_header(s, "Recap", "What We Learned From Today's Five Cases")
rows = [
    ("Subglottic Chondroma", "Needs precise cartilage debulking without destabilising the cricoid \u2192 coblation's controlled shaving"),
    ("Hypopharyngeal Hemangioma", "Needs simultaneous cutting and haemostasis \u2192 coblation's bipolar coagulation"),
    ("Subglottic Necrotising Granuloma (GPA)", "Needs debulking without adding further fibrosis \u2192 coblation's low thermal profile"),
    ("Laryngeal Amyloidosis", "Needs repeatable, tissue-sparing debulking for a recurrence-prone disease \u2192 coblation's low collateral injury"),
    ("Intubation Granuloma", "Needs precise excision with minimal mucosal trauma to curb recurrence \u2192 coblation's atraumatic ablation"),
]
y = 1.75
for name, reason in rows:
    add_rect(s, 0.7, y, 0.1, 0.68, CHAMPAGNE)
    add_text(s, 1.0, y, 3.6, 0.68, name, size=13, color=NAVY, bold=True, anchor=MSO_ANCHOR.MIDDLE, font=SERIF)
    add_text(s, 4.7, y, 7.9, 0.68, reason, size=12.5, color=INK, anchor=MSO_ANCHOR.MIDDLE)
    y += 0.88
add_footer(s)

# ============================== LIMITATIONS ==============================
s = new_slide()
add_header(s, "Learning Point", "Limitations & Honest Appraisal")
add_bullets(s, 0.8, 1.6, 11.5, 5.0, [
    "Current evidence base is dominated by case reports and small case series \u2013 larger prospective, comparative studies are lacking",
    "Recurring cost of disposable coblation wands compared with reusable cold instruments",
    "Wand calibre may limit access in very narrow paediatric airways or deeply recessed sites",
    "Not a substitute for oncologic resection with margin control in malignant disease \u2013 role here is confined to benign / non-malignant pathology",
    "Outcomes remain operator- and technique-dependent; a deliberate learning curve exists in power/setting selection for different tissue types",
], size=16, space_after=14)
add_footer(s)

# ============================== TAKE-HOME MESSAGE ==============================
s = new_slide(NAVY_DEEP)
add_rect(s, 0, 0, SLIDE_W, 0.1, CHAMPAGNE)
add_rect(s, 0, SLIDE_H - 0.1, SLIDE_W, 0.1, CHAMPAGNE)
corner_accent(s)
add_text(s, 0.8, 0.55, 11.7, 0.6, "TAKE-HOME MESSAGE", size=25, color=CHAMPAGNE, bold=True, align=PP_ALIGN.CENTER, font=SERIF)
add_rect(s, 5.6, 1.25, 2.1, 0.025, CHAMPAGNE)
messages = [
    "Coblation is a single, low-temperature plasma-ablation platform that performs reliably across neoplastic, vascular, autoimmune-granulomatous, infiltrative and reactive laryngeal disease.",
    "Recognising these lesions early \u2013 clinically, radiologically and histopathologically \u2013 is the first and most important step; the choice of energy tool comes second.",
    "As shown today, even advanced and previously-untreated laryngeal pathology can be managed safely and efficiently with an experienced, structured, multidisciplinary approach.",
    "Coblation deserves a permanent place in the endoscopic laryngologist's armamentarium \u2013 as a versatile complement to, not a replacement for, cold steel, laser and microdebrider.",
]
y = 1.65
for i, msg in enumerate(messages, 1):
    add_rect(s, 0.9, y, 0.5, 0.5, CHAMPAGNE, shape=MSO_SHAPE.OVAL)
    tf_num = s.shapes[-1].text_frame; tf_num.vertical_anchor = MSO_ANCHOR.MIDDLE
    pnum = tf_num.paragraphs[0]; pnum.alignment = PP_ALIGN.CENTER; pnum.text = str(i)
    pnum.runs[0].font.bold = True; pnum.runs[0].font.size = Pt(16); pnum.runs[0].font.color.rgb = NAVY_DEEP
    add_text(s, 1.65, y - 0.02, 10.75, 1.15, msg, size=14.5, color=WHITE, anchor=MSO_ANCHOR.MIDDLE, font=SERIF)
    y += 1.28
add_footer(s)

# ============================== CLOSING SUMMARY ==============================
s = new_slide()
add_header(s, "Key Takeaways", "Closing Summary")
add_bullets(s, 0.8, 1.6, 11.5, 4.6, [
    "Coblation offers a low-temperature, tissue-selective ablation profile that translates into precision, generally favourable haemostasis and a manageable collateral-injury profile",
    "Across five biologically distinct laryngeal lesions discussed today \u2013 neoplastic, vascular, autoimmune-granulomatous, infiltrative and reactive \u2013 coblation achieved effective, function-preserving control",
    "It is best regarded as a versatile adjunct in the endoscopic laryngologist's armamentarium, complementing rather than replacing cold steel, laser and microdebrider",
    "With structured, experienced multidisciplinary care, advanced and complex laryngeal disease can be managed safely, efficiently and reproducibly",
], size=16.5, space_after=15)
add_rect(s, 0.8, 6.2, 11.7, 0.7, NAVY_MID)
add_text(s, 1.0, 6.2, 11.3, 0.7, "One versatile tool \u2013 many faces of laryngeal disease.", size=16,
         color=CHAMPAGNE, italic=True, bold=True, anchor=MSO_ANCHOR.MIDDLE, align=PP_ALIGN.CENTER, font=SERIF)
add_footer(s)

# ============================== REFERENCES ==============================
s = new_slide()
add_header(s, "Bibliography", "References", size=24)
refs = [
    "Meslemani D, Benninger MS. Coblation removal of laryngeal Teflon granulomas. Laryngoscope. 2010. PMID: 20824780.",
    "Awad R, Shamil E, Aymat-Torrente A. Management of laryngeal papillomatosis using coblation. Eur Arch Otorhinolaryngol. 2019. PMID: 30798335.",
    "Galluzzi F, Garavello W. Surgical treatment of laryngeal amyloidosis: a systematic review. Eur Arch Otorhinolaryngol. 2023. PMID: 36790723.",
    "Yadav KV, Chethana R, Mishra P. Coblator assisted excision of laryngeal paraganglioma. Med J Armed Forces India. 2025. PMID: 40496223.",
    "Svistushkin VM, Starostina SV, Toldanov AV. Possibilities of coblation in otorhinolaryngology: analytical review. Eur Arch Otorhinolaryngol. 2022. PMID: 34482444.",
    "Albazee E, Al-Sebeih KH, Alkhaldi F, et al. Coblation tonsillectomy versus laser tonsillectomy: a systematic review and meta-analysis of RCTs. Eur Arch Otorhinolaryngol. 2022. PMID: 35810212.",
    "Wang C, Zhao Y, Li C, et al. Meta-analysis of low temperature plasma radiofrequency ablation and CO2 laser surgery on early glottic laryngeal carcinoma. Comput Math Methods Med. 2022. PMID: 35844439.",
    "Hao F, Yue L, Yin X, et al. Low-temperature radiofrequency coblation reduces treatment interval and post-operative pain of laryngotracheal recurrent respiratory papillomatosis. Bioscience Reports. 2020. PMID: 32426815.",
    "Karakkandy V, Chappity P, Mishra P, et al. A double-anonymised histopathological comparative study of CO2 laser and coblation in head and neck surgery. Indian J Otolaryngol Head Neck Surg. 2024. PMID: 39376295.",
    "El-Sobki A, Elzayat S, El-Deeb ME, et al. Surgical management of bilateral abductor paralysis: diode laser versus coblation; a prospective study. J Voice. 2023. PMID: 37923654.",
    "Benninger MS, Xiao R, Osborne K, et al. Outcomes following cordotomy by coblation for bilateral vocal fold immobility. JAMA Otolaryngol Head Neck Surg. 2018. PMID: 29242922.",
    "Benninger MS, Syamal M, Gau VL, et al. Coblation cordotomy for the management of bilateral vocal fold immobility. J Voice. 2025. PMID: 36270920.",
    "Lou Z, Lou Z, Lv T, et al. Comparison between coblation and microflap resection of leukoplakia of the vocal fold. J Voice. 2025. PMID: 36414529.",
    "McNally G, Mason R, Bateman N, et al. Recurrent respiratory papillomatosis in children: coblation versus microdebrider. J Laryngol Otol. 2025. PMID: 40518634.",
    "Scott-Brown's Otorhinolaryngology, Head & Neck Surgery, 8th ed. \u2013 Granulomatosis with Polyangiitis; Coblation\u00AE.",
    "Cummings Otolaryngology \u2013 Head & Neck Surgery, 8th ed. \u2013 Chondroma; Contact/Intubation Granuloma; Laryngitis in Systemic Disease (Amyloidosis).",
    "K.J. Lee's Essential Otolaryngology, 11th ed. \u2013 Laryngology; Radiofrequency Ablation (Coblation) in Otolaryngology.",
    "[Add institutional case-series data, local ethics approval number, and any additional references before final submission]",
]
add_bullets(s, 0.8, 1.5, 11.6, 5.4, refs, size=11, space_after=7)
add_footer(s)

# ============================== THANK YOU ==============================
s = new_slide(NAVY_DEEP)
add_rect(s, 0, 0, SLIDE_W, 0.1, CHAMPAGNE)
add_rect(s, 0, SLIDE_H - 0.1, SLIDE_W, 0.1, CHAMPAGNE)
corner_accent(s)
add_text(s, 0.9, 2.9, 11.5, 1.1, "Thank You", size=46, color=WHITE, bold=True, align=PP_ALIGN.CENTER, font=SERIF)
add_text(s, 0.9, 4.1, 11.5, 0.5, "Questions & Discussion", size=17, color=CHAMPAGNE, italic=True, align=PP_ALIGN.CENTER, font=SERIF)
add_text(s, 0.9, 4.9, 11.5, 0.4, "[Presenter Name]  \u2022  [Email/Contact]  \u2022  [Department, Institute]",
         size=13, color=RGBColor(0xC9, 0xD3, 0xDD), align=PP_ALIGN.CENTER, font=SANS)

prs.save("Coblation_in_Diverse_Laryngeal_Lesions.pptx")
print("Total slides:", len(prs.slides._sldIdLst))
print("DONE")