Craniofacial Surgery and Orthodontic Clinical Research
Barry M. Zide, MD
Court B. Cutting, MD
Judah S. Garfinkle, DDS, MS
Pradip R Shetye DDS, MDS, MOrthRCS
Lawrence E. Brecht, DDS
Barry H. Grayson, DDS
Charles H.M. Thorne, MD
Stephen M. Warren, MD
Joseph G. McCarthy, MD
The Craniofacial Imaging Laboratory continues to make progress inthe three dimensional visual reconstruction of the craniofacial skeletonand the development of ridge curves that allow quantitative measurementsin any plane. This project has been supported by the Smile Train andby a National Institutes of Health (NIH) research grant. The PrincipalInvestigator is Dr. Court B. Cutting in collaboration with Dr. FredBookstein at the University of Michigan. This research has developedcomputer graphics techniques to optimize the planning and executionof multiple piece mid-face skeletal advancements. Dr. Cutting has clinicallyadapted this research to robotic surgery in order to improve the resultsof skeletal segmental advancement by using intraoperative computer-assistedtechniques.
Distraction osteognesis as a means of expanding or augmenting thecraniofacial skeleton continues to be investigated by Dr. Joseph G. McCarthy and his colleagues. Previously, they had reported theuse of an extraoral mandibular device in animals and humans. This researchgroup continues to develop new distraction device technology with bothintraoral and extraoral multiplanar devices. Distraction in multipleplanes allows the surgeon to reconstruct the mandible with more accuracy. Less invasive methods of midface distraction are being explored experimentallyby combining endoscopic surgery with distraction osteogenesis. Thisapproach offers great promise for reducing the morbidity of the currentmidface advancement techniques. The effect of distraction osteogenesison the muscles of mastication and the temporomandibular joint is beingevaluated in both humans and in canine models. An animal model has beendeveloped at the Center for Repair and Development to study the biologyof mandibular distraction. Distraction osteogenesis in this model willbe analyzed at both the gene and protein level using biomolecular reagents.Experiments are planned to combine gene therapy with distraction osteogenesisto maximize the rate and minimize the consolidation period of distraction.Animal models for cartilage distraction bone contraction are also beingdeveloped.
Tissue engineering is an exciting new area of research in the craniofaciallaboratory. Prefabrication of cartilage and bone flaps with subsequentflap transfer to the cranium is being studied in an animal model. Analysisof these experiments will included histology and biomedical testing.
The biology of cranial suture fusion is being studied clinically usinghuman specimens as well as experimentally in animal models. A largebody of evidence has been gathered describing an important interactionbetween the brain, dura matter and cranial suture in craniosysnostosis.Analysis of physiologic and pathologic suture fusion at both the geneand protein level demonstrates that bone growth factors play a rolein suture fusion. Numerous scientific publications have been publisheddescribing the biology of cranial suture fusion.
