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 in the three dimensional visual reconstruction of the craniofacial skeleton and the development of ridge curves that allow quantitative measurements in any plane. This project has been supported by the Smile Train and by a National Institutes of Health (NIH) research grant. The Principal Investigator is Dr. Court B. Cutting in collaboration with Dr. Fred Bookstein at the University of Michigan. This research has developed computer graphics techniques to optimize the planning and execution of multiple piece mid-face skeletal advancements. Dr. Cutting has clinically adapted this research to robotic surgery in order to improve the results of skeletal segmental advancement by using intraoperative computer-assisted techniques.

Distraction osteognesis as a means of expanding or augmenting the craniofacial skeleton continues to be investigated by Dr. Joseph G. McCarthy and his colleagues. Previously, they had reported the use of an extraoral mandibular device in animals and humans. This research group continues to develop new distraction device technology with both intraoral and extraoral multiplanar devices. Distraction in multiple planes allows the surgeon to reconstruct the mandible with more accuracy. Less invasive methods of midface distraction are being explored experimentally by combining endoscopic surgery with distraction osteogenesis. This approach offers great promise for reducing the morbidity of the current midface advancement techniques. The effect of distraction osteogenesis on the muscles of mastication and the temporomandibular joint is being evaluated in both humans and in canine models. An animal model has been developed at the Center for Repair and Development to study the biology of mandibular distraction. Distraction osteogenesis in this model will be analyzed at both the gene and protein level using biomolecular reagents. Experiments are planned to combine gene therapy with distraction osteogenesis to maximize the rate and minimize the consolidation period of distraction. Animal models for cartilage distraction bone contraction are also being developed.

Tissue engineering is an exciting new area of research in the craniofacial laboratory. Prefabrication of cartilage and bone flaps with subsequent flap transfer to the cranium is being studied in an animal model. Analysis of these experiments will included histology and biomedical testing.

The biology of cranial suture fusion is being studied clinically using human specimens as well as experimentally in animal models. A large body of evidence has been gathered describing an important interaction between the brain, dura matter and cranial suture in craniosysnostosis. Analysis of physiologic and pathologic suture fusion at both the gene and protein level demonstrates that bone growth factors play a role in suture fusion. Numerous scientific publications have been published describing the biology of cranial suture fusion.