Craniofacial Biology and Craniofacial Surgery

The following sections are included:

• Recognition

• Foreword by Geoffrey H. Sperber

• Foreword by Joseph G. McCarthy

• Preface

• Table of Contents

The following sections are included:

• Introduction
  • BONE GROWTH AND CHANGE
  • NORMAL CRANIOFACIAL GROWTH
    • Environment and Growth

• REFERENCES

The following sections are included:

• INTRODUCTION

• REVIEW OF THE LITERATURE

• MATERIAL AND METHODS
  • Surgical Procedures
  • Lateral Cephalometric Roentgenographs
  • Tracings of the Roentgenographs
  • Preparation of Gross Material

• FINDINGS
  • Gross
  • Serial Lateral Cephalometric Roentgenographs and Tracings
  • Increase in Size
    • Ramus height
    • Ramus width
    • Body height
    • Total mandibular length
  • Eruption of the Permanent Mandibular First and Second Molars Correlated with Mandibular Growth

• DISCUSSION
  • Method of Study
  • Sites of Growth
    • Condyle and posterior border of the ramus
    • Anterior border
    • Alveolar border
    • Inferior border
    • Relationship between the ramus and body growth
    • Correlation of mandibular growth and development of the permanent molars

• SUMMARY AND CONCLUSIONS

• REFERENCES

The following sections are included:

• INTRODUCTION

• MATERIALS AND METHODS

• FINDINGS
  • Anterior Aspect of the Skull
  • Lateral Aspect of the Skull
  • Basal Aspect of the Skull

• COMMENTS
  • Facial Growth

• SUMMARY AND CONCLUSIONS

• REFERENCES

The following sections are included:

• INTRODUCTION

• MATERIALS AND METHODS
  • Animals
  • Anesthesia
  • Surgical Procedure
  • Photographs and Roentgenographs
  • Histological Sections

• RESULTS
  • Antemortem Observations
  • Postmortem Observations
    • Region of the temporomandibular joint of the operated-on side
    • Lateral aspect of the skull
    • Anterior aspect of the skull
    • Ventral aspect of the skull
  • Roentgenographic and Photographic Observations
  • Histological Observations

• DISCUSSION
  • Comparison of Findings after Condylectomy in Adult and Growing Monkeys
  • Dental Occlusion
  • Roentgenographic Changes
  • Controls

• SUMMARY

• REFERENCES

Following resection of the temporalis muscle, a smaller or absent coronoid process has been reported in growing animals (Table 5.1).^1,2 The trauma of resection, altered function, hemorrhage, scar tissue, and changes in vascularity may have influenced the results. The purpose of this experiment was to observe in adult Macaca mulatta the fully grown coronoid process after decreasing or eliminating neurofunctional activity of the temporalis muscle unilaterally without the trauma of local resection. In two males and three females the motor root of the trigeminal nerve which innervates the temporalis muscle was resected intracranially. In three control animals of both sexes the same surgical procedure was performed except for resection of the nerve. At postmortem, one year later, the temporalis muscle mass was atrophic on the resected side. There were no significant morphological differences, however, between the right and left sides of the mandible, including the coronoid process, regardless of which motor root of the fifth nerve had been resected, which side had been sham-operated, or sex. An extensive deposit of calculus on the buccal surfaces of the teeth on the operated nerve side was a consistent, conspicuous finding…

The following sections are included:

• INTRODUCTION
  • Dental Changes
  • Healing of Bone

• REFERENCES

This is the first and only book to deal with the subject in this particular manner. It is of course not feasible to include the contents of the BOOK at this time.

The chosen title indicates our philosophy. We have developed and emphasized a basic biological approach to the difficult and, in many instances, unanswered clinical problems involving the temporomandibular joint and, in the broader context, the masticatory apparatus. There are two parts to the book. Part I emphasizes the biology of the temporomandibular joint region, and incorporates clinical correlations. This serves as a foundation for Part II, which is devoted almost entirely to clinical evaluation, accurate diagnosis, and proper treatment, reinforced by reference to the basic science aspects. We are not aware of another book on the temporomandibular joint that takes this approach…

The following sections are included:

• UNILATERAL HYPERPLASIA OF THE MANDIBULAR CONDYLE

The following sections are included:

• INTRODUCTION

• REPORT OF CASE
  • Examination
  • Operation
  • Postoperative Course

• REFERENCES

The following sections are included:

• INTRODUCTION

• ABNORMAL GROWTH: SOME SURGICAL CONSIDERATIONS

• UNDERDEVELOPMENT OF THE MANDIBLE
  • Local Causes
    • Trauma
    • Inflammation

• ANKYLOSIS AND CONDYLAR RESECTION
  • Systemic Causes
    • Hereditary and congenital conditions
    • Inflammatory lesions
    • Dietary deficiencies
    • Endocrine disturbances: Cretinism

• OVERDEVELOPMENT OF THE MANDIBLE
  • Local Causes
    • Intrinsic factors: Tumors
    • Extrinsic factors: Enlarged tongue
  • Idiopathic
    • Unilateral hyperplasia of the mandibular condyle
    • Prenatal unilateral hypertrophy of the face
    • Prognathic mandible
  • Endocrine Disturbances: Giantism and Acromegaly
    • Giantism
    • Acromegaly

• DISTORTION OF THE MANDIBLE

• OTHER SURGICAL CONSIDERATIONS
  • Chronic Anterior Dislocation of the Mandible

• REFERENCES

The following sections are included:

• PEDIATRIC MANDIBULAR TRAUMA

• MANDIBULAR ASYMMETRY

• MANDIBULAR DEVIATION WITH UNILATERAL CORONAL SYNOSTOSIS

• PIERRE ROBIN SEQUENCE

• DISTRACTION OSTEOGENESIS
  • History
  • Biology
  • Mandibular Distraction
  • Devices and Vectors
  • Neonatal Distraction

• CRANIOFACIAL MICROSOMIA

• TREACHER–COLLINS SYNDROME

• GENIOPLASTY DISTRACTION

• TEMPOROMANDIBULAR JOINT ANKYLOSIS

• SUMMARY

• REFERENCES

The rabbit face comprises, in part, the mandibular, premaxillary, maxillary, and nasal bones (Fig. 11.1).¹

The nasal cavity communicates posteriorly with the ventral surface of the skull by the choanae, which, in the rabbit, are incompletely divided (Fig. 11.1). Anteriorly, it opens to the outside by the piriform aperture…

The following sections are included:

• INTRODUCTION

• MATERIALS AND METHODS
  • Animals
  • Anesthesia
  • Metallic Implants (Direct Measurements)
  • Serial Cephalometric Roentgenography (Indirect Measurements)

• RESULTS
  • Skulls
    • Increased separation of paired implants at the frontonasal suture
    • Increased separation of paired implants at the internasal and interfrontal sutures
  • Serial Roentgenographs

• DISCUSSION
  • Implants

• SUMMARY AND CONCLUSIONS

• REFERENCES

The following sections are included:

• INTRODUCTION

• MATERIAL AND METHODS
  • Animals
  • Anesthesia
  • Extirpation of the Frontonasal Suture
  • Metallic Implants (Direct Measurements)
  • Serial Cephalometric Roentgenography (Indirect Measurements)
  • Gross Observations
  • Direct Measurement
  • Total Longitudinal Growth Between Implants
  • Components of Longitudinal Growth Between Implants
  • Indirect Measurements: Serial Roentgenographs

• DISCUSSION
  • Implants
  • Extirpation Site
  • Some Considerations of Sutural Growth

• SUMMARY AND CONCLUSIONS

• REFERENCES

The following sections are included:

• INTRODUCTION AND PURPOSE

• MATERIALS AND METHODS
  • Animals
  • Anesthesia
  • Metallic Implants
  • Serial Cephalometric Roentgenography

• RESULTS
  • Gross
  • Serial Cephalometric Roentgenographs and Tracings

• DISCUSSION
  • Clinical Comment

• REFERENCES

The following sections are included:

• INTRODUCTION AND PURPOSE

• REVIEW OF THE LITERATURE

• MATERIALS AND METHODS
  • Animals
  • Anesthesia
  • Surgical Procedure
  • Photographs and Roentgenographs

• RESULTS
  • Growing Rabbits
    • Resected septovomeral region and/or cartilaginous nasal septum (large amounts)
      • Antemortem observations
      • Postmortem observations
      • Roentgenographic observations
  • Adult Rabbits

• DISCUSSION
  • The Face and Jaws After Surgical Experimentation with the Septovomeral Region
  • Dental Changes
  • Clinical Considerations

• SUMMARY AND CONCLUSIONS

• REFERENCES

The following sections are included:

• INTRODUCTION

• MATERIAL

• METHODS
  • Anesthesia
  • Metallic Implants (Direct Measurements)
  • Cephalometric Roentgenographs and Tracings (Indirect Measurements)
  • Preparation of Material

• FINDINGS
  • Examination of Skulls
    • Tissue reaction to individual implants
    • Separation of paired implants
  • Examination of Roentgenographs
    • Individual implants
    • Paired implants
    • Rate of separation
  • Examination of Superposed Tracings of Serial Roentgenographs

• DISCUSSION
  • Appositional Growth
  • Sutural Growth
  • Total Facial Growth
  • Comparison between the Roentgenographic and Direct Methods of Measuring Growth

• SUMMARY AND CONCLUSIONS

The following sections are included:

• INTRODUCTION

• BRIEF DESCRIPTION OF THE GROSS ANATOMY OF THE MAXILLARY SINUS OF THE DOG

• BRIEF GROSS DESCRIPTION OF THE MAXILLARY DENTITION OF THE DOG

• MATERIAL AND METHODS

• FINDINGS

• DISCUSSION

• CLINICAL APPLICATION

• SUMMARY AND CONCLUSIONS

• REFERENCES

The following sections are included:

• INTRODUCTION

• MATERIAL AND METHODS

• FINDINGS
  • Postoperative Findings
  • Postmortem Findings
    • Soft tissues of the hard palate
    • Bony palate
    • Other structures

• DISCUSSION
  • Healing After Palatal Surgery
  • Palatal and Facial Growth After Palatal Surgery
  • Maxillary Underdevelopment: Some Possible Causes
    • Genetic and prenatal
    • Surgical interference
    • Scar tissue
  • Need for Further Study

• SUMMARY AND CONCLUSIONS

• REFERENCES

The following sections are included:

• SARNAT'S GROWTH STUDIES IN CLINICAL PRACTICE

• MIDFACE HYPOPLASIA
  • Monobloc Distraction
  • Le Fort I Distraction
  • Septal Surgery

• ALVEOLAR CLEFT
  • Boneborne Rapid Expansion
  • Bone Morphogenetic Protein

• CLEFT PALATE
  • Fibroblast Growth Factor
  • Delayed Cleft Palate Repair

• SUMMARY

• REFERENCES

The orbits of the rabbit separate the cranial from the facial portions of the skull (Davis 1929, Craigie 1960, Prince 1964). They are situated laterally, with the plane of the external opening at an angle of 80° to the transverse plane of the head. The vertical diameter of the orbital rim makes an angle of about 30° with the sagittal plane of the head.

The orbit is incomplete and is formed by the frontal, lacrimal, maxillary, palatine, pterygoid, sphenoid, temporal and zygomatic bones (Figs. 19.1, 19.2). A small portion of the ethmoid bone may reach the medial orbital wall. The orbit can be divided into six walls. Four walls are bony — inner, superior, anterior, and posterior. Two walls are not bony; the inferior one is muscular and the external side is the orbital orifice or entrance…

The following sections are included:

• INTRODUCTION AND PURPOSE

• MATERIALS AND METHODS
  • The Orbit
  • Volumetric Determination
  • Comparison of Direct and Indirect Orbital Volumetric Determinations
  • Surgical Experimentation
    • Orbital volume after reduction of orbital contents
      • Young rabbit orbital volume after evisceration, enucleation, or exenteration
      • Orbital volume after evisceration or enucleation with an implant
      • Adult rabbit orbital volume after enucleation

• RESULTS
  • Orbital Volume in Young and Adult Rabbits
  • Comparison of Direct and Indirect Orbital Volumetric Determinations
  • Surgical Experimentation
    • Orbital volume after reduction of orbital contents
      • Young rabbit orbital volume after evisceration, enucleation, or exenteration
      • Orbital volume after evisceration or enucleation with an implant
      • Adult rabbit orbital volume after enucleation

• DISCUSSION
  • Methods of Determining Orbital Volume
  • Orbital Volume of Young and Adult Rabbits
  • Comparison of Linear Measurements and Estimated Volumes of Orbital, Imprint, and Roentgenographic Imprint Images
  • Surgical Experimentation
    • Orbital volume after reduction of orbital contents
      • Young rabbit orbital volume after evisceration, enucleation, or exenteration
      • Orbital volume after evisceration or enucleation with an implant
      • Adult rabbit orbital volume after enucleation

• SUMMARY AND CONCLUSIONS

• REFERENCES

The following sections are included:

• YOUNG RABBIT ORBITAL VOLUME AFTER PERIODIC INTRABULBAR INJECTIONS OF SILICONE

• ADULT RABBIT ORBITAL VOLUME AFTER PERIODIC INTRABULBAR INJECTIONS OF SILICONE

• RESULTS
  • Orbital Volume After Increase of Orbital Contents
    • Young rabbit orbital volume after periodic intrabulbar injections of silicone
    • Adult rabbit orbital volume after periodic intrabulbar injections of silicone

• DISCUSSION
  • Orbital Volume After Increase of Orbital Contents
    • Young rabbit orbital volume after periodic intrabulbar injections of silicone
    • Adult rabbit orbital volume after periodic intrabulbar injection of silicone

The following sections are included:

• INTRODUCTION

• VOLUMETRIC DETERMINATION

• COMPARISON OF LINEAR AND VOLUMETRIC EYE DETERMINATIONS

• RESULTS
  • Eye Volume in Young and Adult Rabbits
  • Comparison of Linear and Volumetric Eye Determinations
  • Relationship of Eye and Orbital Volume to Each Other and to Age, Weight, and Sex

• DISCUSSION
  • Methods of Determining Eye Volume
    • Comparison of the linear and gravimetric methods of determining eye volume
  • Eye Volume of Young and Adult Rabbits
  • Relationship of Eye and Orbital Volume to Each Other and to Age, Weight, and Sex

• SUMMARY AND CONCLUSIONS

The following sections are included:

• SARNAT'S GROWTH STUDIES OF THE ORBIT AND UPPER FACE

• MICROPHTHALMIA

• CONGENITAL ORBITAL DYSTOPIA
  • Horizontal Dystopia
  • Correction of Hypertelobitism; K Stitch Reconstruction
  • Vertical Dystopia
  • Craniofrontonasal Dysplasia
  • Craniofacial Cleft

• ORBITAL TRAUMA

• SUMMARY

• REFERENCES

The following sections are included:

• EXPERIMENTS OF NATURE: DENTAL AND FACIAL DEVELOPMENT

The following sections are included:

• INTRODUCTION

The following sections are included:

• INTRODUCTION

• GROWING TOOTH

The following sections are included:

• INTRODUCTION

• REPORT OF A CASE
  • Period from 2 to 5 Years of Age
  • Period from 6 to 16 Years of Age
  • Gross Study of Increase in the Size of the Jaws
  • Serial Cephalometric-Roentgenographic Study

• SUMMARY AND CONCLUSIONS

The following sections are included:

• INTRODUCTION

• DIAGNOSIS
  • Clinical Findings
  • Roentgenographic Findings
  • Gross Findings
  • Microscopic Findings

• SURGICAL TREATMENT
  • Intraoral Approach
  • Extraoral Approach
  • Maintenance of Jaw Fragments
  • Reconstruction of the Defect

• SUMMARY AND CONCLUSIONS

• REFERENCES

This report shows the value of routine intraoral roentgenographs of unerupted permanent teeth as an aid in the early diagnosis of congenital syphilis (Fig. 29.1). The growing teeth, like the bones and other organs, may be affected in congenital syphilis. The screwdriver-shaped and notched permanent upper central incisors are the most common and characteristic clinical dental abnormality. In congenital syphilis, the form (size and shape) of the tooth is altered during the stage of morphodifferentiation (Fig. 24.1). The primary requisite of the upper permanent central incisor and of the first permanent molar is a convergence of the lateral surfaces, with a resulting narrowed mesiodistal diameter of the crown…

Enamel hypoplasia occurs in the stage of dental development of appositional growth (Fig. 24.1). An extensive investigation was undertaken of the chronologic incidence, the morphologic pattern, and the possible etiologic factor or factors of enamel hypoplasia in relation to systemic disease (Fig. 30.1). Two-thirds of the enamel hypoplasia occurred during the infancy period (from birth to the end of about the first year), about one-third occurred during the early childhood period (about 13–34 months), and less than 2% occurred during the late childhood period (about 35–80 months). No specific cause was found. Exanthematous disease was not so frequent a cause of enamel hypoplasia as has been commonly believed. Possible causative factors were rickets, hypoparathyroidism, and fluorosis, but development of hypoplasia cannot be predicted with any reliability even in the severe forms of these diseases. In more than 50% of the patients studied, no causative factors could be determined. Except in fluorosis, enamel hypoplasia was not restricted to certain geographic localities, but was as ubiquitous as disease.

The following sections are included:

• INTRODUCTION

• METHODS AND MATERIALS

• RESULTS

• COMMENT
  • Growing Bone

• SUMMARY

• REFERENCES

The following sections are included:

• CRANIOSYNOSTOSIS
  • Normal Suture Fusion: Rodent Model
    • Dura mater influence
      • Silastic barrier experiment
      • Suture rotation experiment
      • Murine cranial suture fusion
      • Murine in vitro study
      • Murine in vitro suture rotation
    • Cytokine signaling
      • Insulin-like growth factors
      • Transforming growth factor beta, fibroblast growth factors, and other candidate genes
  • Pathologic Suture Fusion: Rabbit Model
    • Correction of unilateral coronal synostosis in rabbits leads to resolution of mandibular asymmetry
    • Intracranial pressure changes in craniosynostotic rabbits
    • Noggin and Runx2 in craniosynostotic rabbits
    • Rescue of coronal suture fusion using transforming growth factor beta 3 (TGF-β3)
  • Stress-induced Suture Fusion
    • Stress-induced in vitro cranial suture fusion

• CLINICAL CONSIDERATIONS

• REFERENCES

The following sections are included:

• INTRODUCTION

• EXPERIMENTAL CONSIDERATIONS
  • Bone Growth
    • Sutural growth
      • Several facial sutures
      • Shell
    • Cartilaginous growth
      • Long bone; base of the skull
      • Mandibular condyle
      • Nasal septum
    • Appositional and resorptive (remodeling) growth
      • Nasal bone
      • Mandible
  • Growth of Cavities
    • Orbit
      • Normal orbital volume
    • Maxillary sinus
  • Growth of Teeth
    • Hibernation
  • Sutural Growth
  • Cartilaginous Growth
  • Appositional and Resorptive (Remodeling) Growth
  • Cavities
  • Teeth
  • Healing of Mineralized Tissues

The following sections are included:

• REGROWTH OF SUTURES

• HISTOLOGICAL FINDINGS

• THE SNOUT AFTER EXTIRPATION OF THE FRONTONASAL SUTURE REGION IN YOUNG RABBITS

• SUTURAL GROWTH

• GROWTH AT THE FRONTONASAL SUTURE IN YOUNG RABBITS

• GROWTH AT SEVERAL SUTURES IN YOUNG TURTLE SHELLS

• PATTERN OF SUTURAL GROWTH OF BONES

• COMMENT

• REFERENCES

The following sections are included:

• EDITOR'S NOTE

• INTRODUCTION

• LOCAL SURGICAL INTERVENTION
  • Changes After Mandibular Condylectomy
  • Effects of Extirpation of the Nasal Septum
  • Experimental Changes After Decrease and Increase in Orbital Contents Volume

• SYSTEMIC FACTORS
  • Yellow Phosphorus and Its Effect on Long Bones, the Base of the Skull, and Teeth
  • Effect of Decreased Temperature on Growth

The following sections are included:

• INTRODUCTION

• MATERIALS AND METHODS
  • Turtle Hyoplastron and Hypoplastron

• RESULTS
  • Pig Mandible
  • Rabbit Frontal and Nasal Bones

• DISCUSSION

• REFERENCES

The following sections are included:

• INTRODUCTION

• METHODS USED
  • Anthropometry
  • Impressions and Casts
    • Orbit
      • Orbital imprints
    • Eye
    • Maxillary sinus
    • Dental arches
    • Serial photographs
    • Vital markers
      • Alizarin red S
      • Hibernation
      • Yellow phosphorus
    • Implant markers (and serial roentgenographs)
      • Single bones (apposition and resorption)
      • Mandible: Surgical procedure
      • Nasal bone
      • Rib (endochondral)
      • Multiple bones — sutural (apposition)
      • Frontonasal suture and multiple facial sutures
      • Multiple turtle shell sutures
    • Histology
    • Serial cephalometric roentgenographs
    • Serial cephalometric roentgenographs and implant markers (see "Implant markers")
    • Roentgenographs and metaphysial bands
    • Autoroentgenographs (cartilaginous nasal septum) (see Chap. 11)
      • Cartilaginous nasal septum
    • Fourier descriptors

• REFERENCES

The following sections are included:

• INTRODUCTION

• BASIC CONSIDERATIONS OF CARTILAGE

• HYALINE CARTILAGE
  • Gross Morphology
  • Distribution and Function
  • Histologic Appearance
  • Histogenesis
  • Physiology
    • Nutrition
    • Metabolism
    • Growth
    • Repair
    • Ectopic cartilage formation
    • Age changes
  • Pathology
    • Degeneration
    • Inflammation
    • Abnormal growth and development
    • Neoplasms
    • Effects of irradiation

• ELASTIC CARTILAGE AND FIBROCARTILAGE

• CARTILAGE IMPLANTS
  • Brief Historical Review
  • Classification
    • Donor source
      • Autogenous cartilage grafts
      • Homogenous cartilage implants
      • Heterogenous cartilage implants
    • Donor sites
    • Physical state
  • Clinical Uses of Cartilage Implants
  • Definition of a Successful Implant
  • Factors Influencing Successful Implantation of Cartilage
  • Fate of Implanted Cartilage
    • Gross findings
      • Shape
      • Variations in size
    • Histologic findings
    • Histochemical findings
    • Nutrition and metabolism

• SUMMARY

• REFERENCES

The following sections are included:

• The Teeth as Recorders of Systemic Disease

• Rickets

• Congenital Syphilis

• Sickle Cell Anemia

• Oral and Facial Cancer
  • FOREWORD
  • PREFACE TO THE FIRST EDITION
  • PREFACE

• Oral Occupational Disease
  • REFERENCE

The following sections are included:

• APPENDIX A Becoming a Plastic Surgeon — Yesterday (BGS)
  • INTRODUCTION
  • VILRAY P. BLAIR (1871–1955)
  • VILRAY P. BLAIR AND THE AMERICAN BOARD OF PLASTIC SURGERY
  • JAMES B. BROWN (1899–1971)
  • LOUIS T. (BILL) BYARS (1906–1969)
  • FRANK MCDOWELL (1911–1981)
  • BERNARD G. SARNAT (1912– )
  • BARNES HOSPITAL
  • REFERENCES

• APPENDIX B Becoming a Plastic Surgeon — Today (JPB)
  • REFERENCES

• Index