Court B. Cutting, M.D.

A 12-Year Anthropometric Evaluation of the Nose in Bilateral Cleft Lip-Cleft Palate Patients following Nasoalveolar Molding and Cutting Bilateral Cleft Lip and Nose Reconstruction
Garfinkle, Judah S; King, Timothy W; Grayson, Barry H; Brecht, Lawrence E; Cutting, Court B
2011 Apr;127(4):1659-1667, Plastic & reconstructive surgery
BACKGROUND: : Patients with bilateral cleft lip-cleft palate have nasal deformities including reduced nasal tip projection, widened ala base, and a deficient or absent columella. The authors compare the nasal morphology of patients treated with presurgical nasoalveolar molding followed by primary lip/nasal reconstruction with age-matched noncleft controls. METHODS: : A longitudinal, retrospective review of 77 nonsyndromic patients with bilateral cleft lip-cleft palate was performed. Nasal tip protrusion, alar base width, alar width, columella length, and columella width were measured at five time points spanning 12.5 years. A one-sample t test was used for statistical comparison to an age-matched noncleft population published by Farkas. RESULTS: : All five measurements demonstrated parallel, proportional growth in the treatment group relative to the noncleft group. The nasal tip protrusion, alar base width, alar width, columella length, and columella width were not statistically different from those of the noncleft, age-matched control group at age 12.5 years. The nasal tip protrusion also showed no difference in length at 7 and 12.5 years. The alar width and alar base width were significantly wider at the first four time points. CONCLUSIONS: : This is the first study to describe nasal morphology following nasoalveolar molding and primary surgical repair in patients with bilateral cleft lip-cleft palate through the age of 12.5 years. In this investigation, the authors have shown that patients with bilateral cleft lip-cleft palate treated at their institution with nasoalveolar molding and primary nasal reconstruction, performed at the time of their lip repair, attained nearly normal nasal morphology through 12.5 years of age
— id: 130309, year: 2011, vol: 127, page: 1659, stat: Journal Article,

Comparison of Minimally Invasive versus Conventional Open Harvesting Techniques for Iliac Bone Graft in Secondary Alveolar Cleft Patients
Sharma, Sheel; Schneider, Lisa F; Barr, Jason; Aarabi, Shahram; Chibbaro, Patricia; Grayson, Barry; Cutting, Court B
2011 Aug;128(2):485-491, Plastic & reconstructive surgery
BACKGROUND: : Autologous bone grafts, often harvested from the iliac crest, are the criterion standard for secondary alveolar cleft repair. The best technique for harvest remains controversial. Minimally invasive techniques have been used for bone graft harvest in cleft patients, but outcome studies have been limited by small numbers of patients. METHODS: : A total of 104 patients undergoing bone grafting for alveolar cleft were reviewed. Fifty-five consecutive patients underwent minimally invasive iliac bone graft harvest using the Acumed power-driven trephine system performed by the same surgeon. These patients were compared with 49 control patients undergoing a similar procedure in which the traditional method of open iliac bone harvest with an osteotome was used. RESULTS: : Operative time for the bone graft harvest was significantly shorter with the Acumed device when compared with the osteotome (2.37 hours versus 3.26 hours, p < 0.001). Patients who underwent minimally invasive Acumed bone harvest required significantly less postoperative analgesia than did patients who underwent osteotome harvest, for both narcotic (0.31 mg/kg versus 1.64 mg/kg, p < 0.001) and nonnarcotic (15.1 mg/kg versus 27.2 mg/kg, p < 0.01) pain medication. Acumed patients had significantly less pain on discharge (0.26 versus 3.1 pain scores on a scale from 0 to 10, p < 0.001) and left the hospital more quickly (23.3 hours versus 30.1 hours, p < 0.001). CONCLUSION: : Minimally invasive bone graft harvest technique using the trephine system offers a superior alternative to the conventional open iliac bone harvest method for patients undergoing secondary alveolar cleft repair, with shorter operative time, decreased requirement for pain medications, less pain on discharge, and a shorter hospital stay. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, III.(Figure is included in full-text article.)
— id: 135584, year: 2011, vol: 128, page: 485, stat: Journal Article,

Management of cleft lip and palate in the developing world management of cleft lip and palate in the developing world . M Mars , d sell , N habal
Cutting, Court
2010 Nov;47(6):675-675, Cleft palate-craniofacial journal
— id: 114199, year: 2010, vol: 47, page: 675, stat: Journal Article,

Tensor veli palatini preservation, transection, and transection with tensor tenopexy during cleft palate repair and its effects on eustachian tube function
Flores, Roberto L; Jones, Bethany L; Bernstein, Joseph; Karnell, Michael; Canady, John; Cutting, Court B
2010 Jan;125(1):282-289, Plastic & reconstructive surgery
BACKGROUND: During cleft palate repair, levator sling palatoplasty with tensor veli palatini tendon transection significantly improves speech results. However, the procedure may pose a risk to eustachian tube function. This study assesses the impact of three types of palatoplasty techniques on eustachian tube function: no tensor transection, tensor transection alone, and a new addition to the palatoplasty technique, tensor tenopexy. METHODS: A retrospective review was conducted of all patients undergoing cleft palate repair at two institutions between 1997 and 2001. Three cleft palate repair groups were studied: no tensor transection (n = 64), tensor transection alone (n = 31), and tensor tenopexy (n = 52). The percentages of patients requiring myringotomy tubes at each year of age were compared among the three groups. RESULTS: By 7 years of age, there was a significantly decreased need for myringotomy tubes in patients who underwent no tensor transection compared with patients who underwent tensor transection alone (38 percent versus 61 percent, respectively; p = 0.05), as well as for patients who underwent tensor tenopexy compared with patients who underwent tensor veli palatini tendon transection (23 percent versus 61 percent, respectively; p < 0.001). Also, by the age of 7, there was a trend toward a decreased need for myringotomy tubes in patients who underwent tensor tenopexy compared with patients who underwent no tensor transection (23 percent versus 38 percent, respectively; p = 0.11). CONCLUSIONS: No tensor transection and tensor tenopexy significantly decrease the need for myringotomy tubes compared with tensor transection alone. There is a small decrease in the need for myringotomy tubes when comparing tensor tenopexy with no tensor transection
— id: 134969, year: 2010, vol: 125, page: 282, stat: Journal Article,

Nasoalveolar molding improves long-term nasal symmetry in complete unilateral cleft lip-cleft palate patients
Barillas, Ingrid; Dec, Wojciech; Warren, Stephen M; Cutting, Court B; Grayson, Barry H
2009 Mar;123(3):1002-1006, Plastic & reconstructive surgery
BACKGROUND: Nasoalveolar molding was developed to improve dentoalveolar, septal, and lower lateral cartilage position before cleft lip repair. Previous studies have documented the long-term maintenance of columella length and nasal dome form and projection. The purpose of the present study was to determine the effect of presurgical nasoalveolar molding on long-term unilateral complete cleft nasal symmetry. METHODS: A retrospective review of 25 consecutively presenting nonsyndromic complete unilateral cleft lip-cleft palate patients was conducted. Fifteen patients were treated with presurgical nasoalveolar molding for 3 months before surgical correction, and 10 patients were treated by surgical correction alone. The average age at the time of follow-up was 9 years. Four nasal anthropometric distances and two angular relationships were measured to assess nasal symmetry. RESULTS: All six measurements demonstrated a greater degree of nasal symmetry in nasoalveolar molding patients compared with the patients treated with surgery alone. Five symmetry measurements were significantly more symmetric in the nasoalveolar molding patients and one measurement demonstrated a nonsignificant but greater degree of symmetry compared with the patients treated with surgery alone. CONCLUSIONS: The data demonstrate that the lower lateral and septal cartilages are more symmetric in the nasoalveolar molding patients compared with the surgery-alone patients. Furthermore, the improved symmetry observed in nasoalveolar molding-treated noses during the time of the primary surgery is maintained at 9 years of age
— id: 98781, year: 2009, vol: 123, page: 1002, stat: Journal Article,

A novel cleft rhinoplasty procedure combining an open rhinoplasty with the dibbell and tajima techniques: a 10-year review
Flores, Roberto L; Sailon, Alexander M; Cutting, Court B
2009 Dec;124(6):2041-2047, Plastic & reconstructive surgery
BACKGROUND:: The authors assessed the safety and efficacy of a novel cleft rhinoplasty procedure that combines an open rhinoplasty with the Dibbell and Tajima techniques. METHODS:: A single-surgeon, 10-year, retrospective review was conducted of all unilateral cleft lip rhinoplasties (n = 157). Nonsyndromic patients undergoing a combined open incision/Dibbell/Tajima procedure and who had follow-up of greater than 8 months were included. Thirty-five patients were identified. Standardized patient photographs were studied in 18 patients who had both preoperative and 1-year postoperative photographs. Farkas normal values were applied to the medial canthal distance; from this value, metric measurements of changes in alar base width, columellar height, and nostril apex height were derived. RESULTS:: There were no complications secondary to skin envelope ischemia or cartilage graft infection. The revision rate was 11 percent for alar base position, 3 percent for depressed lower lateral cartilage, and 3 percent for nostril apex overhang. After the procedure, there was a statistically significant decrease in alar base width (19.9 mm versus 18.2 mm; p < 0.01) and an increase in columellar height (8.37 mm versus 9.59 mm; p = 0.02) and nostril apex height (4.70 mm versus 5.44 mm; p = 0.02) on the affected side. The differences in alar base width, columellar height, and nostril apex height between the affected and nonaffected sides all decreased significantly postoperatively. CONCLUSIONS:: The combined open rhinoplasty/Dibbell/Tajima procedure is safe, has a low revision rate, and is associated with a statistically significant decrease in alar base width, an increase in columellar height and nostril apex height, and a greater symmetry of nasal form
— id: 105525, year: 2009, vol: 124, page: 2041, stat: Journal Article,

Real-time complex cognitive surgical simulator with testing
Oliker, Aaron; Cutting, Court B
2009 ;142:239-243, Studies in health technology & informatics
One of the greatest challenges facing surgical education is the inability to effectively test a surgeon's cognitive knowledge of a complex open surgery procedure. Cognitive knowledge is tested by paper, and more recently, computer-based and oral exams. Although these tools are used for testing in surgical education, they have been limited by providing a two-dimensional static representation of complex and dynamic, three-dimensional procedures.A three-dimensional interactive surgical simulator that will engage the surgeon, ask questions, test competency and provide feedback has the potential to revolutionize surgical education. Internet connectivity allows for rapid deployment of surgical modules, networked testing formats, data aggregation, comparative analysis and guided tutorials. Combined with the approval of a surgical society, this platform has the potential to set measurable quantitative surgical standards
— id: 101869, year: 2009, vol: 142, page: 239, stat: Journal Article,

Local flaps: a real-time finite element based solution to the plastic surgery defect puzzle
Sifakis, Eftychios; Hellrung, Jeffrey; Teran, Joseph; Oliker, Aaron; Cutting, Court
2009 ;142:313-318, Studies in health technology & informatics
One of the most fundamental challenges in plastic surgery is the alteration of the geometry and topology of the skin. The specific decisions made by the surgeon concerning the size and shape of the tissue to be removed and the subsequent closure of the resulting wound may have a dramatic affect on the quality of life for the patient after the procedure is completed. The plastic surgeon must look at the defect created as an organic puzzle, designing the optimal pattern to close the hole aesthetically and efficiently. In the past, such skills were the distillation of years of hands-on practice on live patients, while relevant reference material was limited to two-dimensional illustrations. Practicing this procedure on a personal computer [1] has been largely impractical to date, but recent technological advances may come to challenge this limitation. We present a comprehensive real-time virtual surgical environment, based on finite element modeling and simulation of tissue cutting and manipulation. Our system demonstrates the fundamental building blocks of plastic surgery procedures on a localized tissue flap, and provides a proof of concept for larger simulation systems usable in the authoring of complex procedures on elaborate subject geometry
— id: 135019, year: 2009, vol: 142, page: 313, stat: Journal Article,

Fifty years of the Millard rotation-advancement: looking back and moving forward
Stal, Samuel; Brown, Rodger H; Higuera, Stephen; Hollier, Larry H Jr; Byrd, H Steve; Cutting, Court B; Mulliken, John B
2009 Apr;123(4):1364-1377, Plastic & reconstructive surgery
Of all the methods for repair of the unilateral cleft lip, none has gained as much popularity as the rotation-advancement. Millard's original principle of 50 years ago continues to guide surgeons in closure of the cleft lip. Unlike earlier procedures, the brilliance of the rotation-advancement is that it permits individual manipulation and modifications while maintaining Millard's original surgical and anatomical goals. Millard and many other surgeons have made modifications to adjust the procedure to each specific patient, to address some of its faults, and to gain new advantages. In this article, the authors review the techniques of Drs. Ralph Millard, Steve Byrd, Court Cutting, John Mulliken, and Samuel Stal. The variations from Millard's original technique are highlighted, including a discussion of the benefits of each modification
— id: 101870, year: 2009, vol: 123, page: 1364, stat: Journal Article,

The effects of gingivoperiosteoplasty following alveolar molding with a : pin-retained latham appliance versus secondary bone grafting on midfacial growth in patients with unilateral clefts
Cutting, CB; Grayson, BH
2008 SEP ;122(3):871-873, Plastic & reconstructive surgery
— id: 86591, year: 2008, vol: 122, page: 871, stat: Journal Article,

Primary bilateral cleft nasal repair
Cutting, Court B; Kamdar, Mehul R
2008 Sep;122(3):918-919, Plastic & reconstructive surgery
— id: 86560, year: 2008, vol: 122, page: 918, stat: Journal Article,

Nasoalveolar molding improves appearance of children with bilateral cleft lip-cleft palate
Lee, Catherine T H; Garfinkle, Judah S; Warren, Stephen M; Brecht, Lawrence E; Cutting, Court B; Grayson, Barry H
2008 Oct;122(4):1131-1137, Plastic & reconstructive surgery
BACKGROUND: Bilateral cleft lip-cleft palate is associated with nasal deformities typified by a short columella. The authors compared nasal outcomes of cleft patients treated with banked fork flaps to those of patients who underwent nasoalveolar molding and primary retrograde nasal reconstruction. METHODS: A retrospective review of 26 consecutive patients with bilateral cleft lip-cleft palate was performed. Group 1 patients (n = 13) had a cleft lip repair and nasal correction with banked fork flaps. Group 2 patients (n = 13) had nonsurgical columellar elongation with nasoalveolar molding followed by cleft lip closure and primary retrograde nasal correction. Group 3 patients (n = 13) were age-matched controls. Columellar length was measured at presentation and at 3 years of age. The number of nasal operations was recorded to 9 years. The Kruskal-Wallis and Tukey-Kramer tests were used for statistical analysis. RESULTS: Initial columellar length was 0.49 +/- 0.37 mm in group 1 and 0.42 +/- 0.62 mm in group 2. Post-nasoalveolar molding columellar length was 4.5 +/- 0.76 mm in group 2. By 3 years of age, columellar length was 3.03 +/- 1.47 mm in group 1, 5.98 +/- 1.09 mm in group 2, and 6.35 +/- 0.99 mm in group 3. Group 2 columellar length was significantly greater (p < 0.001) than that of group 1 and not statistically different from that of group 3 (p > 0.05). All group 1 patients (13 of 13) needed secondary nasal surgery. No nasoalveolar molding patients (zero of 13, group 2) required secondary nasal surgery. CONCLUSION: Nonsurgical columellar elongation with nasoalveolar molding followed by primary retrograde nasal reconstruction restored columellar length to normal by 3 years and significantly reduced the need for secondary nasal surgery
— id: 87812, year: 2008, vol: 122, page: 1131, stat: Journal Article,

Using elastic stockinette as a head ring [2]
Reisler T.; Cutting C.
2008 ;30(5):251-, European journal of plastic surgery
— id: 75748, year: 2008, vol: 30, page: 251, stat: Journal Article,

Success rate of gingivoperiosteoplasty with and without secondary bone grafts compared with secondary alveolar bone grafts alone
Sato, Yuki; Grayson, Barry H; Garfinkle, Judah S; Barillas, Ingrid; Maki, Koutaro; Cutting, Court B
2008 Apr;121(4):1356-1367, Plastic & reconstructive surgery
BACKGROUND: Gingivoperiosteoplasty has been shown to eliminate the need for secondary alveolar bone grafting in 60 percent of patients. The purpose of this study was to compare radiographic alveolar anatomy following infant gingivoperiosteoplasty, secondary alveolar bone grafting, and secondary alveolar bone grafting in patients who had prior infant gingivoperiosteoplasty with inadequate bone formation. METHODS: Seventy-four consecutive nonsyndromic patients (complete bilateral cleft lip-cleft palate, n = 12; complete unilateral cleft lip-cleft palate, n = 46; complete unilateral cleft lip and alveolus, n = 14) treated at New York University Medical Center were available for evaluation. Eighty-two complete alveolar cleft sites were assigned to three groups: gingivoperiosteoplasty (n = 30), secondary alveolar bone grafting (n = 41), and secondary alveolar bone grafting following gingivoperiosteoplasty (n = 11). All gingivoperiosteoplasties were performed at the time of primary lip surgery, and secondary alveolar bone grafting (cancellous iliac crest at 7 to 12.5 years of age) was performed before eruption of the permanent canine. Radiographs were measured according to the modified method of Long. RESULTS: Seventy-three percent of gingivoperiosteoplasty cases did not require secondary alveolar bone grafting and none had fistulas. The rate of missing teeth in the total sample, adjacent to the cleft, was within normal limits for the population. Group 1 alone and groups 1 and 3 combined had superior alveolar anatomy compared with group 2 (p < 0.01). No significant differences existed between groups 1 and 3 (p > 0.05). Crest height was best in group 1 (p < 0.01), followed by group 3 and then group 2, with no difference between the latter two groups. CONCLUSION: Gingivoperiosteoplasty alone or combined with secondary alveolar bone grafting results in superior bone levels when compared with conventional secondary alveolar bone grafting alone
— id: 95582, year: 2008, vol: 121, page: 1356, stat: Journal Article,

Open techniques in closed rhinoplasty
Cutting, Court B; Culliford, Alfred T 4th; Lin, Shin-e; Sharma, Sheel
2007 Dec;120(7):2121-2122, Plastic & reconstructive surgery
— id: 75679, year: 2007, vol: 120, page: 2121, stat: Journal Article,

A virtual reality atlas of craniofacial anatomy
Smith, Darren M; Oliker, Aaron; Carter, Christina R; Kirov, Miro; McCarthy, Joseph G; Cutting, Court B
2007 Nov;120(6):1641-1646, Plastic & reconstructive surgery
BACKGROUND: Head and neck anatomy is complex and represents an educational challenge to the student. Conventional two-dimensional illustrations inherently fall short in conveying intricate anatomical relationships that exist in three dimensions. A gratis three-dimensional virtual reality atlas of craniofacial anatomy is presented in an effort to address the paucity of readily accessible and customizable three-dimensional educational material available to the student of head and neck anatomy. METHODS: Three-dimensional model construction was performed in Alias Maya 4.5 and 6.0. A basic three-dimensional skull model was altered to include surgical landmarks and proportions. Some of the soft tissues were adapted from previous work, whereas others were constructed de novo. Texturing was completed with Adobe Photoshop 7.0 and Maya. The Internet application was designed in Viewpoint Enliven 1.0. RESULTS: A three-dimensional computer model of craniofacial anatomy (bone and soft tissue) was completed. The model is compatible with many software packages and can be accessed by means of the Internet or downloaded to a personal computer. As the three-dimensional meshes are publicly available, they can be extensively manipulated by the user, even at the polygonal level. CONCLUSIONS: Three-dimensional computer graphics has yet to be fully exploited for head and neck anatomy education. In this context, the authors present a publicly available computer model of craniofacial anatomy. This model may also find applications beyond clinical medicine. The model can be accessed gratis at the Plastic and Reconstructive Surgery Web site or obtained as a three-dimensional mesh, also gratis, by contacting the authors
— id: 79082, year: 2007, vol: 120, page: 1641, stat: Journal Article,

A virtual reality tracking system for distal mandible movement during distraction osteogenesis
Hopper, Richard A; Grayson, Barry H; Dayan, Joseph; Altug, Ayse; McCarthy, Joseph G; Sato, Yuki; Khorramabadi, Deljou; Oliker, Aaron; Cutting, Court B
2006 Feb;117(2):590-594, Plastic & reconstructive surgery
— id: 79083, year: 2006, vol: 117, page: 590, stat: Journal Article,

Invited discussion: Early cleft lip repair in children with unilateral complete cleft lip and palate - A case against primary alveolar repair
Cutting, C; Grayson, B
2005 JUN ;54(6):598-599, Annals of plastic surgery
— id: 55950, year: 2005, vol: 54, page: 598, stat: Journal Article,

A virtual reality model of eustachian tube dilation and clinical implications for cleft palate repair
Dayan, Joseph H; Smith, Darren; Oliker, Aaron; Haring, Julie; Cutting, Court B
2005 Jul;116(1):236-241, Plastic & reconstructive surgery
— id: 61841, year: 2005, vol: 116, page: 236, stat: Journal Article,

Combining the Cutting and Mulliken methods for primary repair of the bilateral cleft lip nose
Morovic, Carmen Gloria; Cutting, Court
2005 Nov;116(6):1613-1619, Plastic & reconstructive surgery
BACKGROUND: Since 1990, primary bilateral cleft nasal reconstruction has been focused on placing the lower lateral cartilages into normal anatomical position. Of the four major techniques in this class, the Cutting (i.e., retrograde) method and the Mulliken method have been most successful. The retrograde method makes no external nasal incisions, but requires either preoperative or postoperative nasal molding to achieve maximum benefit. Mulliken's technique does not require molding, but leaves the footplates of the medial crura in the depression above the projecting premaxilla associated with the diminutive anterior nasal spine. Leaving the footplates in place also prevents adequate approximation of the alar bases. In this article, the two methods are combined to achieve the benefits of both. METHODS: We report our experience with the retrograde nasal approach associated with marginal rim incisions (Mulliken method) in a series of 25 consecutive bilateral cleft lip cases simultaneous with lip repair. We performed a retrograde approach through membranous septum incisions elevating a prolabial-columellar flap. To facilitate alar cartilage manipulation we added bilateral marginal rim incisions. Nasal width, columella length and width, tip projection, and nasolabial angle were analyzed after a minimum of 2 years after surgery. These were compared with a normal, age-matched, control group. We also examined nostril symmetry and marginal nostril scars. RESULTS: Columellar length was not statistically significantly different from that of the control group (p = 0.122442). Nasal width, columellar width, tip projection, and nasolabial angle were all significantly greater in the cleft group than normal (p < 0.001). No hypertrophied scars were found associated with the marginal rim scar. CONCLUSIONS: Adding the Mulliken approach allows alar cartilage manipulation to be performed more easily than when using the retrograde approach alone. Tip projection and alar base narrowing are facilitated using the combined technique rather than the Mulliken approach alone. Prolabial flap manipulation is safe using this combined approach, even in cases with a severely projected premaxilla. We believe that the combined approach is safe and yields better long-term results than either technique alone
— id: 135020, year: 2005, vol: 116, page: 1613, stat: Journal Article,

Applications of virtual reality in aesthetic surgery
Smith, Darren M; Aston, Sherrell J; Cutting, Court B; Oliker, Aaron
2005 Sep;116(3):898-904, Plastic & reconstructive surgery
BACKGROUND: Virtual reality has a long history in plastic and reconstructive surgery, with uses ranging from anatomical demonstration to craniofacial surgical planning. The purpose of this article is to add to the literature a computer graphics-based resource for aesthetic surgery. METHODS: Deformation tools, virtual cameras, and other components of Alias's Maya 4.0 were used to perform virtual surgical procedures on a detailed model of superficial facial anatomy. This three-dimensional model of superficial facial anatomy, derived from the National Library of Medicine's Visible Human Project, was also 'aged' in Maya at key depths of anatomical dissection. Adobe's After Effects 5.5 was used for animation postproduction work for all animations. RESULTS: Three-dimensional computer animations were developed to illustrate techniques in aesthetic surgery. Another animation was created that simulates facial aging at various levels of anatomical dissection. CONCLUSIONS: Computer modeling and animation have the potential to play an important role in education, surgical planning, development, and other aspects of aesthetic surgery
— id: 79084, year: 2005, vol: 116, page: 898, stat: Journal Article,

Designing a virtual reality model for aesthetic surgery
Smith, Darren M; Aston, Sherrell J; Cutting, Court B; Oliker, Aaron; Weinzweig, Jeffrey
2005 Sep;116(3):893-897, Plastic & reconstructive surgery
BACKGROUND: Aesthetic surgery deals in large part with the manipulation of soft-tissue structures that are not amenable to visualization by standard technologies. As a result, accurate three-dimensional depictions of relevant surgical anatomy have yet to be developed. This study presents a method for the creation of detailed virtual reality models of anatomy relevant to aesthetic surgery. METHODS: Two-dimensional histologic sections of a cadaver from the National Library of Medicine's Visible Human Project were imported into Alias's Maya, a computer modeling and animation software package. These two-dimensional data were then 'stacked' as a series of vertical planes. Relevant anatomy was outlined in cross-section on each two-dimensional section, and the resulting outlines were used to generate three-dimensional representations of the structures in Maya. RESULTS: A detailed and accurate three-dimensional model of the soft tissues germane to aesthetic surgery was created. This model is optimized for use in surgical animation and can be modified for use in surgical simulators currently being developed. CONCLUSIONS: A model of facial anatomy viewable from any angle in three-dimensional space was developed. The model has applications in medical education and, with future work, could play a role in surgical planning. This study emphasizes the role of three-dimensionalization of the soft tissues of the face in the evolution of aesthetic surgery
— id: 79085, year: 2005, vol: 116, page: 893, stat: Journal Article,

Invited discussion: Primary cleft nasal repair. The composite V-Y flap with extended mucosal tab
Cutting C
2004 ;53(2):109-110, Annals of plastic surgery
— id: 46302, year: 2004, vol: 53, page: 109, stat: Journal Article,

Prepubertal midface growth in unilateral cleft lip and palate following alveolar molding and gingivoperiosteoplasty
Lee, Catherine T H; Grayson, Barry H; Cutting, Court B; Brecht, Lawrence E; Lin, Wen Yuan
2004 Jul;41(4):375-380, Cleft palate-craniofacial journal
OBJECTIVES: To examine the long-term effect of nasoalveolar molding and gingivoperiosteoplasty (modified Millard type) on midface growth at prepuberty. PROCEDURES: In this retrospective study, 20 consecutive patients with a history of complete unilateral cleft lip and palate were evaluated. Ten patients had nasoalveolar molding and gingivoperiosteoplasty performed at lip closure; 10 control patients had nasoalveolar molding but no gingivoperiosteoplasty because of late start in treatment or poor compliance. A single surgeon (C.B.C.) performed all surgical procedures. Standardized lateral cephalometric radiographs were evaluated at two time periods: T1 at pre-bone-grafting age and T2 at prepuberty age. Superimposition and cephalometric analysis were undertaken to investigate the two groups. Two cephalometric reference planes, sella-nasion and basion-nasion, were used to assess the vertical and sagittal relations of the midface (ANS-PNS). The reference landmarks were procrustes fitted. The mean location and variance of ANS and PNS landmarks were computed. All results were analyzed by permutation test. RESULTS: No significant difference in mean location or variance of ANS-PNS in both vertical and sagittal planes at both T1 and T2 periods were found between the two groups (p > .05). CONCLUSIONS: The results suggested that midface growth in sagittal or vertical planes (up to the age of 9 to 13 years) were not affected by presurgical alveolar molding and gingivoperiosteoplasty (Millard type)
— id: 64810, year: 2004, vol: 41, page: 375, stat: Journal Article,

Lip height and lip width after extended mohler unilateral cleft lip repair
Cutting, Court B; Dayan, Joseph H
2003 Jan;111(1):17-23, Plastic & reconstructive surgery
The purpose of this study was to evaluate the symmetry in lip height and lip width after extended Mohler unilateral cleft lip repair, with long-term follow-up monitoring. In the Mohler repair procedure, Millard's C-flap is used to fill the entire defect created by the downward rotation of the medial lip element. Because a lateral advancement flap is not transposed into this defect, Mohler repair is often expected to produce a short lip. In a retrospective study of 120 patients, anthropometric measurements were made on black-and-white photographs. Of those patients, 49 met the study criterion of having a set of photographs taken 13 months or less postoperatively and another set taken at least 2 years postoperatively. The distance from the Cupid's bow peak to a line tangent to the base of the columella (lip height) and the distance from the Cupid's bow peak to the ipsilateral commissure (lip width) were measured with a Vernier caliper. The medial intercanthal distance was also measured, for standardization of all measurements. All values were normalized to the mean intercanthal distance at age 6, as reported by Farkas. Matched-pair test analyses were used to assess the statistical significance of differences in cleft-side versus non-cleft-side measurements for each group, as well as changes with time. No statistically significant difference in cleft side versus non-cleft-side lip height for the two groups or with time was observed (</=13 months, = 0.28; >2 years, = 0.08; change with time, = 0.69). Statistically significant differences in lip width between the cleft side and the non-cleft side were observed for both time groups. The average difference in lip width at 1 to 13 months was 8.6 percent ( < 0.001). The average difference in lip width at 2 years or more postoperatively was 5.8 percent ( < 0.001). In comparisons of early versus late measurements, it was noted that lip width significantly increased with time (mean, 0.91 mm; = 0.035). The findings suggest that extended Mohler repair does not produce a short lip. Interestingly, lip width was observed to be significantly smaller on the cleft side in the immediate postoperative period. However, this deficiency was observed to decrease significantly during long-term follow-up monitoring
— id: 33286, year: 2003, vol: 111, page: 17, stat: Journal Article,

Cephalometric Analysis of the Consolidation Phase Following Bilateral Pediatric Mandibular Distraction
Hopper, Richard A; Altug, Ayse T; Grayson, Barry H; Barillas, Ingrid; Sato, Yuki; Cutting, Court B; McCarthy, Joseph G
2003 May;40(3):233-240, Cleft palate-craniofacial journal
Objective: The goal of the consolidation phase of mandible distraction is to maintain the improvement in maxillomandibular form and relationship while the generated tissue ossifies. During this period, external deforming forces can act on the healing generated bone. The purpose of this study was to describe the potential cephalometric changes that occur following pediatric bilateral mandibular distraction using external devices. Design: Retrospective lateral superimposition cephalometric analyses. Participants: Thirty-five cases of pediatric mandible distraction were reviewed. Seven of these cases were included in the study after exclusion criteria were applied. These cases represented a group with severe congenital dysmorphology and a mean device activation of 26.5 mm. Main Outcome Measures: Changes in pogonion position, symphyseal plane rotation, mandible length, and mandible length relative to maxillary length during the 18 to 36 days of activation, the eight weeks of consolidation, and the 1-year period following removal of the distraction device were measured. Results: All patients demonstrated variable changes in position of the mandible during the consolidation phase. The most common were retrusion of pogonion, a decrease in mandible length, and a clockwise rotation of the symphyseal plane. In some cases the changes that occurred during consolidation were greater than those that occurred on 1-year follow-up. Conclusions: The consolidation phase of distraction osteogenesis is a dynamic phase and should not be assumed to be static. Multicenter use of this cephalometric technique would help to identify potential risk factors associated with postactivation changes
— id: 34188, year: 2003, vol: 40, page: 233, stat: Journal Article,

Correction of severe secondary cleft lip nasal deformity using a composite graft: Current approach and review - Invited discussion
Cutting, C
2002 FEB ;48(2):137-137, Annals of plastic surgery
— id: 55333, year: 2002, vol: 48, page: 137, stat: Journal Article,

Use of three-dimensional computer graphic animation to illustrate cleft lip and palate surgery
Cutting, C; Oliker, A; Haring, J; Dayan, J; Smith, D
2002 ;7(6):326-331, Computer aided surgery
OBJECTIVE: Three-dimensional (3D) computer animation is not commonly used to illustrate surgical techniques. This article describes the surgery-specific processes that were required to produce animations to teach cleft lip and palate surgery. MATERIALS AND METHODS: Three-dimensional models were created using CT scans of two Chinese children with unrepaired clefts (one unilateral and one bilateral). We programmed several custom software tools, including an incision tool, a forceps tool, and a fat tool. RESULTS: Three-dimensional animation was found to be particularly useful for illustrating surgical concepts. Positioning the virtual 'camera' made it possible to view the anatomy from angles that are impossible to obtain with a real camera. Transparency allows the underlying anatomy to be seen during surgical repair while maintaining a view of the overlaying tissue relationships. Finally, the representation of motion allows modeling of anatomical mechanics that cannot be done with static illustrations. The animations presented in this article can be viewed on-line at http://www.smiletrain.org/programs/virtual_surgery2.htm. CONCLUSIONS: Sophisticated surgical procedures are clarified with the use of 3D animation software and customized software tools. The next step in the development of this technology is the creation of interactive simulators that recreate the experience of surgery in a safe, digital environment
— id: 79086, year: 2002, vol: 7, page: 326, stat: Journal Article,

Anatomy of the nasal cartilages of the unilateral complete cleft lip nose
Li, Ai-Qun; Sun, Yong-Gang; Wang, Guang-He; Zhong, Zhen-Kang; Cutting, Court
2002 May;109(6):1835-1838, Plastic & reconstructive surgery
The purpose of this study was to disclose the relationship between the anomaly of the cartilaginous framework and the nasal deformity of cleft lip. The noses of six stillborn infants with unilateral complete cleft lip were carefully dissected. The size and weight of the lower lateral cartilages were measured to determine whether there was a significant difference between the normal and involved sides. The position of the nasal cartilages was observed, and the distance between them was measured to determine whether they were normal. The surgical dissection revealed that the lower lateral cartilages from both sides were asymmetrical in three dimensions, indicating the displacement of the lower lateral cartilage on the involved side. There was displacement of the cartilaginous septum and the upper lateral cartilage. The statistical evaluation did not demonstrate a significant difference between weight and size of the two sides. One of the major causative factors of nasal deformity is displacement of the nasal cartilages. There is no hypoplasia of nasal cartilage in newborn infants with cleft lip
— id: 135021, year: 2002, vol: 109, page: 1835, stat: Journal Article,

Nasoalveolar molding and gingivoperiosteoplasty versus alveolar bone graft: an outcome analysis of costs in the treatment of unilateral cleft alveolus
Pfeifer, Tracy M; Grayson, Barry H; Cutting, Court B
2002 Jan;39(1):26-29, Cleft palate-craniofacial journal
OBJECTIVE: The purpose of this study was to compare the financial impact of two treatment approaches to the unilateral cleft alveolus. The recently advocated nasoalveolar molding (NAM; and gingivoperiosteoplasty (GPP; at the time of lip repair were compared with the traditional approach of secondary alveolar bone graft. DESIGN: The records of all patients (n = 30) with unilateral cleft lip and alveolus treated by a single surgeon during 1985 through 1988 were examined retrospectively. The patients were divided into two groups: group 1 patients (n = 14) were treated by lip repair, primary nasal repair, and secondary alveolar bone graft prior to eruption of permanent dentition; group 2 patients (n = 16) were treated by NAM, GPP, lip repair, and primary nasal repair. Patients who required secondary alveolar bone graft after GPP were noted. The cost of treatment by each protocol was calculated in 1998 dollars. RESULTS: The average cost of treatment for a patient treated by lip repair, primary nasal repair, and secondary alveolar bone graft prior to eruption of permanent dentition was $22,744. Of the 16 patients treated by NAM, GPP, lip repair, and primary nasal repair, 10 required no further treatment of the unilateral cleft alveolus; six patients required secondary alveolar bone graft. The average per-patient treatment cost in this group was $19,745. The average cost savings of NAM and GPP, compared with alveolar bone graft is $2999. CONCLUSIONS: The treatment of unilateral cleft alveolus by nasoalveolar molding and gingivoperiosteoplasty results in substantial cost savings, compared with treatment by secondary alveolar bone graft
— id: 33288, year: 2002, vol: 39, page: 26, stat: Journal Article,

The course of the inferior alveolar nerve in craniofacial microsomia: virtual dissection using three-dimensional computed tomography image analysis
Tiwari, Pankaj; Chin, Douglas H L; Cutting, Court B; Longaker, Michael T; Holliday, Roy; McCarthy, Joseph G
2002 Apr 15;109(5):1513-1521, Plastic & reconstructive surgery
Computer-assisted medical imaging was used to locate the mandibular foramen and the portion of the inferior alveolar nerve canal at the level of the angle of the mandible in 19 hemimandibles of patients with craniofacial microsomia. The distance from each of these two points to the borders of the mandible was measured. The ratios of these distances to the height, anteroposterior, and buccolingual extents of the mandibular ramus were calculated. These ratios were compared among affected hemimandibles (Pruzansky classification I, n = 4; and Pruzansky classification II, n = 10), unaffected hemimandibles (n = 9), and the hemimandibles of patients with nonsyndromic, sutural synostosis (n = 7). Comparison of mean distance ratios showed that the mandibular foramen was located significantly more proximally in the affected cohort than in either the unaffected or synostosis control groups. The mandibular foramen was also located significantly closer to the buccal cortex of the mandible in the affected cohort when compared with unaffected patients. The distance from the mandibular foramen to the anterior or posterior tables of the mandible divided by the total anteroposterior distance did not vary among the three groups studied. The distance ratios between the inferior alveolar nerve canal at the level of the angle of the mandible and the mandibular borders also did not vary significantly among the groups studied. An inferior alveolar nerve canal could not be identified in any patient with Pruzansky grade III mandibular deficiency. This quantitative, three-dimensional description of points along the proximal path of the inferior alveolar nerve canal in patients with craniofacial microsomia provides useful information to assist the surgeon during osteotomy planning and may help in avoiding injury to the nerve at the time of surgery
— id: 33287, year: 2002, vol: 109, page: 1513, stat: Journal Article,

Short stay after cleft palate surgery
Cronin ED; Williams JL; Roesel JF; Shayani P; Cutting CB
2001 ;108(4):841-841, Plastic & reconstructive surgery
— id: 26874, year: 2001, vol: 108, page: 841, stat: Journal Article,

Presurgical nasoalveolar orthopedic molding in primary correction of the nose, lip, and alveolus of infants born with unilateral and bilateral clefts
Grayson BH; Cutting CB
2001 May;38(3):193-198, Cleft palate-craniofacial journal
This addendum to the 'State of the Art Dental Treatment of Predental and Infant Patients With Clefts and Craniofacial Anomalies,' by Prahl-Andersen (Cleft Palate Craniofac J. 2000;37:528532), offers an extended perspective on this controversial subject. This article reviews the role of combined nasal and alveolar (nasoalveolar) molding in the primary correction of the nose, lip, and alveolus of infants born with unilateral and bilateral clefts. The background of presurgical nasoalveolar orthopedic molding, the technique, and the literature are presented. The proposed benefits of treatment from the traditional techniques of presurgical orthopedics have been shown to be unsubstantiated (Kuijpers-Jagtman and Prahl, 1996). A close comparison of the proposed benefits of earlier forms of presurgical orthopedics, along with those of the current technique of nasoalveolar molding, is presented
— id: 20634, year: 2001, vol: 38, page: 193, stat: Journal Article,

Associations between severity of clefting and maxillary growth in patients with unilateral cleft lip and palate treated with infant orthopedics
Peltomaki T; Vendittelli BL; Grayson BH; Cutting CB; Brecht LE
2001 Nov;38(6):582-586, Cleft palate-craniofacial journal
OBJECTIVE: The purpose of this study was to examine possible associations between severity of clefting in infants and maxillary growth in children with complete unilateral cleft lip and palate. DESIGN: This was a retrospective study of measurements made on infant maxillary study casts and maxillary cephalometric variables obtained at 5 to 6 years of follow-up. SETTING: The study was performed at the Institute of Reconstructive Plastic Surgery of New York University Medical Center, New York, New York. PATIENTS: Twenty-four consecutive nonsyndromic unilateral complete cleft lip and palate patients treated during the years 1987 to 1994. INTERVENTIONS: All the patients received uniform treatment (i.e., presurgical orthopedics followed by gingivoperiosteoplasty to close the alveolar cleft combined with repair of the lip and nose in a single stage at the age of 3 to 4 months). Closure of the palate was performed at the age of 12 to 14 months. RESULTS: Infant maxillary study cast measurements correlated in a statistically significant manner with maxillary cephalometric measurements at age 5 to 6 years. CONCLUSIONS: The results demonstrate the large variation in the severity of unilateral cleft lip and palate deformity at birth. Patients with large clefts and small arch circumference, arch length, or both demonstrated less favorable maxillary growth than those with small clefts and large arch circumference or arch length at birth
— id: 33289, year: 2001, vol: 38, page: 582, stat: Journal Article,

Second-language acquisition following pharyngeal flap surgery in non-English-speaking immigrants
Borud LJ; Ceradini D; Eng N; Cutting CB
2000 Sep;106(3):640-644, Plastic & reconstructive surgery
— id: 33291, year: 2000, vol: 106, page: 640, stat: Journal Article,

Secondary cleft lip nasal reconstruction: state of the art
Cutting CB
2000 Nov;37(6):538-541, Cleft palate-craniofacial journal
OBJECTIVE: This paper summarizes the state of the art in secondary cleft lip nasal reconstruction, distilled from the many papers written on the subject and from the author's experience with many of those procedures over the past 25 years. METHODS: The evaluation starts with the skeletal base and the need for LeFort 1 or alveolar bone grafting is discussed. The boney dorsum is next evaluated and a 'monobloc' osteotomy considered. The cartilaginous dorsum follows and a 'spreader-strut' graft is entertained. The tip cartilages are approached with either an open Potter or Dibbell preferred or replacement conchal graft if the tip has been destroyed by previous surgery. The skin envelope is then adjusted using methods described by Tajima, Dibbell, and Bardach
— id: 33290, year: 2000, vol: 37, page: 538, stat: Journal Article,

A rat model of gingivoperiosteoplasty
Mehrara BJ; Saadeh PB; Steinbrech DS; Dudziak M; Grayson BH; Cutting CB; McCarthy JG; Gittes GK; Longaker MT
2000 Jan;11(1):54-58, Journal of craniofacial surgery
The ability to avoid a subsequent bone graft makes the use of gingivoperiosteoplasty (GPP) at the time of cleft lip repair an attractive technique. The use of GPP, in combination with presurgical orthodontics, has been shown to result in successful bony union in the majority of patients. However, secondary bone grafting is still necessary in 30% to 40% of patients due to persistent alveolar bony defects. The elucidation of methods to improve the success rates of these procedures has been hampered by the lack of reproducible animal models. The purpose of this study was, therefore, to develop a rodent model of GPP that would facilitate the investigation of methods to improve osteogenesis in alveolar defects. We report a surgically produced rat model (9 x 5 x 3-mm alveolar defect) that is reproducible, inexpensive (relative to large-animal models), and simple technically. In addition, healing in this model occurs in a predictable manner during a 12-week period, thus enabling analysis of methods designed to accelerate or facilitate osseous regeneration
— id: 20721, year: 2000, vol: 11, page: 54, stat: Journal Article,

Cerclage suture method for closed-tip rhinoplasty
Cutting CB
1999 Nov;104(6):1839-1842, Plastic & reconstructive surgery
This article presents a method for passing a cerclage suture around the nasal tip complex to narrow it. The method does not require elevation of the skin from the lower lateral cartilages. The method requires a double-pointed straight needle with the suture swaged on in the center
— id: 11921, year: 1999, vol: 104, page: 1839, stat: Journal Article,

Presurgical nasoalveolar molding in infants with cleft lip and palate
Grayson BH; Santiago PE; Brecht LE; Cutting CB
1999 Nov;36(6):486-498, Cleft palate-craniofacial journal
Presurgical infant orthopedics has been employed since the 1950s as an adjunctive neonatal therapy for the correction of cleft lip and palate. In this paper, we present a paradigm shift from the traditional methods of presurgical infant orthopedics. Some of the problems that the traditional approach failed to address include the deformity of the nasal cartilages in unilateral as well as bilateral clefts of the lip and palate and the deficiency of columella tissue in infants with bilateral clefts. The nasoalveolar molding (NAM) technique we describe uses acrylic nasal stents attached to the vestibular shield of an oral molding plate to mold the nasal alar cartilages into normal form and position during the neonatal period. This technique takes advantage of the malleability of immature cartilage and its ability to maintain a permanent correction of its form. In addition, we demonstrate the ability to nonsurgically construct the columella through the application of tissue expansion principles. This construction is performed by gradual elongation of the nasal stents and the application of tissue-expanding elastic forces that are applied to the prolabium. Use of the NAM technique has eliminated surgical columella reconstruction and the resultant scar tissue from the standard of care in this cleft palate center
— id: 11924, year: 1999, vol: 36, page: 486, stat: Journal Article,

Long-term effects of nasoalveolar molding on three-dimensional nasal shape in unilateral clefts
Maull DJ; Grayson BH; Cutting CB; Brecht LL; Bookstein FL; Khorrambadi D; Webb JA; Hurwitz DJ
1999 Sep;36(5):391-397, Cleft palate-craniofacial journal
OBJECTIVE: This objective of this study was to determine the effect of presurgical nasoalveolar molding on long-term nasal shape in complete unilateral clefts. DESIGN: The study was retrospective, and the subjects were chosen at random. Nasal casts of the subjects were scanned in three dimensions. Each nose was best fit to its mirror image, and a numerical asymmetry score was determined. SETTING: All patients were treated at the Institute of Reconstructive Plastic Surgery, NYU Medical Center, New York, New York. PATIENTS: The study subjects (n = 10) were selected from a group that had undergone presurgical nasal molding in conjunction with alveolar molding. The control subjects (n = 10) were selected from a group that had undergone presurgical alveolar molding alone. INTERVENTIONS: All subjects underwent presurgical orthopedic treatment until the age of approximately 4 months at which time the primary surgery was performed. MAIN OUTCOME MEASURE: The nasal shape following nasal molding should be more symmetrical than if molding had not been done. RESULTS: The mean asymmetry index for the nasoalveolar molding group was 0.74, and the control group was 1.21. This difference was statistically significant (p < .05). CONCLUSIONS: Presurgical nasoalveolar molding significantly increases the symmetry of the nose. The increase in symmetry is maintained long term into early childhood. The limitations of this study include (1) asymmetry alone is not an adequate shape result in most situations, (2) the children evaluated in this study were not fully grown, and (3) the control group was not age matched
— id: 56475, year: 1999, vol: 36, page: 391, stat: Journal Article,

Columellar elongation in bilateral cleft lip
Cutting C; Grayson B; Brecht L
1998 Oct;102(5):1761-1762, Plastic & reconstructive surgery
— id: 7540, year: 1998, vol: 102, page: 1761, stat: Journal Article,

Presurgical columellar elongation and primary retrograde nasal reconstruction in one-stage bilateral cleft lip and nose repair
Cutting C; Grayson B; Brecht L; Santiago P; Wood R; Kwon S
1998 Mar;101(3):630-639, Plastic & reconstructive surgery
We present a new combined approach to primary bilateral cleft lip, nose, and alveolus repair using presurgical nasoalveolar molding combined with a one-stage lip, nose, and alveolus repair. Presurgical alveolar molding is used to bring the protruding premaxilla back into proper alignment with the lateral segments in the maxillary arch. Presurgical nasal molding produces tissue expansion of the short columella and nasal lining. A coordinated surgical approach involves a one-stage repair of the lip, nose, and alveolus. The nasal repair uses a retrograde approach in which the prolabial flap and columella are reflected over the nasal dorsum by continuing the dissection behind the prolabium up the membranous septum and over the septal angle. Tissues are dissected out from between the tip cartilages, and the domes are sutured together in the midline. This method joins a new class of bilateral cleft repairs that place the primary emphasis on correction of the deformity of the nasal tip cartilages
— id: 7539, year: 1998, vol: 101, page: 630, stat: Journal Article,

A virtual reality system for bone fragment positioning in multisegment craniofacial surgical procedures
Cutting C; Grayson B; McCarthy JG; Thorne C; Khorramabadi D; Haddad B; Taylor R
1998 Dec;102(7):2436-2443, Plastic & reconstructive surgery
This article reports our clinical experience since 1994 with rigid-motion tracking of bone fragments during craniofacial surgical procedures, using a virtual reality approach. Three noncollinear infrared diodes are fixed to the skull base. A pointer is used to register anatomic features on the patient to those on the computerized tomography-based model of the patient within a computer work station. Three diodes are then attached to each fragment just before the osteotomy is completed. Rigid motions of the fragment are thus tracked and reported to the surgeon by using virtual reality techniques. Errors in fragment positioning are reported both graphically and numerically with respect to a precomputed optimum fragment position. This guidance system allows multisegment midface osteotomies to be performed more precisely. The main problems encountered so far have been devascularization-infection and difficulties in maintaining correct position during application of rigid fixation. Devascularization-infection problems have been addressed by minimizing surgical exposure of the bone. Soft-fixation plates and temporary Kirschner wire fixation have helped with intermediate positioning, but an intraoperative mechanical positioning device would be useful in the future
— id: 7541, year: 1998, vol: 102, page: 2436, stat: Journal Article,

Average African American three-dimensional computed tomography skull images: the potential clinical importance of ethnicity and sex
Dean D; Bookstein FL; Koneru S; Lee JH; Kamath J; Cutting CB; Hans M; Goldberg J
1998 Jul;9(4):348-358, Journal of craniofacial surgery
The production of average 'normative' three-dimensional (3D) computed tomography surface images of the bony skull has only recently been explored. The authors wish to determine the effect of using sex- and ethnicity-specific adult average 3D skull images for comparisons with patient images at various stages of craniofacial surgical management (i.e., diagnosis, treatment planning, prosthetic design, image-guided operative procedures, and outcomes assessment). Craniofacial surgical reconstruction for abnormal patterns of development, cancer resection, or trauma are most likely to benefit from these comparisons. To morphometrically test the significance of separating normative 3D skull data by sex and ethnicity, the authors collected 52 3D, anatomical landmarks from 3D computed tomography scans of dry skulls of 20 Americans of European ethnicity and 20 Americans of primarily African (i.e., primarily African and some European) ethnicity. A Procrustes-based morphometric analysis of shape detects 1.2 times as much interethnic variance as intersex variance. The African American sample presents 4.2% more dolichocephaly, wider orbits, flatter nasal area, larger gnathic anatomy, and more procumbent dentition. Pooling the sexes across both groups, it is seen that men tend to have less bulbous crania, more protruding brows, noses, and masticatory muscle attachments, and relatively less protrusive palettes and anterior mandibles. Despite a small sample size (N = 40), the authors' results are statistically significant (P approximately 0.001 overall) for both of the main factors, sex and ethnicity, separately
— id: 57131, year: 1998, vol: 9, page: 348, stat: Journal Article,

Reduced need for alveolar bone grafting by presurgical orthopedics and primary gingivoperiosteoplasty
Santiago PE; Grayson BH; Cutting CB; Gianoutsos MP; Brecht LE; Kwon SM
1998 Jan;35(1):77-80, Cleft palate-craniofacial journal
OBJECTIVE: The purpose of this study was to evaluate if narrowing and approximation of the alveolar cleft through presurgical alveolar molding followed by gingivoperiosteoplasty (GPP) at the time of lip repair reduces the need for a bone-grafting procedure. DESIGN: This was a retrospective blind study of patients with unilateral or bilateral alveolar clefts who underwent presurgical infant alveolar molding and GPP by a single surgeon. Alveolar bone formation was assessed prior to the eruption of the maxillary lateral incisor or canine by clinical examination, panoramic and periapical radiographs, and/or a dental CT scan. The criterion for bone grafting was inadequate bone stock to permit the eruption and maintenance of the permanent dentition. SETTING: This study was performed at the Institute of Reconstructive Plastic Surgery by the members of the Cleft Palate Team. PATIENTS: All patients with unilateral (n = 16) or bilateral (n = 2) alveolar clefts who underwent presurgical infant alveolar molding and GPP by a single surgeon from 1985 to 1988 were studied. The control population consisted of all alveolar cleft patients (n = 14) who did not undergo alveolar modeling or GPP during the same time period. INTERVENTIONS: Presurgical alveolar modeling was performed with an intraoral acrylic molding plate. This plate was modified on a weekly basis to align the alveolar segments and close the alveolar gap. The surgical intervention consisted of a modified Millard GPP. MAIN OUTCOME MEASURES: The primary study outcome measure was the elimination of the need for a secondary bone graft in patients who underwent presurgical alveolar molding and GPP. RESULTS: Of the 20 sites in the 18 patients who underwent GPP, 12 sites did not require an alveolar bone graft. Of the 8 sites requiring a bone graft, 4 presented minimal bony defects. All 14 patients in the control group required bone grafts. CONCLUSIONS: In this series of 20 alveolar cleft sites treated with presurgical orthopedics and GPP, 60% did not need a secondary alveolar bone graft in the mixed dentition
— id: 57246, year: 1998, vol: 35, page: 77, stat: Journal Article,

Controlled multiplanar distraction of the mandible, Part II: Laboratory studies of sagittal (anteroposterior) and vertical (superoinferior) movements
Williams JK; Rowe NM; Mackool RJ; Levine JP; Hollier LH; Longaker MT; Cutting CB; Grayson BH; McCarthy JG
1998 Nov;9(6):504-513, Journal of craniofacial surgery
The application of distraction osteogenesis in craniofacial surgery has significantly altered the treatment of congenital mandibular deficiencies. However, evaluation of results in both animal studies and clinical cases has revealed deficiencies, particularly in two areas. First, distraction using a uniplanar device in an anteroposterior direction can result in a persistent anterior open bite. Second, the lateralization of the distracted hemimandible was often limited, with insufficient incremental gain in the bigonial distance. To overcome these shortcomings, a multiplanar distraction device was developed and tested in the canine model. This report details canine studies addressing the first problem: combined anteroposterior or sagittal (z-axis) and superoinferior or vertical (y-axis) movements. Six dogs underwent bilateral mandibular distraction with an external (extraoral), multiplanar device and completed sagittal plus vertical distraction. Evaluation included clinical examination (facial form, jaw position, and occlusion), photography, cephalograms (posteroanterior, basilar, and lateral), three-dimensional computed tomography reconstructions, and examination of dry skulls. The dogs averaged 18.5 mm (range, 15-20 mm) of sagittal distraction and 41.0 degrees (range, 21-50 degrees) of vertical distraction. Marked anterior open bites were produced after vertical distraction secondary to premature contact of the maxillary and mandibular molars. Distraction in the vertical direction also had the additive effect of increasing the sagittal gains by approximately 5% to 10%. In conclusion, a multiplanar distraction device (with the potential for distraction in three planes) was effective in increasing mandibular anteroposterior thrust (sagittal distraction) and also in creating an anterior open bite (vertical or superoinferior distraction). Vertical distraction probably requires bilateral osteotomies to obtain optimal results. The preliminary gains in sagittal length are modified (reduced or increased) after distraction in a second plane (vertical and horizontal). Specifically, vertical distraction in the inferior direction (creating an open bite) also leads to isolated increases in the anteroposterior plane. Conversely, vertical distraction in the superior direction (closing an open bite), as seen in a human malocclusion, may lead to isolated decreases in the anteroposterior plane, but this question remains to be investigated in the laboratory
— id: 7853, year: 1998, vol: 9, page: 504, stat: Journal Article,

The potential of surface laser scanning to measure facial movement - Discussion
Cutting, CB
1997 APR ;99(4):988-989, Plastic & reconstructive surgery
— id: 33464, year: 1997, vol: 99, page: 988, stat: Journal Article,

Gingivoperiosteoplasty and midfacial growth
Wood RJ; Grayson BH; Cutting CB
1997 Jan;34(1):17-20, Cleft palate-craniofacial journal
The objective of this study was to report the effect of gingivoperiosteoplasty on growth of the midfacial skeleton 6 years following primary surgical repair. Patients with complete unilateral cleft lip and palate who underwent primary cleft lip and nose repair with and without gingivoperiosteoplasty (GPP) were retrospectively compared by means of a lateral cephalogram. Mean age at the time of evaluation was 5.7 years. All patients were treated at the Institute of Reconstructive Plastic Surgery, New York University Medical Center. All surgery and presurgical orthopedics was performed by the same surgeon and the same orthodontist. Twenty-five consecutively treated patients who presented with complete unilateral clefts of the primary and secondary palate were included in the study. Of these, 20 patients were available for 6-year follow-up cephalometric documentation and review. All patients received preoperative orthopedics with passive molding appliances, followed by repair of the lip, alveolus, and nose in a single stage at the age of 3 months. The repair was performed using the rotation/advancement technique. The difference between the two groups was whether or not gingivoperiosteoplasty was performed. The reason for not performing gingivoperiosteoplasty was incomplete approximation of the alveolar segments usually due to a late start in beginning therapy. Lateral cephalograms (68.5 months post primary surgery) were obtained and traced. Cranial base (S-N), maxilla (ANS-PNS), and mandible (Go-Pg) were digitized for shape coordinate analysis. No significant difference in the mean position of ANS-PNS was found between groups (with or without gingivoperiosteoplasty). There was, however, a significant difference in the variance of position for the points ANS-PNS between the groups (p < .002). We were unable to observe any difference (anteroposterior or supero-inferior) in the average position of the hard palate (ANS-PNS) between groups. We conclude that gingivoperiosteoplasty results in a more uniform position of the hard palate (ANS-PNS) relative to patients that did not receive gingivoperiosteoplasty. We were unable to demonstrate any clear impairment of maxillary growth in the patients treated with gingivoperiosteoplasty when compared to patients treated without gingivoperiosteoplasty
— id: 33292, year: 1997, vol: 34, page: 17, stat: Journal Article,

A classification of plagiocephaly utilizing a three-dimensional computer analysis of cranial base landmarks
Glat PM; Freund RM; Spector JA; Levine J; Noz M; Bookstein FL; McCarthy JG; Cutting CB
1996 May;36(5):469-474, Annals of plastic surgery
Plagiocephaly is a term commonly used to describe congenital forehead asymmetry. Previous classification systems based on the various etiologies of dysmorphic crania have been used in an effort to categorize the patients into groups and to assist in treatment planning. The system most commonly used today was described by Bruneteau and Mulliken in 1992. The authors separated frontal plagiocephaly into three types: synostotic, compensational, and deformational. The present study was undertaken in order to define a simple system for classifying plagiocephaly based on Bruneteau and Mulliken's system using the patients' preoperative craniofacial computed tomography scans. The involvement of the entire coronal ring in synostotic plagiocephaly led to the choice of 20 skull base landmarks as the basis of the analysis. Nine lateral landmarks (the superior orbital fissure, the optic foramen, the zygomatic arch, the greater palatine foramen, the foramen ovale, the mastoid tip, the hypoglossal canal, the external auditory canal, and the internal auditory canal) and two midline landmarks (the crista galli and the internal occipital protuberance) were used. The changes that occurred in these landmarks were analyzed in 30 patients. The results demonstrated that Bruneteau and Mulliken's classification system underestimated the number of different subtypes of plagiocephaly. As a result, three major types of frontal plagiocephaly and several different subtypes based on the different etiologies were described. Type I plagiocephaly includes plagiocephaly resulting from cranial suture synostosis. Type II includes those with a nonsynostotic etiology. Type III describes patients with craniofacial microsomia-associated plagiocephaly. Statistical analysis was unavailable because of the small number of patients in each subtype. With a larger number of patients, we hope to refine this system for use by the surgeon in preoperative diagnosis and surgical planning. The analysis is unique in its ability to quantitate changes from normal on the x-, y-, and z-coordinates, and therefore allows for identification of both horizontal (frontal bone deviation) and vertical (ear shear) growth disturbances
— id: 12608, year: 1996, vol: 36, page: 469, stat: Journal Article,

Septoplasty for obstructive sleep apnea in infants after cleft lip repair
Josephson GD; Levine J; Cutting CB
1996 Nov;33(6):473-476, Cleft palate-craniofacial journal
A neonate with a unilateral cleft lip and palate usually presents with a deviated nasal septum due to the asymmetric bony base associated with cleft palate. Prior to repair, the facial cleft offers a wide open breathing passage despite the septal deviation. Cleft lips are traditionally repaired in neonates at about 3 months of age. These patients usually do not present with significant symptoms of nasal obstruction following repair, except in unusual cases. Severe septal deviation may cause obstructive sleep apnea. Repair of septal deformities in children is controversial due to the potential alteration of facial growth. We present two patients with documented obstructive sleep apnea that began after cleft lip repair. Conservative surgical correction of the septal deviation resulted in relief of the sleep apnea
— id: 33293, year: 1996, vol: 33, page: 473, stat: Journal Article,

COLUMELLAR ELONGATION IN THE BILATERAL CLEFT-LIP AND NOSE PATIENT
BRECHT, LE; GRAYSON, BH; CUTTING, CB
1995 AUG ;74(2):257-257, Journal of dental research
— id: 33466, year: 1995, vol: 74, page: 257, stat: Journal Article,

EFFECT OF PRESURGICAL NASAL MOLDING ON CLEFT-LIP AND NOSE SYMMETRY
BRECHT, LE; TURK, AE; GRAYSON, BH; CUTTING, CB
1995 AUG ;74(2):257-257, Journal of dental research
— id: 33465, year: 1995, vol: 74, page: 257, stat: Journal Article,

A three-dimensional smooth surface analysis of untreated Crouzon's syndrome in the adult
Cutting C; Dean D; Bookstein FL; Haddad B; Khorramabadi D; Zonneveld FW; McCarthy JG
1995 Nov;6(6):444-453, Journal of craniofacial surgery
This study compares the three-dimensional smooth surface shape of five adult patients with Crouzon's disease with nine normal skulls. A new analysis method is described which is based on smooth surface curvature. Surface samples are subdivided by a common ridge curve structure. Three-dimensional images of an average normal and an average Crouzon skull are illustrated. Comparisons between groups are performed on landmarks, as well as ridge curve and surface patch midpoints. There was as much discriminant information in the ridge curves and surface patches between landmarks as there was at the landmarks themselves. When compared with normal samples, the Crouzon's syndrome sample exhibits the following major characteristics: The midface is concave and wide, with the piriform aperture in the center more recessed than the perifery of the midface. The forehead is recessed above a frontal sinus bulge. The orbits are shallow, wide, concave, and tilted inferiorly with a mild hypertelorism. These data suggest that advancement of large, one-piece osteotomy segments will not produce a normal face, and a multisegment approach should be considered
— id: 56808, year: 1995, vol: 6, page: 444, stat: Journal Article,

Complete avulsion of a tendon of flexor digitorum profundus from its myotendinous junction
Madhavan, P; Nadim, Y; Cutting, C
1995 Dec;26(10):697-697, Injury
— id: 135022, year: 1995, vol: 26, page: 697, stat: Journal Article,

Twenty-year experience with early surgery for craniosynostosis: I. Isolated craniofacial synostosis--results and unsolved problems
McCarthy JG; Glasberg SB; Cutting CB; Epstein FJ; Grayson BH; Ruff G; Thorne CH; Wisoff J; Zide BM
1995 Aug;96(2):272-283, Plastic & reconstructive surgery
Early surgery for isolated craniosynostosis is designed to improve morphology, to prevent functional disturbances, and equally important, to enhance the psychosocial development of the child. As the first of a two-part series, 104 patients with isolated craniofacial synostosis were retrospectively analyzed. Diagnoses included bilateral coronal (10), unilateral coronal (57), metopic (29), and sagittal synostosis (8). All patients underwent primary fronto-orbital advancement-calvarial vault remodeling procedures at less than 18 months of age (mean 8.1 months). Thirteen percent of patients (14) required a secondary cranial vault operation (mean age 22.6 months) to address residual deficits in craniofacial form. Perioperative complications were minimal (5.0 percent), and there was no mortality. Average length of postoperative follow-up was 46.0 months. By the classification of Whitaker et al., which assesses surgical results, 87.5 percent of patients were considered to have at least satisfactory craniofacial form (category I-II) at latest evaluation. Overall rates of hydrocephalus, shunt placement, and seizures (3.8, 1.0, and 2.9 percent, respectively) were low. Among the isolated craniosynostoses, unilateral coronal synostosis/plagiocephaly poses the most complex problems, including vertical orbital dystopia, nasal tip deviation, and residual craniofacial asymmetry; there is also a wide spectrum of findings and growth patterns in this subgroup
— id: 12744, year: 1995, vol: 96, page: 272, stat: Journal Article,

Twenty-year experience with early surgery for craniosynostosis: II. The craniofacial synostosis syndromes and pansynostosis--results and unsolved problems
McCarthy JG; Glasberg SB; Cutting CB; Epstein FJ; Grayson BH; Ruff G; Thorne CH; Wisoff J; Zide BM
1995 Aug;96(2):284-295, Plastic & reconstructive surgery
As the second of a two-part series, 76 patients with pansynostosis and craniofacial synostosis syndromes were retrospectively analyzed. Diagnoses included pansynostosis (7), craniofrontonasal dysplasia (8), and Apert (24), Crouzon (15), and Pfeiffer (15) syndromes. All patients underwent primary fronto-orbital advancement-calvarial vault remodeling procedures at less than 18 months of age (mean 6.1 months). Twenty-eight patients (36.8 percent) required a secondary cranial vault operation (mean age 28.4 months). Additionally, a major tertiary procedure was necessary in 5 patients to deal with persistent unacceptable craniofacial form. To address the associated finding of midface hypoplasia, 64.8 percent (n = 35) of patients underwent Le Fort III midface advancement or had that procedure recommended for them. The remainder were awaiting appropriate age for this reconstruction. The more extensive pathologic involvement of the pansynostosis and craniofacial syndrome group is illustrated. As compared with the isolated craniofacial synostosis group previously reported, the incidence of major secondary procedures (36.8 versus 13.5 percent), perioperative complications (11.3 versus 5.0 percent), follow-up complications (44.7 versus 7.7 percent), hydrocephalus (42.1 versus 3.9 percent), shunt placement (22.4 versus 1.0 percent), and seizures (11.8 versus 2.9 percent) was significantly increased. Complex problems including those of increased intracranial pressure, airway obstruction, and recurrent turricephaly or cranial vault maldevelopment are repeatedly encountered. In addition, that early fronto-orbital advancement-cranial vault remodeling failed to promote midface development and hypoplasia of this region is almost a consistent finding in the craniofacial syndromic group. The average length of postoperative follow-up was 6 years. According to the classification of Whitaker et al., which assesses surgical results, 73.7 percent of patients were considered to have at least satisfactory craniofacial form (category I-II) at latest evaluation. An algorithmic approach to the treatment of all patients with craniosynostosis is presented utilizing early surgical intervention as the key element
— id: 12743, year: 1995, vol: 96, page: 284, stat: Journal Article,

Introduction of an intraoral bone-lengthening device
McCarthy JG; Staffenberg DA; Wood RJ; Cutting CB; Grayson BH; Thorne CH
1995 Sep;96(4):978-981, Plastic & reconstructive surgery
It has been demonstrated that distraction osteogenesis is an effective clinical tool with applications for the entire human skeleton. Therapeutic exploitation in the correction of the asymmetrical and hypoplastic mandible has been reported previously. However, the main criticism of this technique has been the residual cutaneous scars resulting from the surgical incision and the path of the expansion device. In order to obviate the need for skin incisions, we have developed and demonstrated the feasibility of a miniaturized mandibular bone lengthener that is suitable for intraoral placement. Ten growing mongrel dogs were studied. Under general anesthesia, a buccal mucosal incision was made along the oblique line, and the body and ramus of the mandible were exposed in a supraperiosteal plane. Two 2.0-mm half-pins were placed percutaneously in the area of the angle of the mandible, and two other pins were placed 3.5 cm anteriorly. The clamps of the lengthening device were then attached to the half-pins in an intraoral position. An osteotomy was made by connecting percutaneously made drill holes between the clamps in a line positioned posterior to the third molar. The mucosa was closed loosely over the device. Distraction was commenced on the eighth postoperative day. The results were assessed with pre- and post-lengthening photographs, cephalograms, and CT scans with three-dimensional reconstruction. All animals demonstrated a contralateral cross-bite. The newly developed bone also was examined histologically. The intraoral method of mandibular lengthening offers the same advantages of extraoral lengthening but without the need for a cutaneous incision and resulting scar
— id: 56775, year: 1995, vol: 96, page: 978, stat: Journal Article,

Sympathetic blockade of isolated rat hindlimbs by intra-arterial guanethidine: the effect on blood flow and arterial-venous shunting
McCarty ME; Grossi EA; Cutting C; Prevel CD; Elluru R; Eppley BL
1995 ;16(7):476-481, Microsurgery
In order to improve the understanding of the role of sympathetic nerve degeneration in reimplantation failure, the hindlimbs of eight rats (Group I) underwent near-complete amputation. The soft tissues of the hindlimb were transected at the proximal thigh with the femoral artery, vein and femur left intact. The femoral vessels were clamped and guanethidine was infused into a branch of the femoral artery of the right leg of each animal, while saline was injected into the left leg. The clamps were removed after 15 minutes. A baseline preoperative injection of radiolabeled microspheres was made, and subsequent injections at 6, 12, 18, and 24 hours postoperation. Twelve rats (Group II) were then used to assess the amount of arterial-venous shunting preoperatively (n = 6) and at 18 hours postoperation (n = 6), by venous sampling. Blood flow to both limbs increased postoperation, but there was significantly more flow in the guanethidine treated limb at 18 and 24 hours postoperation. The amount of shunting was approximately 50% in both limbs at 18 hours, as compared to 10% preoperation. These results highlight the potential benefit of guanethidine and other sympathetic blocking agents in reimplantation to increase blood flow, decrease tissue ischemia and increase anastomotic patency rates. They also suggest that sympathetic nerve degeneration did not affect the volume of arterial-venous shunting in this model, but the difference in blood flow was likely due to arteriolar vasospasm. Further study is needed to elucidate the clinical significance of sympathetic nerve degeneration in reimplantation failure
— id: 33346, year: 1995, vol: 16, page: 476, stat: Journal Article,

An analysis of extradural dead space after fronto-orbital surgery
Spinelli HM; Irizarry D; McCarthy JG; Cutting CB; Noz ME
1994 Jun;93(7):1372-1377, Plastic & reconstructive surgery
This study was undertaken to evaluate several concerns regarding the extradural space resulting from elective fronto-orbital advancement or frontal sinus cranialization techniques. The questions are (1) Do infants undergoing these techniques have the potential to obliterate this space at an accelerated rate, e.g., within 1 or 2 days? (2) Do adults have any potential to obliterate the space? (3) Do children obliterate the space like infants or like adults? (4) What is the specific time sequence for dead-space obliteration? Twenty patients ranging in age from 6 months to 35 years were studied before and after fronto-orbital advancement. The patients were divided into three groups: (1) infants (up to 15 months), (2) children (up to 9 years), and (3) adults (9 years and beyond). Postoperative intracranial dead space was assessed by serial CT scans. Ten patients had CT scans more than 14 days after surgery. These data demonstrate that intracranial dead space in infants is obliterated in a delayed fashion. Children tend to obliterate intracranial dead space in a manner similar to that of infants. Adults are able to obliterate the space over a longer, but finite, period of time as compared with infants and children. Part of the mechanism responsible for obliteration of the postoperative space may be enlargement of the ventricular system
— id: 33294, year: 1994, vol: 93, page: 1372, stat: Journal Article,

The prolabial unwinding flap method for one-stage repair of bilateral cleft lip, nose, and alveolus
Cutting C; Grayson B
1993 Jan;91(1):37-47, Plastic & reconstructive surgery
This paper describes a one-stage reconstruction of the complete bilateral cleft lip, nose, and alveolus using an asymmetrically designed prolabial flap. The columella of the nose and the central lip are produced by 'unwinding' the columellar and labial sections of the prolabium around a small central tab, which is used to center the junction between the lip and columella. Only two scars are produced, both of which run vertically along each philtral column. Accurate preoperative orthopedics without lip adhesion is considered essential to this repair. The principal advantage/disadvantage to the method is its asymmetrical design. If asymmetries result, they have been easily corrected. Eight consecutive cases are presented with follow-up ranging from 1.5 to 6.3 years
— id: 13312, year: 1993, vol: 91, page: 37, stat: Journal Article,

Preoperative columella lengthening in bilateral cleft lip and palate
Grayson, B H; Cutting, C; Wood, R
1993 Dec;92(7):1422-1423, Plastic & reconstructive surgery
— id: 135023, year: 1993, vol: 92, page: 1422, stat: Journal Article,

APLASIA-CUTIS-CONGENITA OF THE SCALP - ISSUES IN ITS MANAGEMENT
ABBOTT, R; CUTTING, CB; WISOFF, JH; THORNE, CH; EPSTEIN, FJ
1992 JUN ;17(4):182-184, Pediatric neurosurgery
Two cases of aplasia cutis congenita with associated bony defects are presented to highlight the dangers of delayed coverage of exposed dura. Management of one case was complicated by repeated local and systemic sepsis and the other by repeated, life-threatening hemorrhage. Early, definitive coverage of these defects using full thickness skin flaps avoids the risks of hemorrhage and should, if the recipient bed is clean, lessen the incidence of complicating sepsis
— id: 33467, year: 1992, vol: 17, page: 182, stat: Journal Article,

A STEREOTAXIC SYSTEM FOR GUIDING COMPLEX CRANIOFACIAL RECONSTRUCTION
CUTTING, C
1992 FEB ;89(2):346-348, Plastic & reconstructive surgery
— id: 52103, year: 1992, vol: 89, page: 346, stat: Journal Article,

Aplasia cutis congenita of the scalp: issues in its management
Abbott R; Cutting CB; Wisoff JH; Thorne CH; Epstein FJ
1991 92;17(4):182-184, Pediatric neurosurgery
Two cases of aplasia cutis congenita with associated bony defects are presented to highlight the dangers of delayed coverage of exposed dura. Management of one case was complicated by repeated local and systemic sepsis and the other by repeated, life-threatening hemorrhage. Early, definitive coverage of these defects using full thickness skin flaps avoids the risks of hemorrhage and should, if the recipient bed is clean, lessen the incidence of complicating sepsis
— id: 14208, year: 1991, vol: 17, page: 182, stat: Journal Article,

Landmarks in three dimensions: reconstruction from cephalograms versus direct observation
Bookstein FL; Grayson B; Cutting CB; Kim HC; McCarthy JG
1991 Aug;100(2):133-140, American journal of orthodontics & dentofacial orthopedics
A method for generating three-dimensional landmark locations from routine biplane pairs of cephalograms was previously introduced. In this article we compare the locations thus reconstructed to the same configurations as directly recorded through a redundant network of interpoint distances measured with calipers. Six mandibular landmarks were located by both methods on each of 10 dry skulls. With the caliper distances is associated a standard error that can be estimated without explicit remeasurement by the method of 'adjustment of networks' familiar from surveying. These standard errors are consistent with the remeasurement error both of the caliper measurements and of the stereolocation from cephalograms; the methods appear to have the same precision, about 0.4 mm per distance. The bias (systematic shift) of the biplane reconstructions with respect to the points used for laying down the calipers may be estimated by regressions of distance discrepancies on the direction cosines of the separations between pairs of landmarks. The caliper tips placed condylion approximately 10 mm medially and a bit forward of where we chose to reconstruct it from biplane cephalograms. The caliper locations of gonion average about 1.6 mm back of their cephalometric position, while those at menton and lower incisal edge are forward by some 1.4 mm. We conclude that the biplane reconstruction (the 'three-dimensional cephalogram') is sufficiently accurate for routine clinical and surgical application
— id: 33295, year: 1991, vol: 100, page: 133, stat: Journal Article,

QUANTITATIVE AND QUALITATIVE COMPARISON OF VOLUMETRIC AND SURFACE RENDERING TECHNIQUES
RUSINEK, H; NOZ, ME; MAGUIRE, GQ; KALVIN, A; HADDAD, B; DEAN, D; CUTTING, C
1991 APR ;38(2):659-662, IEEE transactions on nuclear science
The fidelity of visualizing craniofacial features using two modern three-dimensional (3D) imaging algorithms - one employing surface and the other volume rendering - are compared. Each rendering technique was evaluated for its ability to display closed cranial sutures, loss of thin bone through partial volume averaging, and the presence of artifacts. Linear measurements of the orbits, foramina, and mounting holes were taken on the 3D renderings and compared with direct measurements. Both techniques visualized the closed cranial sutures, orbits, mandibles, and teeth. The errors in linear measurement averaged less than 1.5 mm (root mean square) and were not statistically different between the two techniques. Errors are attributable to uncertainty in locating edges due to partial transparency (volume rendering) and sub- optimal lighting. Both rendering techniques suffer from step pattern and thin bone artifacts. We conclude that an algorithm for surface construction can provide detailed and accurate representation of the craniofacial anatomy
— id: 33374, year: 1991, vol: 38, page: 659, stat: Journal Article,

Computerized tomographic analysis of orbital hypertelorism repair: spatial relationship of the globe and the bony orbit
Hoffman WY; McCarthy JG; Cutting CB; Zide BM
1990 Aug;25(2):124-131, Annals of plastic surgery
Computerized tomographic scans provide a new means of evaluating the spatial and geometric relationships between the movement of the bony orbit and its soft tissue contents (the globe and extraocular muscles) [1, 12]. Preoperative and postoperative computerized tomographic scans were analyzed in four patients to explore these relationships. Measurement of the changes in distance between the globes correlated most closely with the change in the distance between the lateral orbital walls; resection of medial (inter-orbital) bone provides space into which the globe is translocated. The medial rectus muscle may be bowed across the medial wall osteotomy line, creating a functional shortening of the muscle; this finding may explain the esotropia that is commonly seen after this procedure [2, 3]. These observations should have a direct impact on the understanding and planning of orbital hypertelorism correction
— id: 18180, year: 1990, vol: 25, page: 124, stat: Journal Article,

The timing of surgical intervention in craniofacial anomalies
McCarthy JG; Cutting CB
1990 Jan;17(1):161-182, Clinics in plastic surgery
When treating an infant or younger child with severe craniofacial synostosis, the burden is placed on the surgeon in making a decision regarding not only the design of the osteomy but also the timing of the surgical intervention. This article reviews the current treatment protocols for craniofacial anomalies
— id: 33297, year: 1990, vol: 17, page: 161, stat: Journal Article,

Hypertelorism correction in the young child
McCarthy JG; La Trenta GS; Breitbart AS; Zide BM; Cutting CB
1990 Aug;86(2):214-225, Plastic & reconstructive surgery
This series reports on 20 patients who underwent orbital hypertelorism correction under 5.3 years of age (average age 3.9 years). The patients were followed an average of 5 years, and six patients were followed in excess of 7 years with clinical and cephalometric parameters. The study demonstrated that the procedure could be safely performed at this age and was aesthetically desirable. There was minimal clinical or cephalometric evidence of skeletal orbital relapse except in three patients, for whom individual explanations are given. During the period of postoperative study, nasomaxillary growth and development proceeded as expected, except in those patients with associated clefting. All patients demonstrated increased cranial width measurements preoperatively and postoperatively, but bigonial and bimastoid measurements were generally within normal range. Excessive resection of nasoglabellar skin at the time of hypertelorism correction appeared to adversely affect nasal development
— id: 18179, year: 1990, vol: 86, page: 214, stat: Journal Article,

A comparison of two approaches to three-dimensional imaging of craniofacial anomalies
Rusinek H; Karp NS; Cutting CB
1990 May;3(2):81-88, Journal of digital imaging
Volume-based and surface-based algorithms for three-dimensional rendering of computed tomography (CT) scans of the human skull were compared in patients with craniofacial anomalies. Both methods were applied to a selected sample of 12 clinical CT studies. The number of sections ranged from 24 to 72 and the section thickness from 1.5 to 6.0 mm. Volume renderings were more prone to interpolation artifacts but captured the anatomy in greater detail. The sites of closed cranial sutures, visualized using the volume technique, were not demonstrated using the specific surface rendering technique used in this study. In both techniques the areas of thin bone appeared as gaps
— id: 33296, year: 1990, vol: 3, page: 81, stat: Journal Article,

A comparative study of the skin envelope of the unilateral cleft lip nose subsequent to rotation-advancement and triangular flap lip repairs
Cutting CB; Bardach J; Pang R
1989 Sep;84(3):409-417, Plastic & reconstructive surgery
The secondary nasal skin envelope asymmetries were studied after unilateral cleft lip repair using the original (obsolete) rotation-advancement (Millard I) and the triangular flap techniques (Bardach's modification). Secondary correction of the nasal deformity was not performed in either group. Our findings indicated that in both groups, vertical asymmetries of the nasal skin envelope were similar. The alar dome on the cleft side was depressed, the columella was shorter on the cleft side, and there was hooding at the nostril apex. The principal difference between the two lip repairs was observed in the horizontal dimension of the nasal skin envelope. The position of the alar base was more normal following the Millard I repair, while the triangular flap repair left the alar base laterally displaced. When considered together with flattening of the cleft alar dome, a horizontal skin-envelope deficiency from middome to lateral alar crease was produced in the Millard I group. More lateral positioning of the alar base after the triangular flap technique minimized this horizontal skin deficiency. The triangular flap technique produced a secondary nasal deformity that looked worse but was easier to correct. The clinical implications of these findings are discussed
— id: 33298, year: 1989, vol: 84, page: 409, stat: Journal Article,

Three-dimensional rendering of medical images : surface and volume approach
Rusinek H; Karp N; Cutting C
1989 ;1091(III):204-211, Medical imaging (SPIE)
— id: 73283, year: 1989, vol: 1091, page: 204, stat: Journal Article,

Three-dimensional input of body surface data using a laser light scanner
Cutting CB; McCarthy JG; Karron DB
1988 Jul;21(1):38-45, Annals of plastic surgery
This article presents a device for automated input of three-dimensional body surface data using a laser light scanner. The device scans the surface in a few seconds. The data are available immediately in digital form for computer-aided presentation and analysis. Although the initial cost is moderately high, the cost per patient and processing time are low. This device makes possible the quantitative evaluation of plastic surgical procedures that are designed to alter body surface form
— id: 11029, year: 1988, vol: 21, page: 38, stat: Journal Article,

The three-dimensional cephalogram: theory, technique, and clinical application
Grayson, B; Cutting, C; Bookstein, F L; Kim, H; McCarthy, J G
1988 Oct;94(4):327-337, American journal of orthodontics & dentofacial orthopedics
The Broadbent-Bolton cephalostat produces intrinsically three-dimensional information about cranial form. Yet in the clinical setting, this information has been used primarily two dimensions at a time in the separate study of lateral or posteroanterior cephalograms. In this article we demonstrate an expedient use of existing cephalostat-based data sets to derive certain analyses of three-dimensional form. The technique is essentially the same as that of the Broadbent-Bolton 'Orientator,' an exploitation of the geometry of the cephalostat to simulate stereophotogrammetry. The three-dimensional method supports the usual biometrics of landmark locations, and takes advantage of a normative data base that is suited for semiautomatic analysis of syndromic data. The principal drawback of the method is its inability to represent curving form in three dimensions. However, in comparison with computed tomography (CT), it involves low radiation dose, is simpler to obtain, has an available normative data base, and is more practical for quantitative or long-term serial analysis
— id: 99051, year: 1988, vol: 94, page: 327, stat: Journal Article,

Bone graft survival in expanded skin
LaTrenta GS; McCarthy JG; Epstein M; Cutting CB; Orentreich C
1988 Mar;81(3):406-413, Plastic & reconstructive surgery
The effect of tissue expansion on iliac bone graft (onlay) survival was studied on the skulls of 35 New Zealand white rabbits. Wet bone weights at the time of grafting and at sacrifice in control animals (group I) were compared to three experimental groups. Histologic sections of the developing and resolving pseudosheath and skin envelope were performed. A self-inflating 5-mil-thick silicone expander was used for soft-tissue expansion over the rabbit snout. Bone grafts were subsequently placed in this site. Elliptical snout excision without expansion (group II) demonstrated no statistically significant difference in bone graft survival when compared to controls (group I) (p = 0.350). Full tissue expansion followed by immediate bone grafting (group III) within the pseudosheath cavity likewise demonstrated no statistically significant difference in bone graft survival when compared to controls (group I) (p = 0.500); however, when full tissue expansion was followed by delayed (2 weeks) bone grafting to allow for resolution of the giant cell inflammatory reaction of the pseudosheath (group IV), a statistically significant increased bone graft survival was achieved (p less than 0.001). The study demonstrates that the increased vascularity in the pseudosheath and in the expanded soft-tissue envelope significantly increased bone graft survival only when bone grafting was delayed
— id: 11172, year: 1988, vol: 81, page: 406, stat: Journal Article,

Radiographical documentation of direct injury of the intracanalicular segment of the optic nerve in the orbital apex syndrome
Stuzin JM; Cutting CB; McCarthy JG; Dufresne CR
1988 Apr;20(4):368-373, Annals of plastic surgery
In the radiographical evaluation of the orbital apex syndrome, standard radiographs, tomograms, and computed tomographic scans have proved useful in the demonstration of the bony pathology, especially for optic canal fractures. The limitation of these methods, however, remains in their inability to provide accurate delineation of the associated soft tissue pathology, including the presence of optic nerve sheath hematoma. Recent developments in computer technology and graphic imaging are now available to provide an accurate three-dimensional radiographical analysis of the extent of skeletal and soft tissue injury in the orbital apex syndrome. The physician, in essence, can perform a radiographical 'living autopsy'. The technique was used to evaluate a patient with bilateral apex syndrome. It clearly showed that a severe direct injury to the intracanalicular portion of the optic nerve was responsible for the development of blindness in this patient. The progression of optic nerve injury, from perineural sheath hematoma to the ultimate development of optic nerve atrophy and fibrosis, was radiographically documented
— id: 11125, year: 1988, vol: 20, page: 368, stat: Journal Article,

Volumetric quantification of intracranial and ventricular volume following cranial vault remodeling: a preliminary report
Dufresne CR; McCarthy JG; Cutting CB; Epstein FJ; Hoffman WY
1987 Jan;79(1):24-32, Plastic & reconstructive surgery
This preliminary study documents preoperative and postoperative changes in cerebral tissue as well as intracranial and ventricular volume in patients who underwent cranial vault remodeling for craniosynostosis. The documentation and calculations were provided from CT data according to a craniofacial protocol. Three-dimensional images were then obtained of the preoperative and postoperative skulls and cerebral tissues. From these data, comparisons of preoperative and postoperative volumes of the cerebral tissue and ventricles could be examined. In one case, a frontal bone advancement combined with anterior cranial vault remodeling was associated with an increase in intracranial volume of 110 cc (8 percent) and a ventricular volume increase of 112 percent. The reported technique should allow more complete evaluation of the preoperative pathology and documentation and prediction of the projected intracranial and ventricular volume changes
— id: 33302, year: 1987, vol: 79, page: 24, stat: Journal Article,

Reconstruction of mandibular and floor of mouth defects using the trapezius osteomyocutaneous flap
Dufresne, C; Cutting, C; Valauri, F; Klein, M; Colen, S; McCarthy, J G
1987 May;79(5):687-696, Plastic & reconstructive surgery
The trapezius osteomyocutaneous island flap has evolved in postablative head and neck reconstruction as a versatile and hardy local flap which can provide intraoral lining, well-vascularized bone, and muscle bulk for the reconstruction of a complex defect. This investigative study examines the anatomy of 20 osteomyocutaneous flaps in 10 fresh cadavers and in 8 clinical patients. In our series, 80 percent (type I) of the major vascular pedicle arose from the thyrocervical trunk. In 20 percent (type II), the major pedicle arose separately from the subclavian artery. The regions perfused by the vascular trunk were further examined with microopaque and Prussian blue injections through the transverse cervical artery. Consistent areas of cutaneous staining as well as bony staining were noted over the shoulder, arm, and back and into the scapula itself. Experience with eight clinical applications of this osteomyocutaneous flap resulted in successful healing with an excellent aesthetic and functional result. Long-term follow-up was maintained on the patients for up to 36 months. Panorex radiographs and biopsies of the grafted bone were obtained on several patients. These disclosed evidence of bony remodeling and viable bone tissue. Tetracycline labeling also revealed evidence of active bony turnover
— id: 99055, year: 1987, vol: 79, page: 687, stat: Journal Article,

The growth of vascularized onlay bone transfers
LaTrenta GS; McCarthy JG; Cutting CB
1987 Jun;18(6):511-516, Annals of plastic surgery
The growth of vascularized onlay bone (autogenous) transfers on the skulls of 27 newborn New Zealand white rabbits was studied. Freeze-dried bone weight in control newborns and control adults (group 1) was compared with that in experimental adult animals (group 2). In the experimental group, the bone was transferred on the auricularis anterior muscle and neurovascular pedicle. The flap was deliberately maintained without osseous contact or functional-myogenic stress. The myoosseous bone transfers (group 2) exhibited statistically significant osseous enlargement when compared with the control newborns (p = 0.006); however, the weights were significantly less than those of the adult matched controls (group 1, p less than 0.001). Representative histological sections were also studied. Skeletal unit growth of a portion of the New Zealand white rabbit's skull was achieved despite marked alteration in the 'functional matrix.' The study demonstrated that vascular supply is the other independent factor affecting bone growth. Generally neglected as a variable in the literature of the subject, vascular supply should be considered within the functional matrix concept of craniofacial growth
— id: 33300, year: 1987, vol: 18, page: 511, stat: Journal Article,

Vascularized calvarial flaps
McCarthy JG; Cutting CB; Shaw WW
1987 Jan;14(1):37-47, Clinics in plastic surgery
Vascularized calvarial transfers offer many advantages. In this article the anatomic (soft tissue, vascular, osseous) basis of flap design is summarized, and the technical details of two calvarial flaps, the temporoparietal and the frontoparietal, are presented
— id: 33301, year: 1987, vol: 14, page: 37, stat: Journal Article,

The effects of unilamellar perichondrial dissection on the growth of rabbit ear cartilage
Wellisz TZ; Cutting CB; McCarthy JG
1987 Jun;79(6):935-940, Plastic & reconstructive surgery
The effects of elevation of the perichondrium from a surface of growing ear cartilage were investigated in immature rabbits. Eight 21-day-old rabbits completed the study in which perichondrium was elevated from one cartilaginous surface of one ear and the nonoperated ear served as a control. By maturity, both ears had developed symmetrically and no statistically significant difference could be demonstrated in length and surface area. Although several ears demonstrated subtle shape changes, the overall growth and development of the surgically manipulated ear cartilages did not appear to be affected. These findings appear to contradict a widely held view that perichondrial dissection of developing cartilage has a high potential for subsequent growth disturbances. The corollary has been that cartilage manipulation, such as that required in the surgical repair of the cleft lip nose deformity, should be delayed until the growth of cartilage is complete. These data would support the findings of long-term clinical studies which demonstrate the efficacy of early limited perichondrial dissection in the correction of the cleft lip nose deformity
— id: 33299, year: 1987, vol: 79, page: 935, stat: Journal Article,

Three-dimensional computer-assisted design of craniofacial surgical procedures: optimization and interaction with cephalometric and CT-based models
Cutting C; Bookstein FL; Grayson B; Fellingham L; McCarthy JG
1986 Jun;77(6):877-887, Plastic & reconstructive surgery
A computer program is described which aids the clinician in planning craniofacial surgical procedures. It operates on a three-dimensional landmark data base derived by combining posteroanterior and lateral cephalograms from the patient and from the Bolton normative standards. A three-dimensional surgical simulation program based on computerized tomographic (CT) data is also described which can be linked to the cephalometrically based program. After the clinician has selected the number and type of osteotomies to be performed on the patient, an automated optimization program computes the postoperative positions of these fragments which best fit the appropriate normal cephalometric form. The clinician then interactively modifies the design to account for such variables as bone-graft resorption, relapse tendency, occlusal disparities, and the condition of the overlying soft-tissue matrix. Osteotomy movement specifications are easily transferred between the CT-based and the cephalometrically based surgical simulation programs. This allows the automated positioning step to be performed on the cephalometrically based model while the interactive step is performed using the superior image provided by the CT-based model
— id: 65760, year: 1986, vol: 77, page: 877, stat: Journal Article,

Computer-aided planning and evaluation of facial and orthognathic surgery
Cutting, C; Grayson, B; Bookstein, F; Fellingham, L; McCarthy, J G
1986 Jul;13(3):449-462, Clinics in plastic surgery
The desire to apply the scientific method to aesthetic facial surgery is the underpinning of this article, which summarizes the attempts that have been made to apply numeric methods to facial surgery, with particular emphasis on computer methods
— id: 99056, year: 1986, vol: 13, page: 449, stat: Journal Article,

Three-dimensional computer simulation of craniofacial anatomy
Grayson BH; Cutting CB; Dufresne CR; Bookstein FL; McCarthy JG; Patnaik S
1986 Oct;52(8):29-31, New York state dental journal
— id: 33303, year: 1986, vol: 52, page: 29, stat: Journal Article,

Organized bibliography of the microsurgical literature
Ballantyne, Donald L; Rosenberg, Benjamina; Hoffman, Lloyd; Cutting, Court
Rockville MD : Aspen Systems Corp, 1985,
— id: 1382, year: 1985, vol: , page: , stat: ,

BIOSTEREOMETRICS AND COMPUTER-GRAPHICS FOR PATIENTS WITH CRANIOFACIAL MALFORMATIONS - DIAGNOSIS AND TREATMENT PLANNING - DISCUSSION
Cutting, C
1985 ;75(4):500-501, Plastic & reconstructive surgery
— id: 30946, year: 1985, vol: 75, page: 500, stat: Journal Article,

The median forehead flap revisited: the blood supply
McCarthy JG; Lorenc ZP; Cutting C; Rachesky M
1985 Dec;76(6):866-869, Plastic & reconstructive surgery
In 6 fresh cadavers, an injection study of the facial vessels with disulfine blue dye and Microfil demonstrated visualization of large-caliber vessels of the median forehead skin even when the supraorbital and supratrochlear vessels were interrupted. The results of the study would suggest that the median forehead flap can be elevated without incorporating the supratrochlear vessels, but the flap design should be reserved for those clinical situations where the pedicle must be extensively mobilized, e.g., reconstruction of the nasal tip and columella and the presence of a low-lying frontal hairline
— id: 19562, year: 1985, vol: 76, page: 866, stat: Journal Article,

Blood supply of the upper craniofacial skeleton: the search for composite calvarial bone flaps
Cutting CB; McCarthy JG; Berenstein A
1984 Nov;74(5):603-610, Plastic & reconstructive surgery
This study investigated the blood supply of the upper craniofacial skeleton by injection studies. The major supply to the calvaria is provided by the middle meningeal artery and its branches. This vessel is difficult for the plastic surgeon to exploit in composite bone-flap design. The majority of the outer surface of the craniofacial skeleton is supplied by tiny perforators from the overlying periosteum. The vascular interconnections within the periosteum are poorly developed. For this reason, the galea and the overlying vascular network (derived from the superficial temporal, occipital, supraorbital, and supratrochlear vessels) should be left broadly attached to the bone when transferring a vascularized calvarial bone flap. Dissection of the scalp away from this vascular network should be carried out just below the hair follicles. By observing these principles, vascularized calvarial bone can be transferred on the superficial temporal, deep temporal, supraorbital, supratrochlear, or occipital vessels. Details of the use of each are discussed
— id: 33304, year: 1984, vol: 74, page: 603, stat: Journal Article,

Workstations for medical PACS: image processing and graphics
Horii, S.C.; Cutting, C.; Isles, G.; Bergeron, R.T.
1984 ;48(2):40-, Proceedings ISMII (International Symposium on Medical Images & Icons)
Summary form only given, as follows. As part of their PAC system, the authors are developing two types of workstations to meet the needs of both the radiologists and referring physicians. In examining these needs, they found a difference in requirements. Radiologists are most interested in a workstation which can emulate a CT viewing console and provide some added capability. Referring physician requirements are either for a very simple viewbox-like system, or (for some specialists) much more elaborate graphics displays. The authors examine the reasons for these requirements and their approaches to fulfilling them
— id: 98859, year: 1984, vol: 48, page: 40, stat: Journal Article,

Comparison of residual osseous mass between vascularized and nonvascularized onlay bone transfers
Cutting CB; McCarthy JG
1983 Nov;72(5):672-675, Plastic & reconstructive surgery
Composite flaps containing vascularized frontal bone were transferred on muscle pedicles in immature rabbits. Vascular continuity was maintained on one side and interrupted on the other. Bone weights at 16 weeks following transfer were compared with those of unoperated controls. The conventional bone graft demonstrated significant reduction in osseous mass. The vascularized bone maintained its mass compared with unoperated controls. Vascularized bone transfer appears to be the preferred surgical technique whenever possible
— id: 33305, year: 1983, vol: 72, page: 672, stat: Journal Article,

THE SIGNIFICANCE OF DISTAL ARTERIOVENOUS SHUNTING ON SKIN FLAP SURVIVAL - AN EXPERIMENTAL-STUDY IN PIGS
BARDACH, J; CUTTING, C; MOONEY, MP
1982 ;8(4):284-286, Annals of plastic surgery
— id: 50584, year: 1982, vol: 8, page: 284, stat: Journal Article,

Critical closing pressure, local perfusion pressure, and the failing skin flap
Cutting, C; Ballantyne, D; Shaw, W; Converse, J M
1982 Jun;8(6):504-509, Annals of plastic surgery
A simple apparatus was devised to perfuse the rat groin flap to study the relationship between perfusion pressure and flow. Results demonstrate that a relatively high intraarterial pressure must be applied to this skin flap before blood flow will commence. Results suggest that this critical closing phenomenon is the result of surface tension, blood rheology, venous pressure, tissue pressure, and vascular smooth muscle tone. Correlating the experiments of Milton and Landis reveals that, beyond a certain distance, local perfusion pressure in a skin flap gradually decreases with increasing distance from the flap base. These observations suggest that the perfusion boundary in a skin flap forms at the point where perfusion pressure has fallen to the level of the critical closing pressure. Methods of increasing survival length of a flap by decreasing critical closing pressure are discussed. The effects of edema and pressure dressings on flap and replant survival are examined in terms of the closing pressure concept
— id: 119878, year: 1982, vol: 8, page: 504, stat: Journal Article,

CHANGES IN QUANTITATIVE NOREPINEPHRINE LEVELS IN DELAYED PIG FLANK FLAPS
CUTTING, C; BUMSTED, R; BARDACH, J; MOONEY, M; JOHNSON, S
1982 ;69(4):652-655, Plastic & reconstructive surgery
— id: 50598, year: 1982, vol: 69, page: 652, stat: Journal Article,

Relationships between muscle activity and velar position
Kuehn DP; Folkins JW; Cutting CB
1982 Jan;19(1):25-35, Cleft palate journal
Five normal subjects were used to study the relations between muscle activity and velar position. The speech sample consisted of the sustained sounds /i/, /u/, /s/, nonnasal /a/, and nasalized /a/. Velar position was determined using lateral-view x-rays. Electromyographic activity was measured from hooked-wire electrodes intended to record from the levator veli palatini, palatoglossus, palatopharyngeus, and the superior pharyngeal constrictor muscles. A transnasal approach was used to insert electrodes intended for superior constrictor. It was found that 1) the level of levator activity was not directly related to velar position, 2) for a given velar position the level of levator activity was related to palatoglossus and/or palatopharyngeus activity in most cases, and 3) superior constrictor was active during all speech samples studied, but the level of activity was inconsistent both within and between subjects
— id: 33306, year: 1982, vol: 19, page: 25, stat: Journal Article,

Haemodynamics of the delayed skin flap: a total blood-flow study
Cutting CB; Bardach J; Finseth F
1981 Apr;34(2):133-135, Plastic & reconstructive surgery
Pedicle skin flaps in dogs were delayed and venous outflow measured at various times following a delay procedure. An initial small but significant decrease in blood flow was noted in the first 48 hours postoperatively in several flaps suggesting that a denervation supersensitivity-arteriovenous shunt mechanism may be active at this time. In all flaps after the second day, total flap blood flow markedly increased compared to the initial measurement. This suggests that the most significant haemodynamic event occurring during the delay period is the development of vascular collaterals
— id: 33307, year: 1981, vol: 34, page: 133, stat: Journal Article,

Skin flap delay procedures: proximal delay versus distal delay
Cutting, C; Bardach, J; Rosewall, D
1980 Apr;4(4):293-296, Annals of plastic surgery
An experimental study was designed to determine which portion of a flap, distal or proximal, contributes more to the delay phenomenon. (Since flap necrosis usually occurs in it distal portion, it is often assumed that only this portion of a flap must be delayed to improve flap survival.) Random-pattern pig flank flaps (16 X 3 cm) were used. All control flaps survived to at least 8 cm. Survival of flaps in which the distal half was delayed was not significantly different from that of controls. Survival of flaps in which the proximal half was delayed was significantly greater than undelayed controls. Completely delayed flaps, however, had significantly better survival than any other group. These findings are inconsistent with the metabolic adaptation hypothesis. They suggest that the denervation supersensitivity-arteriovenous anastomosis hypothesis is incorrect. They are consistent with the vascular collateral hypothesis and the new basal capillary shunting hypothesis
— id: 135025, year: 1980, vol: 4, page: 293, stat: Journal Article,

AN ELECTROMYOGRAPHIC-RADIOGRAPHIC STUDY OF STATIC VELAR POSITION
KUEHN, DP; FOLKINS, JW; CUTTING, CB
1980 JAN ;17(4):354-355, Cleft palate journal
— id: 33468, year: 1980, vol: 17, page: 354, stat: Journal Article,

Trapezius osteomyocutaneous island flap for reconstruction of the anterior floor of the mouth and the mandible
Panje, W; Cutting, C
1980 Sep-Oct;3(1):66-71, Head & neck surgery
The anterior mandible defect following cancer excision presents a formidable reconstructive challenge. A trapezius osteomyocutaneous island flap based on the transverse cervical vessels is described which allows immediate reconstruction of the entire defect. The various classes of bone flaps retaining an intact vascular pedicle are discussed. The osseous extension of the trapezius island flap appears to be adequate perfused. The anatomy involved and the orthopedic sequelae of using flap are discussed
— id: 135024, year: 1980, vol: 3, page: 66, stat: Journal Article,

Denervation supersensitivity and the delay phenomenon
Cutting CB
1978 Sep;62(3):442-442, Plastic & reconstructive surgery
— id: 33308, year: 1978, vol: 62, page: 442, stat: Journal Article,

Denervation supersensitivity and the delay phenomenon
Cutting CB; Robson MC; Koss N
1978 Jun;61(6):881-887, Plastic & reconstructive surgery
We have reviewed the denervation supersensitivity-AV shunt hypothesis (explaining the delay phenomenon) and assessed the contribution of each of the two components of denervation supersensitivy to delay. We concluded that adrenergic denervation supersensitivity contributes little to the delay phenomenon. We propose a new hypothesis, based on the effects of prolonged vascular smooth muscle relaxation in the precapillary arterioles, to explain the delay phenomenon
— id: 33309, year: 1978, vol: 61, page: 881, stat: Journal Article,

An experimental neurovascular island skin flap for the study of the delay phenomenon
Finseth, F; Cutting, C
1978 Mar;61(3):412-420, Plastic & reconstructive surgery
We present an experimental neurovascular island skin flap. It is a consistent, reproducible model which produces a definite pattern of surviving skin flap area versus skin flap necrosis. There is a constant, anatomically definable nerve and vascular supply to the flap. This model permits independent experimental manipulation of the neural, arterial, and venous supply to the skin. It is useful, therefore, for the study of the vascular mechanisms of the skin microcirculation. We also demonstrated that increased flap survival can be produced by a delay involving denervation alone (leaving the vascular supply intact) or by devascularization alone (leaving the nerve supply intact). We conclude that both the adrenergic denervation and the ischemia contribute to the production of the delay phenomenon. We suggest that sustained vasodilation--vascular smooth muscle relaxation--is the vascular mechanism that accounts for the delay phenomenon
— id: 135026, year: 1978, vol: 61, page: 412, stat: Journal Article,

Pharmacology and flap physiology
Cutting CB; Koss N; Robson MC
1976 ;27(62):563-565, Surgical forum
— id: 33310, year: 1976, vol: 27, page: 563, stat: Journal Article,

NEW SAFE AND EFFECTIVE TECHNIQUE FOR DIAGNOSIS OF OCCULT TRACHEO ESOPHAGEAL FISTULAS
CUTTING, CB; WILLIAMSON, BRJ; HILL, JL
1976 JAN ;11(5):374-374, Investigative radiology
— id: 33469, year: 1976, vol: 11, page: 374, stat: Journal Article,