Barry H Grayson, D.D.S.

Long-Term Evaluation of Midface Position after Le Fort III Advancement: A 20-Plus-Year Follow-Up
Warren, Stephen M; Shetye, Pradip R; Obaid, Sacha I; Grayson, Barry H; McCarthy, Joseph G
2012 Jan;129(1):234-242, Plastic & reconstructive surgery
BACKGROUND: : Patients with syndromic craniosynostosis and midface hypoplasia are often treated with Le Fort III advancement. The authors present four patients with extraordinarily long-term follow-up (in excess of 20 years). METHODS: : An institutional review board-approved retrospective chart review was performed on all patients with syndromic craniofacial synostosis who underwent Le Fort III advancement. Patients with greater than 20 years of cephalometric and photographic records were identified. Lateral cephalograms were obtained preoperatively, immediately postoperatively, at 1-year follow-up, and at long-term follow-up. Cephalograms were traced, digitized, and averaged. Fifty cephalometric landmarks were identified for serial measurements. RESULTS: : Of the four patients identified, one had Apert syndrome and three had Crouzon syndrome. Average age at the time of Le Fort III advancements was 11 years (range, 4 to 20 years). Average length of postoperative follow-up was 25 years (+/-5 years). No patient had significant anterior midfacial growth following Le Fort III advancement. Both young patients (<10 years) had substantial vertical inferior midfacial growth after advancement. CONCLUSIONS: : These data demonstrate that the Le Fort III segment of children with syndromic craniosynostosis does not grow significantly forward. Moreover, the traditional Le Fort III osteotomy does not provide the amount of midface advancement necessary to avoid phenotypic recidivism in these syndromic patients. This study also suggests that patients undergoing Le Fort III advancement appear to have zygomatic effacement and ptosis of the overlying soft tissue with deepening of the facial folds; collectively, it is suggested that these changes give the appearance of accelerated facial aging. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, V
— id: 147703, year: 2012, vol: 129, page: 234, stat: Journal Article,

A Quantitative 3D Analysis of Coronoid Hypertrophy in Pediatric Craniofacial Malformations
Chang CC; Allori AC; Wang E; Farina R; Warren SM; Grayson BH; McCarthy JG
2011 Feb;129(2):312e-318e, Plastic & reconstructive surgery
INTODUCTION:: Coronoid process hypertrophy can be associated with a variety of congenital or acquired anomalies. There is, however, no consensus on a quantitative or objective measure to define coronoid hypertrophy. Here, we describe a novel analytical technique using three-dimensional (3D) computed tomographic data to accurately and reproducibly assess coronoid size and diagnose coronoid:condyle disproportion. METHODS:: A total of 24 patients were analyzed using 3D medial axis analysis: eight cases of unilateral coronoid hypertrophy, 4 cases of bilateral coronoid hypertrophy, and 12 age-matched normal control cases were identified. RESULTS:: Measurement of normal subjects (n=12) demonstrated a coronoid:condyle volumetric ratio </= 0.5. Analysis of patients with coronoid hypertrophy demonstrated that a coronoid:condyle volumetric ratio >/= 1.0 was consistent with marked coronoid:condylar disproportion and a ratio between 0.5 and 1.0 was indicative of modest disproportion. Surface area ratios comparing coronoid to condyle were also elevated (ratio >/= 0.5) in patients with coronoid hypertrophy. CONCLUSIONS:: Quantitative assessment of coronoid size using 3D volume and surface-area analysis of computed tomographic data may be helpful to the clinician in diagnosing coronoid hypertrophy and in guiding treatment. It may also serve a role in monitoring the temporal evolution of coronoid hypertrophy in early cases that have not yet resulted in trismus or decreased interincisal opening
— id: 138702, year: 2011, vol: 129, page: 312e, stat: Journal Article,

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,

Current Concepts in Pediatric TMJ Disorders: Part 1: Etiology, Epidemiology, and Classification
Allori AC; Chang CC; Farina R; Grayson BH; Warren SM; McCarthy JG
2010 Oct;126(4):1263-1275, Plastic & reconstructive surgery
BACKGROUND:: Pediatric temporomandibular joint (TMJ) dysfunction, resulting from either soft tissue or skeletal disorders, may be congenital or acquired. Congenital TMJ disorders are uncommon. Here we review our experience with pediatric TMJ disorders and propose a new classification system. METHOD:: Clinical records, cephalograms, computed tomography, magnetic resonance images, and pathologic specimens of all pediatric patients (< 18 years) with trismus or restricted mandibular excursion from 1976-2008 were reviewed. Cases were stratified according to soft tissue or skeletal pathology; skeletal abnormalities were further characterized as intra- or extra-capsular. RESULTS:: 38 patients, ranging in age from 1 day to 18 years of age at diagnosis, were identified with TMJ disorders. Ten cases (26.3%) were due to soft tissue pathology. The remaining 28 cases (73.7%) were due to skeletal pathology, consisting of 14 congenital and 14 acquired cases (50% each). Acquired skeletal deformities included 12 (85.7%) intracapsular ankyloses and 2 (16.7%) extracapsular ankylosis (extra-articular bone blocks). Congenital skeletal deformities accounted for 5 (35.7%) intracapsular ankyloses and 9 (64.3%) extracapsular ankyloses. CONCLUSION:: On initial survey, the data are consistent with published reports that attribute TMJ dysfunction to acquired pathology (i.e., trauma and infection). However, we observed a significantly higher percentage (50%) of congenital TMJ skeletal disorders than previously reported. Most congenital cases involved extracapsular pathology (i.e., coronoid hypertrophy); only a minority of cases had glenocondylar fibro-osseous fusion (i.e., intracapsular ankyloses). Since the diagnosis and classification of TMJ disorders determines treatment options, we provide a new classification that characterizes the extent of capsular involvement
— id: 138347, year: 2010, vol: 126, page: 1263, stat: Journal Article,

The evolution of mandibular distraction: device selection
Davidson, Edward H; Brown, Daniel; Shetye, Pradip R; Greig, Aina V H; Grayson, Barry H; Warren, Stephen M; McCarthy, Joseph G
2010 Dec;126(6):2061-2070, Plastic & reconstructive surgery
BACKGROUND: Mandibular distraction has evolved from the use of external to the use of intraoral and semiburied devices. The authors highlight the evolution of the semiburied technique. The authors evaluate advantages and limitations, and report perioperative events for external and semiburied techniques to establish the indications for selection of the different devices. METHODS: A retrospective review was conducted of patients undergoing mandibular distraction at the New York University Langone Medical Center from the authors' introduction of mandibular distraction in May of 1989 to June 30, 2009. Perioperative events were stratified into three groups: minor incidents, moderate incidents, and major incidents. RESULTS: A total of 211 mandibular distraction procedures were performed: 129 external procedures on native bone, 37 external procedures on grafted bone, and 45 semiburied procedures on native bone. Minor incidents were more common with the semiburied device (62 percent) compared with external devices on native (26 percent) and grafted (38 percent) bone. There were fewer moderate incidents with the semiburied device (18 percent) than with the external device on native (22 percent) and grafted (30 percent) bone. In contrast to the external technique, no major incidents were seen with semiburied distraction. CONCLUSIONS: The semiburied device reduces scarring and has the mechanical advantages of being applied directly to the bone, less vulnerable to dislodgment, and more favorable for a vertical vector. However, its use requires more bone stock and it has the disadvantage of requiring a second operation for removal. Semiburied distraction is safe, reliable, and indicated for lengthening of the hypoplastic mandible where there is adequate bone stock for its attachment
— id: 116202, year: 2010, vol: 126, page: 2061, stat: Journal Article,

Creating a virtual surgical atlas of craniofacial procedures: part I. Three-dimensional digital models of craniofacial deformities
Flores, Roberto L; Deluccia, Nicholette; Grayson, Barry H; Oliker, Aaron; McCarthy, Joseph G
2010 Dec;126(6):2084-2092, Plastic & reconstructive surgery
BACKGROUND:: Three-dimensional digital animation can enable surgeons to create anatomically accurate, virtual models of normal and pathologic human anatomy. From these models, surgical procedures can be digitally performed, recorded, and distributed as a teaching tool or as a virtual surgical atlas. The idea of a virtual surgical atlas has recently become a part of contemporary surgical teaching. In the field of craniofacial surgery, no such educational tool exists. Presented is the first part of the creation of a virtual atlas of craniofacial surgical procedures: the three-dimensional digital modeling of pathologic deformities commonly treated by craniofacial surgeons. METHODS:: Three-dimensional craniofacial models were constructed using Maya 8.5. A skeletally 'normal' craniofacial skeleton was first produced from a preexisting digital skull using Bolton tracings as a reference. The remaining soft-tissue elements were then added to create an anatomically complete three-dimensional face. The 'normal' model was then deformed in Maya to produce specific craniofacial deformities using computed tomographic scans, cephalograms, and photographs as a reference. One of the craniofacial deformity models was created directly from computed tomographic data. RESULTS:: One model of the normal face and eight pathologic models of craniofacial deformities were created: microgenia, micrognathia, prognathia, temporomandibular joint ankylosis, maxillary hypoplasia, Crouzon syndrome with and without the need for cranial vault expansion, and bicoronal craniosynostosis. CONCLUSIONS:: For the first time, anatomically accurate three-dimensional digital models of craniofacial deformities have been created. The models are the first step in the creation of a virtual surgical atlas of craniofacial procedures
— id: 114867, year: 2010, vol: 126, page: 2084, stat: Journal Article,

Evaluation of three surgical techniques for advancement of the midface in growing children with syndromic craniosynostosis
Shetye, Pradip R; Davidson, Edward H; Sorkin, Michael; Grayson, Barry H; McCarthy, Joseph G
2010 Sep;126(3):982-994, Plastic & reconstructive surgery
BACKGROUND:: The purpose of this study was to compare clinical outcomes and 1-year postsurgical stability with three different techniques of Le Fort III midface advancement. METHODS:: The records of 212 syndromic craniosynostosis patients were reviewed from the period 1973 to 2006. A total of 60 patients satisfied the inclusion criteria, and the mean age of the sample at surgery was 6.2 years. In group I (1977 to 1987), fixation was performed by interosseous wiring and intermaxillary fixation; in group II (1987 to 1996), fixation was achieved by only rigid plate fixation; and in group III (2000 to 2005), the patients underwent midface distraction with the rigid external distraction device. Cephalometric landmarks were identified and digitized at each of the time intervals (preoperatively, postoperatively, and 1 year postoperatively). RESULTS:: The mean advancement measured at point A in group I averaged 9.7 mm; in group II, it was 10.6 mm; and in group 3, it was 16.1 mm. There was no statistically significant difference in the amount of advancement between groups I and II. However, when groups I and II were compared with group III, there was a statistically significant difference (p < 0.05). No statistical significance was noted within and between all three groups at 1-year follow-up. CONCLUSIONS:: Significantly larger midface advancement was achieved with rigid external distraction (group III) compared with classic Le Fort III midface advancement with wire (group I) or plate (group III) fixation. At 1 year after surgery, the three groups showed relative stability of the advanced midface segment
— id: 112055, year: 2010, vol: 126, page: 982, stat: Journal Article,

Le Fort III distraction: controlling position and path of the osteotomized midface segment on a rigid platform
Shetye, Pradip R; Grayson, Barry H; McCarthy, Joseph G
2010 Jul;21(4):1118-1121, Journal of craniofacial surgery
BACKGROUND: Precise control of the position of the midface through distraction with the rigid external distraction (RED) device has been a challenge. The present RED device with wire attachments to the intraoral dental splint and to the skeletal bone plates allows for flexibility in the vertical plane of the osteotomized Le Fort III segment. This tends to rotate the midface in a counterclockwise direction with inferior movement of the posterior nasal spine. OBJECTIVES: To report the development of a rigid distraction splint attachment to the RED device that permits precise control of the position of the midface during the latency period and through the activation and consolidation phases. METHODS: This paper describes the appliance design and the clinical application of a new device in controlling the position of the midface during distraction. Placement of the device and application of the desired force vectors are discussed. Patients treated by this modified device are illustrated to document the planned midface position after Le Fort III midface advancement. RESULTS: Examination of predistraction and postdistraction cephalograms of 2 patients treated with the new device showed advancement with minimum inferior displacement of the midface during all phases of the distraction process. CONCLUSIONS: The new device prevents undesired inferior movement of the posterior midface immediately after osteotomy and helps to stabilize the midface during the latency period. The device enables directional control of the distraction vectors, resulting in more predictable midface position at the end of treatment
— id: 111356, year: 2010, vol: 21, page: 1118, stat: Journal Article,

A 10-year study of skeletal stability and growth of the midface following Le Fort III advancement in syndromic craniosynostosis
Shetye, Pradip R; Kapadia, Hitesh; Grayson, Barry H; McCarthy, Joseph G
2010 Sep;126(3):973-981, Plastic & reconstructive surgery
BACKGROUND: Patients with Apert, Crouzon, and Pfeiffer syndromes who have severe midfacial hypoplasia are treated by Le Fort III midface advancement. The purpose of this study was to examine long-term (10-year) midface skeletal stability and growth following Le Fort III midface advancement in growing children. METHODS: A review of 192 patients with syndromic craniosynostosis treated by classic (nondistracted) Le Fort III advancement osteotomy between 1973 and 1998 was performed. Twenty-five patients met the inclusion criteria (age at surgery < 11 years and availability of cephalograms of diagnostic quality before treatment, after surgery, and at 1-, 5-, and 10-year follow-up). The mean age at the time of surgery was 5.8 years and the diagnosis was either Crouzon (n = 10), Apert (n = 9), or Pfeiffer (n = 6) syndrome. RESULTS: After surgery, point A advanced sagittally 10.72 mm and moved downward 3.77 mm. At 1 year, point A moved forward 0.10 mm and downward 0.47 mm. At 5 years, point A moved back 0.18 mm, whereas at 10 years it advanced 0.12 mm. During the same periods, however, pogonion came forward 5.72 mm and 7.32 mm, respectively. CONCLUSIONS: Le Fort III midface advancement in growing children with syndromic craniosynostosis is stable after the first year postoperatively. There is minimal horizontal growth of the midface between postoperative years 5 and 10, although the mandible continues to grow. Due to the differential growth rate of the midface and mandible, the facial profile becomes concave, thereby necessitating secondary midface surgery at the completion of skeletal growth
— id: 112423, year: 2010, vol: 126, page: 973, 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,

Airway changes following Le Fort III distraction osteogenesis for syndromic craniosynostosis: a clinical and cephalometric study
Flores, Roberto L; Shetye, Pradip R; Zeitler, Daniel; Bernstein, Joseph; Wang, Edwin; Grayson, Barry H; McCarthy, Joseph G
2009 Aug;124(2):590-601, Plastic & reconstructive surgery
BACKGROUND: Le Fort III distraction osteogenesis improves midface form and dental relationships in patients with syndromic craniosynostosis, but its effect on the upper airway is not well documented. METHODS: A retrospective review was conducted of patients with syndromic craniosynostosis undergoing Le Fort III distraction osteogenesis from 2000 to 2006 (n = 20). Changes in velar angle and nasopharyngeal, velopharyngeal, oropharyngeal, and hypopharyngeal spaces were measured cephalometrically. Three-dimensional airway casts were created from computed tomographic data to ascertain circumferential airspace changes. Patients with the preoperative diagnosis of severe obstructive sleep apnea or a tracheostomy were designated as having significant airway compromise. Cephalometric differences in the preoperative superior airspace were compared between patients with and without significant airway compromise. Improvement in the symptoms of obstructive sleep apnea was studied. RESULTS: Cephalometric analysis revealed an increase in the velar angle (121 degrees to 148 degrees; p < 0.001) and an increase in the nasopharyngeal (3.9 mm to 13.0 mm; p < 0.001) and velopharyngeal airspaces (2.0 mm to 5.9 mm; p < 0.01). Three-dimensional computed tomographic analysis confirmed these findings. Comparison between preoperative cephalograms of patients with (n = 10) and without significant airway compromise (n = 10) revealed smaller nasopharyngeal (2.2 mm versus 5.7 mm; p < 0.05) and velopharyngeal airspaces (0.9 mm versus 3.0 mm; p = 0.05). Nine of 10 patients with significant airway compromise experienced improvement in their symptoms of obstructive sleep apnea or had their tracheostomy removed. CONCLUSIONS: Le Fort III distraction osteogenesis significantly increases nasopharyngeal and velopharyngeal airspaces in patients with syndromic craniosynostosis. Midface distraction improves but does not resolve all causes of obstructive sleep apnea in this patient population
— id: 130354, year: 2009, vol: 124, page: 590, stat: Journal Article,

Presurgical nasoalveolar moulding treatment in cleft lip and palate patients
Grayson, Barry H; Shetye, Pradip R
2009 Oct;42 Suppl:S56-S61, Indian journal of plastic surgery
Presurgical infant orthopedics has been employed since 1950 as an adjunctive neonatal therapy for the correction of cleft lip and palate. Most of these therapies did not address deformity of the nasal cartilage in unilateral and bilateral cleft lip and palate as well as the deficiency of the columella tissue in infants with bilateral cleft. The nasolaveolar molding (NAM) technique a new approach to presurgical infant orthopedics developed by Grayson reduces the severity of the initial cleft alveolar and nasal deformity. This enables the surgeon and the patient to enjoy the benefits associated with repair of a cleft deformity that is minimal in severity. This paper will discuss the appliance design, clinical management and biomechanical principles of nasolaveolar molding therapy. Long term studies on NAM therapy indicate better lip and nasal form, reduced oronasal fistula and labial deformities, 60 % reduction in the need for secondary alveolar bone grafting. No effect on growth of midface in sagittal and vertical plane has been recorded up to the age of 18 yrs. With proper training and clinical skills NAM has demonstrated tremendous benefit to the cleft patients as well as to the surgeon performing the repair
— id: 105185, year: 2009, vol: 42 Suppl, page: S56, stat: Journal Article,

Le Fort III distraction: Part I. Controlling position and vectors of the midface segment
Shetye, Pradip R; Giannoutsos, Efstatios; Grayson, Barry H; McCarthy, Joseph G
2009 Sep;124(3):871-878, Plastic & reconstructive surgery
BACKGROUND: The purpose of this investigation was to determine the response of the osteotomized Le Fort III midface bony segment to variations in the location and direction, or vector, of force application on using the rigid external distraction device. METHODS: This retrospective study involved 18 consecutive syndromic craniosynostotic patients (average age, 5.7 years) who underwent Le Fort III midface advancement distraction. Various cephalometric and novel landmarks, located on the mobilized Le Fort III segment and on the components of the distraction device, were identified before activation and at mid-activation. The direction and magnitude of change for these points were recorded. RESULTS: Based on the observed change in the position of the midface during distraction, the sample was divided into the following groups. In group 1 (n = 5), the Le Fort III segment translated forward and no rotation was noted. In group 2 (n = 3), the Le Fort III segment rotated clockwise and showed downward displacement. In group 3 (n = 6), the Le Fort III segment showed forward displacement and rotated counterclockwise. In group 4 (n = 4), the Le Fort III segment translated forward and downward. CONCLUSIONS: Direction of movement and resultant change in position of the Le Fort III segment during distraction are directly related to the location and direction of force application. Translation forward, with minimal rotation, was achieved when the force was applied at a location 55 percent above the occlusal plane (between the occlusal plane and the nasion) and in a direction parallel to the maxillary occlusal plane
— id: 102158, year: 2009, vol: 124, page: 871, stat: Journal Article,

Documentation of the incidents associated with mandibular distraction: introduction of a new stratification system
Shetye, Pradip R; Warren, Stephen M; Brown, Daniel; Garfinkle, Judah S; Grayson, Barry H; McCarthy, Joseph G
2009 Feb;123(2):627-634, Plastic & reconstructive surgery
BACKGROUND: This article aims to assess the spectrum of unfavorable events or incidents encountered during mandibular distraction and to evaluate the difference in the incident rates among the following treatment groups: (1) native bone distraction using an external device, (2) native bone distraction using an internal device, and (3) grafted bone distraction using an external device. METHODS: This retrospective study examined the records of 141 patients treated by mandibular distraction over a 16-year period. Of the total 141 patients, 56 underwent unilateral mandibular distraction and 85 underwent bilateral mandibular distraction, contributing to a total of 226 sided distraction procedures. The number of procedures performed on native bone using external devices was 149, versus 41 internal devices. There were 36 distractions performed on grafted bone with external devices. Incidents were broadly classified into three groups based on a severity index. A minor incident was one that resolved satisfactorily with minimal or no invasive intervention. A moderate incident was one that resolved satisfactorily with moderate clinical intervention. A major incident was one that did not resolve or could not be resolved with surgical intervention, and compromised treatment outcome. RESULTS: The major incident rate was 5.31 percent (total of 226 distraction procedures). A higher rate of major incidents was observed when distracting grafted bone. The overall minor incident rate was 26.99 percent and the moderate incident rate was 20.35 percent. CONCLUSION: Mandibular distraction can be considered a safe and predictable procedure for lengthening/augmenting the mandible in patients with lower jaw deficiencies
— id: 93572, year: 2009, vol: 123, page: 627, stat: Journal Article,

Bisphosphonate-associated osteonecrosis of the jaw: successful treatment at 2-year follow-up
Aarabi, Shahram; Draper, Lawrence; Grayson, Barry; Gurtner, Geoffrey C
2008 Aug;122(2):57e-59e, Plastic & reconstructive surgery
— id: 96561, year: 2008, vol: 122, page: 57e, stat: Journal Article,

Comparison of skeletal and soft-tissue changes following unilateral mandibular distraction osteogenesis
Altug-Atac, Ayse T; Grayson, Barry H; McCarthy, Joseph G
2008 May;121(5):1751-1759, Plastic & reconstructive surgery
BACKGROUND: The purpose of this study was to investigate the relationship between soft-tissue and underlying skeletal structures before and after unilateral mandibular distraction osteogenesis. METHODS: The sample consisted of 11 patients (three girls and eight boys) with an average age of 4.6 years at the time of treatment. All patients had unilateral craniofacial microsomia (four right-sided and seven left-sided unilateral craniofacial microsomia) and all underwent unilateral mandibular distraction osteogenesis. Measurements were performed on frontal medical photographs and posteroanterior cephalograms at predistraction (time 1) and postdistraction (time 2) periods. Left and right ramus heights, skeletal midline deviation, and transverse occlusal plane were measured on the posteroanterior cephalograms and compared with the linear distances between the lip commissures and the orbital plane, the circumference of both sides of the faces, and the angulation of the oral commissure plane as recorded on the medical photographs, respectively. To reduce magnification error, ratios of affected to less affected sides of the mandibles and soft-tissue facial structures were selected and studied. RESULTS: A similar relationship was observed between soft-tissue and skeletal components. However, there was no 1:1 relationship between the changes in ramus height and improvement in parallelism of lip commissures to the orbital plane. CONCLUSIONS: A significant improvement in soft- and hard-tissue anatomy has been observed following unilateral distraction osteogenesis of the mandible. The relationship between the soft-tissue and skeletal correction was different for all patients because of the large range in severity of the craniofacial malformation. Greater skeletal deficiency requires more correction to achieve symmetry of both hard and soft tissue
— id: 96494, year: 2008, vol: 121, page: 1751, stat: Journal Article,

Intraoperative fluoroscopic verification of condylar position in orthognathic surgery
Boutros, Sean; Shetye, Pradip; Carter, Christina; Grayson, Barry; McCarthy, Joseph
2008 May;121(5):1781-1784, Plastic & reconstructive surgery
— id: 89939, year: 2008, vol: 121, page: 1781, 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,

The importance of vector selection in preoperative planning of unilateral mandibular distraction
Dec, Wojciech; Peltomaki, Timo; Warren, Stephen M; Garfinkle, Judah S; Grayson, Barry H; McCarthy, Joseph G
2008 Jun;121(6):2084-2092, Plastic & reconstructive surgery
BACKGROUND: Unilateral craniofacial microsomia is characterized by soft-tissue and bony deficiencies. Mandibular distraction osteogenesis can be used to augment the hypoplastic skeleton and improve facial symmetry. The aim of this study was to determine how the vector of unilateral mandibular distraction affects treatment outcomes. METHODS: A retrospective chart and radiographic review was conducted of all patients treated with external mandibular distraction osteogenesis between October of 1990 and February of 2004 (n = 185). A subset of 42 patients underwent primary unilateral, uniplanar, external distraction, and 13 patients were found to have satisfied inclusion criteria and had adequate predistraction and postdistraction lateral and posteroanterior cephalograms. Cephalometric tracings were made and multiple points and planes were assessed before and after distraction. RESULTS: A strong correlation was noted between the vector of distraction and the movement of the mandible. A horizontal vector of distraction resulted in minimal increase in ramal length but a marked shift in the mandibular midline (r = 0.68, p < 0.05). In contrast, a vertical vector of distraction resulted in marked mandibular ramus lengthening but minimal mandibular midline shift (r = 0.73, p < 0.05). Mathematical formulas were derived to correlate the distraction vector and mandibular movements to improve preoperative planning. CONCLUSIONS: Successful distraction is dependent on accurate preoperative planning and prediction of outcomes. This study demonstrates a predictable relationship between the vector of unilateral distraction and the mandibular response
— id: 79459, year: 2008, vol: 121, page: 2084, 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,

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,

The importance of vector selection in preoperative planning of bilateral mandibular distraction
Vendittelli, Bruno L; Dec, Wojciech; Warren, Stephen M; Garfinkle, Judah S; Grayson, Barry H; McCarthy, Joseph G
2008 Oct;122(4):1144-1153, Plastic & reconstructive surgery
BACKGROUND: The application of distraction osteogenesis is an effective treatment for mandibular deficiencies. A priori, a horizontal vector of distraction was hypothesized to produce horizontal movement of the mandible and a vertical vector of distraction to produce primarily downward vertical elongation of the ramus. This study was designed to test this hypothesis. METHODS: A retrospective clinical and radiographic review was conducted of all patients who underwent bilateral, uniplanar distraction with an external device at the New York University Medical Center between October of 1990 and February of 2004 (n = 185). A subset of 15 patients was identified who satisfied inclusion criteria and had adequate predistraction and postdistraction lateral cephalograms. Cephalometric tracings were made and multiple landmarks were assessed before and after distraction. RESULTS: A strong correlation was noted between the vector of distraction and rotation of the symphyseal plane, movement of the mandibular symphysis, and change in interocclusal angle. A horizontal vector of distraction resulted in minimal counterclockwise rotation of the symphyseal plane, greater downward vertical translation of the mandibular symphysis, and minimal closure of an anterior open bite. In contrast, a vertical vector resulted in greater counterclockwise rotation of the symphyseal plane, greater horizontal projection of the mandibular symphysis, and greater closure of an anterior open bite. Mathematical formulas were derived to correlate the distraction vector and mandibular movements. CONCLUSIONS: Successful distraction is dependent on accurate prediction of outcomes. This study demonstrates that the vector of distraction predictably affects the mandibular response during bilateral distraction osteogenesis but contradicts the a priori hypothesis
— id: 87813, year: 2008, vol: 122, page: 1144, stat: Journal Article,

Morphology and growth of the mandible in Crouzon, Apert, and Pfeiffer syndromes
Boutros, Sean; Shetye, Pradip R; Ghali, Shadi; Carter, Christina R; McCarthy, Joseph G; Grayson, Barry H
2007 Jan;18(1):146-150, Journal of craniofacial surgery
The purpose of this study was to examine mandibular morphology and growth in patients with Crouzon, Pfeiffer, and Apert syndromes using posteroanterior cephalograms. Fifteen patients with Apert (n = 2), Crouzon (n = 11), and Pfeiffer (n = 2) (11 female, 4 male) syndrome were included in this study. All patients had serial posteroanterior cephalograms at 5, 10, and 15 years of age. The bicondylar width, bigonial width, bicondylar/bigonial ratio, and ramus to intercondylar plane angle for each patient were measured on the cephalograms and compared with age-match controls. An analysis of variance analysis was carried out to detect differences between patients and controls and sex differences between patients. In both male and female patients, there was a statistically significant reduction in bicondylar width compared with age-matched controls. Male patients also had a statistically significant increase in bigonial width compared with controls and female patients at 10 and 15 years. The resulting bicondylar/bigonial ratios were significantly reduced, and the ramus to intercondylar plane angles were significantly increased in both male and female patients compared with controls. Unlike previous reports of patients with syndromic synostosis, this study demonstrates that the mandible has significant morphologic and growth abnormalities, including constriction of bicondylar width with near normal bigonial width in female patients. These findings suggest a narrowing at the cranial base with resulting restriction of normal transverse mandibular growth at the condyle. The secondary nature of the mandibular finding is suggested by the near normal or increased transverse growth at the gonion in females and males, respectively. Consequently, the ramus appears torqued inward, forming a greater angle with the cranial base
— id: 89940, year: 2007, vol: 18, page: 146, stat: Journal Article,

Bone deposition/generation with LeFort III (midface) distraction
Jensen, John N; McCarthy, Joseph G; Grayson, Barry H; Nusbaum, Annette O; Eski, Muhittin
2007 Jan;119(1):298-307, Plastic & reconstructive surgery
BACKGROUND: It is essential to critically assess bone deposition in midface distraction. The aim of this study was to characterize the quality and volume of bone deposition at specific osteotomy sites following midface distraction. METHODS: At approximately 6 months after distraction, computed tomographic scans with three-dimensional reconstruction were obtained on 10 craniosynostosis syndromal patients who had undergone LeFort III osteotomy and midface distraction. Patient age ranged from 37 to 109 months (mean, 63.7 months) and the distractions ranged from 7 to 15 mm. Both the reconstructed scans and axial cuts were independently evaluated by four blinded observers (two plastic surgeons, an orthodontist, and a radiologist) and graded for bone deposition in predetermined anatomical sites correlated to the osteotomy. RESULTS: The authors found that variable bony bridging occurred at all sites along the osteotomy, but bone deposition was most reliably seen at the pterygomaxillary buttress and nasofrontal junction. In addition, the medial orbital walls tended to show greater consistency in bone deposition than the lateral orbital walls, and deposition at the zygomatic arches was shown to be least likely to occur. The technique of evaluation and the clinically significant findings are discussed. CONCLUSIONS: Bony deposition occurs more reliably in the medial facial skeleton following LeFort III osteotomy, and osteotomy through the zygomatic body was more likely to result in deposition than one through the arch
— id: 73825, year: 2007, vol: 119, page: 298, stat: Journal Article,

Midterm follow-up of midface distraction for syndromic craniosynostosis: a clinical and cephalometric study
Shetye, Pradip R; Boutros, Sean; Grayson, Barry H; McCarthy, Joseph G
2007 Nov;120(6):1621-1632, Plastic & reconstructive surgery
BACKGROUND: The authors studied the effect of midface distraction on maxillary skeletal position and clinical appearance in patients with Crouzon, Pfeiffer, and Apert syndromes, and examined the stability of these changes at 1 year after distraction. METHODS: Fifteen consecutive patients (six male and nine female; average age, 5.9 years) underwent Le Fort III osteotomy with midface advancement using a rigid external distraction device. Six patients had Crouzon, five had Pfeiffer, and four had Apert syndrome. Midface advancement was initiated at the level of the occlusal splint and at the zygomatic/maxillary anchor screws. The device was activated 11 mm on average, at a rate of 1 mm per day. Twenty anatomical landmarks were identified and digitized at three time intervals, and displacement of each landmark was compared with its pretreatment position. RESULTS: By the time of device removal, point A had advanced sagittally along the x axis 15.85 mm and moved downward 1.06 mm along the y axis; the orbitale was moved sagittally along the x axis 12.72 mm and downward 1.99 mm along the y axis. Maximum mean advancement (17.16 mm) was observed at the upper incisal edge. Maxillary and mandibular skeletal discrepancy was significantly decreased, with the ANB angle changing from -5.87 to +13.17 degrees. At 1 year after distraction, point A had advanced an additional 0.81 mm, and the orbitale and upper incisal edge had moved posteriorly 0.07 mm and 1.34 mm, respectively. CONCLUSION: Significant midface advancement can be achieved and maintained with rigid external distraction of the Le Fort III osteotomy segment (up to 24 mm), with excellent stability of the advanced midfacial skeleton
— id: 75409, year: 2007, vol: 120, page: 1621, 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,

Distraction osteogenesis in a patient with juvenile arthritis
Mackool, Richard L; Shetye, Pradip; Grayson, Barry; McCarthy, Joseph G
2006 Mar;17(2):387-390, Journal of craniofacial surgery
We present a 26-year-old patient with juvenile-onset arthritis, Alagille's syndrome, micrognathia, and progressive sleep apnea. Despite the presence of significant temporomandibular joint pathology, mandibular distraction was indicated to correct life-threatening sleep apnea. Before distraction, the patient had only 10 mm of maximal interincisal opening and bilateral temporomandibular joint symptomatology. After distraction, the patient's sleep apnea resolved. There was slight improvement in her maximal incisal opening (12 mm) with neither exacerbation nor improvement of her temporomandibular joint symptomatology
— id: 99030, year: 2006, vol: 17, page: 387, stat: Journal Article,

Long-term stability and growth following unilateral mandibular distraction in growing children with craniofacial microsomia
Shetye, Pradip R; Grayson, Barry H; Mackool, Richard J; McCarthy, Joseph G
2006 Sep 15;118(4):985-995, Plastic & reconstructive surgery
BACKGROUND: The purpose of this study was to evaluate long-term mandibular skeletal stability and growth following unilateral mandibular distraction in growing children. METHODS: This retrospective longitudinal study of 12 consecutive patients with unilateral craniofacial microsomia who underwent mandibular distraction had a range of 5 years of postdistraction follow-up; five patients were followed for 10 years. Records included clinical photographs, dental study models, lateral and posteroanterior cephalograms, and panoramic radiographs obtained before distraction, at the time of device removal, and 1, 5, and 10 years after distraction. The mean patient age at the time of distraction was 48 months. The device was activated an average of 21.7 mm at the rate of 1 mm per day. The mean latency period was 6.1 days, and the mean consolidation period was 60.6 days. Fifty-two parameters were examined at each of the five time intervals. RESULTS: On average, the ramal length (condylion to gonion) increased 13.04 mm in the distracted rami. At 1 year after distraction, this dimension decreased by 3.46 mm. At 5 and 10 years after distraction, the average condylion-gonion dimension increased by 3.83 and 4 mm, respectively, with an average growth rate of 0.87 mm per year; during the same period, the unaffected ramus grew 1.15 mm per year. CONCLUSIONS: The distraction technique does not eliminate the inherent growth potential of the affected mandibular side. Facial asymmetry is significantly improved after distraction, and despite mild relapse observed during the first year, surgical correction is stable in the later years of follow-up
— id: 68788, year: 2006, vol: 118, page: 985, 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,

The effect of an early Le Fort III surgery on permanent molar eruption
Santiago, Pedro E; Grayson, Barry H; Degen, Mark; Brecht, Lawrence E; Singh, G Dave; McCarthy, Joseph G
2005 Feb;115(2):423-427, Plastic & reconstructive surgery
The purpose of this retrospective study was to evaluate the extent to which an early Le Fort III osteotomy affects the position and eruption of the permanent maxillary first and second molars. To test the null hypothesis that there are no changes in eruption patterns, 31 patients diagnosed with craniosynostoses (13 with Crouzon's syndrome, nine with Apert's syndrome, eight with Pfeiffer's syndrome, and one with Carpenter's syndrome) with a mean age at the time of surgery of 5.3 +/- 1.3 years were studied. All patients underwent a Le Fort III osteotomy performed by a single surgeon to correct the anatomical deformity for functional and psychosocial reasons. Eighteen patients with craniosynostoses who had not been operated on (11 with Crouzon's syndrome, four with Apert's syndrome, and three with Pfeiffer's syndrome) served as controls; they had a mean age of 21.2 +/- 9.5 years. First and second molar positions and eruption patterns were assessed separately on panoramic radiographs by three observers. For the patients who underwent surgery, long-term evaluation showed that although 79 percent of all first molars erupted compared with 100 percent for the control group (p < 0.001), only 18 percent of all second permanent molars erupted compared with 89 percent for the control group (p < 0.0001). The authors conclude that in a significant minority of cases, early Le Fort III osteotomy affects first molar eruption, whereas the probability of second molar eruption is significantly decreased in the majority of cases. Therefore, Le Fort III osteotomy sites should be positioned distal to the second molar tooth buds. If this is not possible, patients, parents, and dental professionals should be made aware of these early postosteotomy sequelae so that later treatment planning can be enhanced
— id: 64809, year: 2005, vol: 115, page: 423, stat: Journal Article,

Nasoalveolar molding for infants born with clefts of the lip, alveolus, and palate
Grayson, Barry H; Maull, Deirdre
2004 May;31(2):149-58, vii, Clinics in plastic surgery
The principle objective of presurgical nasoalveolar molding (NAM) is to reduce the severity of the initial cleft deformity. This enables the surgeon and the patient to enjoy the benefits associated with a repair of a cleft deformity that is of minimal severity. Retraction of the premaxilla, presurgical elongation of the columella, correction of the nasal cartilage deformity, alignment of the cleft alveolar segments, increase in the surface area of the nasal mucosal lining, up-righting of the columella, and achieving close approximation of the cleft lip segments at rest result from gentle application of forces through the NAM appliance. Preservation of these presurgical changes is achieved through the coordinated and modified surgical technique of the primary cleft repair
— id: 46039, year: 2004, vol: 31, page: 149, stat: Journal Article,

Long-term skeletal stability after maxillary advancement with distraction osteogenesis device in cleft maxillary using a rigid external distraction deformities - Discussion
Grayson, BH
2004 NOV ;114(6):1393-1394, Plastic & reconstructive surgery
— id: 46901, year: 2004, vol: 114, page: 1393, 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,

Volumetric assessment of the distracted human mandible
Mackool, Richard J; Grayson, Barry H; McCarthy, Joseph G
2004 Sep;15(5):745-750, Journal of craniofacial surgery
The mandibles of five patients who underwent unilateral or bilateral distraction osteogenesis were analyzed using computed tomography scans. The mandibles were reconstructed in three dimensions using General Electric computed tomography software. The total volume of each hemimandible was determined before and after distraction and compared. The mandibles were then segmented at 1-cm intervals, and the volumes of the segments were determined. The volumes of the mandibular segments before and after distraction were compared to determine the distribution of new bone through the mandible and the quantity of bone generated by distraction. The distracted hemimandibles increased in total volume by an average of 19.9% (statistically significant by the Student paired t test; P < 0.0001), whereas the nondistracted hemimandibles increased in total volume by an average of 5.2%. The segmental volumes of the distracted mandible were of similar or greater volume when compared to the preoperative mandibular segments. In addition, the distribution of regenerate bone mirrored the physiological distribution of the preoperative mandibular bone. This study indicates that distraction not only creates new bone but distributes that bone through the remodeled mandible in an anatomical pattern similar to that of the preoperative bone
— id: 47797, year: 2004, vol: 15, page: 745, stat: Journal Article,

Removal of mandibular tooth follicles before distraction osteogenesis
Regev, Eran; Jensen, John N; McCarthy, Joseph G; Grayson, Barry H; Eski, Muhittin
2004 Jun;113(7):1910-1915, Plastic & reconstructive surgery
Distraction osteogenesis is an innovative technique that has transformed the treatment of craniofacial malformations in young children. Bone generation obviates the need for graft material, which is in short supply in young patients, thus making possible surgical procedures on the craniofacial skeleton in young children. Sufficient mandibular volume is required for the osteotomy and placement of the device screws and/or pins. To have adequate bone stock and to facilitate distraction, the authors preoperatively examined all patients radiographically and selected those with tooth follicles that precluded successful osteotomy and pin placement for planned mandibular distraction. This report is of the first 13 children, aged 9 months to 6 years, who underwent predistraction enucleation. The osteotomy and device placement were performed successfully at least 4 months after enucleation. The described procedure has minimal morbidity and has resulted in successful subsequent distraction. The advantages, disadvantages, and cost-benefit issues are discussed
— id: 96495, year: 2004, vol: 113, page: 1910, 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,

Volumetric change of the medial pterygoid following distraction osteogenesis of the mandible: an example of the associated soft-tissue changes
Mackool, Richard J; Hopper, Richard A; Grayson, Barry H; Holliday, Roy; McCarthy, Joseph G
2003 May;111(6):1804-1807, Plastic & reconstructive surgery
Mandibular distraction osteogenesis lengthens not only the affected skeleton but also the associated muscles of mastication. The purpose of this study was to determine medial pterygoid volume before and after distraction by using computed tomography. Using computed tomographic scans, the volume of the medial pterygoid muscle was determined before and after mandibular distraction in six pediatric patients. In four unilateral distraction patients (average age, 65 months), the average increase of the medial pterygoid muscle on the distracted side of the mandible was 29 percent, and on the contralateral nondistracted side, 10 percent. The average increase in medial pterygoid muscle volume in two bilateral distraction patients (each aged 8 months) was 75 percent. Results of this study demonstrate that distraction osteogenesis of the human mandible not only lengthens deficient bone, but it also increases the volume of the attached musculature
— id: 68421, year: 2003, vol: 111, page: 1804, stat: Journal Article,

Molding of the regenerate in mandibular distraction: clinical experience
McCarthy, Joseph G; Hopper, Richard A; Hollier, Larry H Jr; Peltomaki, Timo; Katzen, Timothy; Grayson, Barry H
2003 Oct;112(5):1239-1246, Plastic & reconstructive surgery
Initial clinical experience with distraction osteogenesis has demonstrated the risk of developing postdistraction malocclusion that requires secondary orthodontic correction. In addition, optimal mandibular form is not always achieved. Both animal studies and preliminary clinical investigations have suggested that the regenerate can be successfully 'molded' during active mandibular distraction. The authors have applied this concept clinically to obtain a more desirable occlusal relationship in a group of mandibular distraction patients. Eleven patients are described in whom angulation of the distraction device or intermaxillary/interdental elastics were employed to mold the regenerate. Two representative case studies are provided to illustrate the principles. When using elastic traction to close an anterior open bite, care must be taken that extrusion of individual teeth is minimized by distributing the force over the entire dental arch, especially the basilar portions of the jaws. The authors demonstrate that molding of the regenerate can be successfully accomplished not only during device activation but also early in the consolidation period. The outer limit of the time window in which molding is effective remains to be defined
— id: 96496, year: 2003, vol: 112, page: 1239, stat: Journal Article,

Molding of the regenerate in mandibular distraction: Part Laboratory study
Luchs, Johnathan S; Stelnicki, Eric J; Rowe, Norman M; Naijher, Navinderdeep S; Grayson, Barry H; McCarthy, Joseph G
2002 Mar;13(2):205-211, Journal of craniofacial surgery
Distraction osteogenesis has evolved as a mainstream surgical technique for lengthening and augmentation of the hypoplastic mandible. As clinical experience accumulated, there developed the need to 'mold' the bony regenerate to avoid the development of postdistraction malocclusion and to achieve the desired craniofacial form. Although the potential to mold the regenerate has important clinical implications, the safety and efficacy of such an acute manipulation of the bony regenerate form have not yet been investigated in the laboratory. The purpose of this study was to determine if the distraction regenerate could be molded and result in a bony union. Four adult female dogs underwent bilateral mandibular distraction with an external multiplanar device (Stryker, Osteonics). After a latency period of 5 days, the mandibles underwent linear (anteroposterior) and angular (superoinferior) distraction to produce an anterior open bite of approximately 30 degrees. At the conclusion of the distraction procedure, the distraction sites were molded to close the open bite. In two dogs, the maneuver was performed over 3 days by changing the angulation of the devices (gradual molding), and in the other two dogs, molding was achieved with a single movement (acute molding). In the latter, the distraction devices were adjusted and reapplied to allow for anatomical fixation during the consolidation period of 49 days. According to the research protocol, the mandibles were assessed serially by cephalograms and computed tomography (CT) scans. All dogs survived the study without complications. The bony regenerate was easily molded in both groups to close the surgically created open bite. After molding, all the regenerates showed CT scan evidence of solid bone (consolidation), which was classified as 'extended' on the Hamanishi scale. After the dogs were killed and soft tissue was removed, the regenerate seemed to be robust on gross examination without any evidence of fibrous nonunion. In addition, histological study of the regenerate confirmed the bony union. The study demonstrates that the mandible can be successfully molded into a desired anatomical position immediately after distraction without producing a fibrous union. Furthermore, it has been demonstrated that the bony regenerate is sufficiently malleable before consolidation to undergo either acute or gradual angular molding without disturbing osteogenic potential. The ability to mold the regenerate without the fear of creating a fibrous union or destroying bony potential provides the surgeon the capability to optimize the dental occlusion and mandibular form as part of the distraction treatment process
— id: 32462, year: 2002, vol: 13, page: 205, stat: Journal Article,

The first decade of mandibular distraction: lessons we have learned
McCarthy, Joseph G; Katzen, J Timothy; Hopper, Richard; Grayson, Barry H
2002 Dec;110(7):1704-1713, Plastic & reconstructive surgery
— id: 99034, year: 2002, vol: 110, page: 1704, stat: Journal Article,

Moulding of the generate to control open bite during mandibular distraction osteogenesis
Peltomaki, Timo; Grayson, Barry H; Vendittelli, Bruno L; Katzen, Timothy; McCarthy, Joseph G
2002 Dec;24(6):639-645, European journal of orthodontics
Distraction osteogenesis of the craniofacial skeleton has become a widely accepted, safe, and effective means of craniofacial reconstructive surgery. Despite excellent results in general, there are still some uncertainties related to the procedure, such as development of an anterior open bite (AOB) during mandibular distraction. The aim of this study was to examine whether 'moulding of the generate', i.e. use of intermaxillary elastics during the active distraction phase is possible to close the mandibular plane angle and open bite. Three subjects, 13- and 15-year-old males and a 7-year-old female, underwent mandibular linear and angular bilateral distraction osteogenesis with moulding of the generate. Lateral cephalograms were obtained before the introduction of elastics and following distraction, once the activation was stopped and the patients were ready for the consolidation phase. Conventional cephalometric measurements were used to assess possible changes in the mandibular plane angle and incisor position. Three different anchorage systems (dental, orthopaedic, and skeletal) were used for placement of the intermaxillary elastics. Cephalometric examination showed that the mandibular plane angle was decreased during active distraction osteogenesis with the introduction of elastics and angulation of the distraction device. Depending on the type of elastic anchorage system, smaller or greater amounts of extrusion of the incisors were noted. Moulding of the generate during active distraction can be performed to reduce the mandibular plane angle and open bite. To prevent unwanted dentoalveolar changes from occurring during elastic traction, skeletal rather than dental fixation of the elastics is recommended. Intrusive mechanics may be incorporated into the orthodontic appliances to balance extrusive force by the moulding elastics
— id: 96497, year: 2002, vol: 24, page: 639, 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,

Distraction osteogenesis of costochondral bone grafts in the mandible
Stelnicki, Eric J; Hollier, Larry; Lee, Catherine; Lin, Wen-Yuan; Grayson, Barry; McCarthy, Joseph G
2002 Mar;109(3):925-933, Plastic & reconstructive surgery
Costochondral grafting for reconstruction of the Pruzansky type III mandible has given variable results. Lengthening of the rib graft by means of distraction had been advocated when subsequent growth of the grafted mandible is inadequate. This retrospective study reviews a series of patients with mandibular costochondral grafts who underwent subsequent distraction osteogenesis of the graft. A retrospective review identified two patient groups: group 1 consisted of individuals (n = 9) who underwent costochondral rib grafting of the mandible followed by distraction osteogenesis several months later at a rate of 1 mm/day. Group 2 consisted of patients with Pruzansky type II mandibles who had distraction osteogenesis without prior rib grafting (n = 9). The biomechanical parameters, orthodontic treatment regimens, and complications were examined versus patient age and quality of the rib graft. Distraction osteogenesis was successfully performed in six of the rib graft patients (group 1) and in all of the group 2 individuals. On the basis of the Haminishi scale, the computed tomographic scan appearance of the regenerate was classified as 'standard or external' in six of the group 1 patients and as either 'agenetic' or 'pillar' (fibrous union) in the remaining three patients. In group 1, the average device was expanded 23 mm (range, 20 to 30 mm). Group 2 mandibular distraction results were all classified as either standard or external, and there was an average device expansion of 22.4 mm (range, 16 to 30 mm). The length of consolidation averaged 12.6 weeks in group 1, compared with 8.5 weeks in the traditional mandibular distraction patients (group 2). The mean shift of the dental midline to the contralateral side was 2.5 mm in group 1 versus 4.0 mm in group 2. Complex multiplanar and transport distractions were successfully performed on grafts of adequate bony volume. All four patients in group 1 with tracheostomies were successfully decannulated after consolidation. Rib graft distraction complications included pin tract infections in two patients, hardware failure with premature pin pullout in one patient, and evidence of fibrous nonunions in three young patients with single, diminutive rib grafts. In group 2, there were no distraction failures. Distraction osteogenesis can be successfully performed on costochondral rib grafts of the mandible; however, the complication rate is higher than in non-rib-graft patients. Performing the technique on older, more cooperative individuals seems to reduce this risk. In addition, placement of a double rib graft or an iliac bone graft of sufficient volume to create a neomandible with greater bone stock is an absolute requirement to decrease the risk of fibrous nonunion and provide a bone base of sufficient size for retention of the distraction device and manipulation of the regenerate
— id: 99036, year: 2002, vol: 109, page: 925, stat: Journal Article,

Long-term outcome study of bilateral mandibular distraction: a comparison of Treacher Collins and Nager syndromes to other types of micrognathia
Stelnicki, Eric J; Lin, Wen-Yuan; Lee, Catherine; Grayson, Barry H; McCarthy, Joseph G
2002 May;109(6):1819-1825, Plastic & reconstructive surgery
A long-term follow-up study of patients who underwent bilateral mandibular distraction is presented, and the results of patients with Treacher Collins syndrome and Nager syndrome are compared with results for other forms of congenital micrognathia. It was hypothesized that the factors responsible for the predetermined, syndrome-specific shape of the mandible in patients with Treacher Collins and Nager syndromes would alter the long-term results of linear (uniplanar) distraction of the mandible. Thus, over time, the mandibles would remodel to preoperative form while maintaining the increase in volume. To investigate this hypothesis, all patients treated with bilateral mandibular distraction who had at least 1.5 years of follow-up, including satisfactory cephalometric examinations, were retrospectively reviewed. Two groups were identified. Group 1 (n = 6) were Treacher Collins and Nager syndrome patients (ages, 2 to 13 years; mean, 5.2 years) and group 2 (n = 6) included other forms of bilateral, congenital micrognathia (ages, 1.5 to 19 years; mean, 8.4 years). Serial cephalometric measurements were recorded before distraction, after distraction, and at least 18 months after distraction. Mandibular mean linear distraction distance (as recorded on the device) averaged 24.5 mm in group 1 and 26.2 mm in group 2. In group 1, the antegonial angle (angle from the mandibular plane to the top of the antegonial notch) decreased after distraction by 3.8 degrees, and the antegonial notch height was reduced by 1.6 mm. The posttreatment morphologic change was modified significantly over time, with a 3.7-degree increase of the antegonial angle and a 1.2-mm deepening of the antegonial notch. In group 2, the immediate reduction in height of the antegonial notching was subtler; however, long-term recurrence of the antegonial notching was also observed. At the end of distraction, the mean group 1 gonial angle became 8 degrees more obtuse. In contrast, patients in group 2 developed a more acute angle (mean, 8 degrees). The mandibles of the Treacher Collins syndrome patients (group 1) maintained their more obtuse postdistraction gonial angle during the period of follow-up, whereas over time this change was reversed in group 2 patients. In conclusion, experience with bilateral mandibular distraction has demonstrated that long-term determination of mandibular form is more complex than either the amount of distraction or the direction of the distraction vector. The underlying genotype and the musculoskeletal milieu must be taken into account when planning distraction, as these factors tend to remodel the mandible into its preoperative shape over time, despite the fact that the increased mandibular volume and projection are maintained
— id: 99035, year: 2002, vol: 109, page: 1819, 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,

Development of a device for the delivery of agents to bone during distraction osteogenesis
Grayson BH; Rowe NM; Hollier LH Jr; Williams JK; McCormick S; Longaker MT; McCarthy JG
2001 Jan;12(1):19-25, Journal of craniofacial surgery
Various agents have been theoretically and experimentally implicated as mediators of distraction osteogenesis (DO). The purpose of this study was to develop a vehicle for the potential delivery of these factors to the region of the distraction site in an attempt to manipulate this biologic process. Three adult mongrel dogs (12 months old) had oblique osteotomies performed bilaterally through the gonial regions. In group I, the external distracter was affixed to the right hemimandible of two dogs (n = 2 hemimandibles) with cannulated pins (external diameter = 1.5 mm; lumen diameter = 1.0 mm; length = 60 mm), whereas the distracter on the left was affixed with standard, noncannulated pins of the same dimensions. In group II, cannulated pins were used to affix the external distracter to both hemimandibles (n = 2 hemimandibles) of a dog. The devices were activated after a 5-day latency period and were lengthened at a rate of 1 mm/day for 20 days. During the distraction period, 0.1 ml/d of sterile india ink was injected into the cannulated pins, after which the sterile stylet was replaced. The activation protocol was followed by 28 days of fixation (consolidation period). The hemimandibles from group I underwent removal of soft tissues, acetone fixation, and gross examination/photography, whereas the hemimandibles from group II were prepared for histologic evaluation (whole mount, hematoxylin and eosin staining). All dogs survived to the end of the study and demonstrated successful DO without evidence of complications. Hemimandibles in group I displayed evidence of india ink on both the lingual and buccal cortex around the cannulated pin site, in the regenerate and on the neocortices of the distracted segment. Hemimandibles of group II showed histologic evidence of the india ink being deposited densely around the cannulated pin site and extending in a radial fashion around the pin site into the regenerate. This study demonstrates for the first time a vehicle device for the delivery of an inert dye to the regenerate site during distraction osteogenesis. This vehicle offers the potential of delivery of various factors implicated in distraction osteogenesis (i.e., mitogens) in an attempt to alter this process and also substances (i.e., chemotherapy, antibiotics, etc.) for use in the treatment of various osteopathies
— id: 20718, year: 2001, vol: 12, page: 19, 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,

Single-follicular-unit hair transplantation to correct cleft lip moustache alopecia
Reed ML; Grayson BH
2001 Sep;38(5):538-540, Cleft palate-craniofacial journal
OBJECTIVE: To present the case of an 18-year-old boy with a cleft lip scar and an obligatory need for facial hair who underwent single-follicular-unit graft hair transplantation that resulted in significant moustache hair restoration in a single procedure. SETTING: The surgery was performed in an outpatient private practice setting using oral sedation and local anesthesia. RESULTS: Advances in instrumentation technology and an increased understanding of the anatomical clustering of hair follicles into so-called 'follicular units' containing one to six hairs per unit has resulted in a rapid expansion of hair restoration surgery into new areas including female-pattern alopecia, scarring alopecias, and cosmetic surgery scars. These new techniques can be employed to create natural-looking hair lines in front of artificial hair replacement systems; to improve unnatural looking, old 'large-plug' hair transplants; and to correct discontinuity of eyebrows and hairlines in patients with congenital facial clefts. Increased awareness is needed to incorporate follicular-unit graft hair transplant surgery into the family of corrective surgery subspecialties
— id: 26625, year: 2001, vol: 38, page: 538, stat: Journal Article,

Force level and strain patterns during bilateral mandibular osteodistraction - Discussion
Grayson, B
2000 FEB ;58(2):178-179, Journal of oral & maxillofacial surgery
— id: 54758, year: 2000, vol: 58, page: 178, stat: Journal Article,

Congenital muscular torticollis and the associated craniofacial changes
Hollier L; Kim J; Grayson BH; McCarthy JG
2000 Mar;105(3):827-835, Plastic & reconstructive surgery
— id: 8522, year: 2000, vol: 105, page: 827, stat: Journal Article,

Controlled multiplanar distraction of the mandible. Part III: Laboratory studies of sagittal (anteroposterior) and horizontal (mediolateral) movements
Hollier LH; Rowe NM; Mackool RJ; Williams JK; Kim JH; Longaker MT; Grayson BH; McCarthy JG
2000 Mar;11(2):83-95, Journal of craniofacial surgery
Distraction osteogenesis has proven to be an effective technique for the correction of mandibular deficiencies. However, problems have been encountered in achieving a final, idealized form of the mandible when using distraction devices capable of moving the bone segments in only one dimension (uniplanar). Specifically, occlusal irregularities and deficiencies in lower facial contour have been seen following uniplanar distraction. To address these problems, a distraction device capable of independent movements in three planes (multiplanar) was developed. Previously reported studies in a canine model have demonstrated that this device can successfully distract the mandible along both the sagittal axis (anteroposterior or z-axis) and the vertical axis (superoinferior or y-axis). This study examines the ability of the multiplanar device to distract along the sagittal and horizontal axes (mediolateral or x-axis). A total of 12 dogs were included in the study. All animals underwent unilateral or bilateral mandibular distraction using an external multiplanar device. After a latency period of 5 days, primary distraction along the anteroposterior axis at a rate of 1 mm/day for 10 days (10 mm total) was performed. During the following 10 days, along with an additional 11 mm to 20 mm of anteroposterior axis distraction, concomitant secondary distraction was performed along the horizontal (mediolateral) axis at a rate of 5 degrees/day (50 degrees total). Cephalometric radiographs were obtained preoperatively and at the conclusion of both anteroposterior and combined anteroposterior-mediolateral distraction. Computed tomography (CT) scans were obtained preoperatively and at the end of consolidation (28 days), after which all animals were sacrificed and the dry skulls examined. In all animals, distraction along the mediolateral or x-axis was found to change the anteroposterior projection of the mandible. Varus angulation of the device with respect to the midline of the mandible caused compression of the distracted segments and reduced the anteroposterior thrust of the mandible. In contrast, valgus positioning of the device, with respect to the midline of the mandible, created the opposite effect, increasing the distracted length in the anteroposterior direction. The bone (mandibular) segments being distracted assumed the orientation of the device only for valgus positioning of the device (producing a decrease in the bigonial distance). Conversely, there was no effect from the mediolateral angulation on the distracted segments during varus positioning of the device. A possible explanation for this finding may be a greater resistance to an increase in the bigonial distance (varus positioning of the device) posed by obstruction of lateral movement of the condyle. This stands in contrast to a decrease in the bigonial distance observed following valgus positioning of the device. These findings confirm the clinical impression that distraction along the anteroposterior or sagittal axis remains the critical or keystone therapeutic maneuver in distraction of the mandible. Mediolateral or horizontal axis distraction is best used only as a supplementary movement; in essence, it only affects the anteroposterior dimension with little impact on clinically relevant changes to the bigonial distance
— id: 20719, year: 2000, vol: 11, page: 83, 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,

Treatment planning and biomechanics of distraction osteogenesis from an orthodontic perspective
Grayson BH; Santiago PE
1999 Mar;5(1):9-24, Seminars in orthodontics
As in traditional combined surgical and orthodontic procedures, the orthodontist has a role in the planning and orthodontic support of patients undergoing distraction osteogenesis. This role includes predistraction assessment of the craniofacial skeleton and occlusal function in addition to planning both the predistraction and postdistraction orthodontic care. Based on careful clinical evaluation, dental study models, photographic analysis, cephalometric evaluation, and evaluation of three-dimensional computed tomographic scans, the orthodontist, in collaboration with the surgeon, plans distraction device placement and the predicted vectors of distraction. Both surgeon and orthodontist closely monitor the patient during the active distraction phase, using intermaxillary elastic traction, sometimes combined with guide planes, bite plates, and stabilization arches, to mold the newly formed bone (regenerate) while optimizing the developing occlusion. Postdistraction change caused by relapse is minimal. Growth after mandibular distraction is variable and appears to be dependent on the genetic program of the native bone and the surrounding soft tissue matrix. A significant advantage of distraction osteogenesis is the gradual lengthening of the soft tissues and surrounding functional spaces. Distraction osteogenesis can be applied at an earlier age than traditional orthognathic surgery because the technique is relatively simple and bone grafts are not required for augmentation of the hypoplastic craniofacial skeleton. In this new technique, the surgeon and the orthodontist have become collaborators in a process that gradually alters the magnitude and direction of craniofacial growth
— id: 56445, year: 1999, vol: 5, page: 9, stat: Journal Article,

Treatment planning and vector analysis of mandibular distraction osteogenesis
Grayson BH; Santiago PE
1999 Mar;7(1):1-13, Atlas of the oral & maxillofacial surgery clinics of North America
— id: 27268, year: 1999, vol: 7, page: 1, 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,

Mandibular growth after distraction in patients under 48 months of age
Hollier LH; Kim JH; Grayson B; McCarthy JG
1999 Apr;103(5):1361-1370, Plastic & reconstructive surgery
Distraction osteogenesis is an effective technique for reconstruction of the congenitally deficient mandible. However, the age at which it is best performed remains under discussion. Distraction performed at an early age, while possibly allowing the face to develop with a more normal functional matrix, may entail a higher rate of complications. Additionally, it is possible that subsequent asymmetric growth of the mandible may necessitate serial distraction. To address this issue, the clinical records and cephalometric radiographs of all patients less than 48 months of age undergoing mandibular distraction at New York University Medical Center between August of 1989 and August of 1997 were examined. There was a total of 14 patients ranging in age from 19 months to 43 months. Nine patients had a diagnosis of unilateral craniofacial microsomia, three had Treacher Collins syndrome, one had Nager syndrome, and one had bilateral developmental micrognathia. The average amount of distraction was 27 mm (range, 23 to 39 mm) in unilateral cases and 24 mm in bilateral cases (range, 15 to 31 mm). The period of clinical follow-up averaged 32.6 months (range, 12 to 92 months). All patients showed significant improvement in craniofacial appearance, and in four patients, long-term tracheostomy tubes were removed. There were two major complications. In one patient with craniofacial microsomia, there was a relapse in the early postretention phase related to the presence of a dentigerous cyst. This required removal of the cyst and repeat distraction. In the patient with Nager syndrome, a coronoid ankylosis developed requiring surgical release. There were no other major complications. The scars required revision in only two of the patients. Cephalometric analysis of the patients in the study revealed a differential in the rate of growth between the affected and the unaffected side in all cases of craniofacial microsomia. The affected side always grew at a slower rate than the contralateral side after the distraction process was complete. This led to a progressive asymmetry of the rami, clinically expressed by some degree of facial asymmetry and an occlusal cant. For this reason, secondary distraction was required in one patient and is planned in a second. Initial overcorrection of the patient would seem to minimize the likelihood that secondary distraction will be necessary. Distraction osteogenesis for reconstruction of the mandible in this subset of young patients was a safe and effective technique for improving the craniofacial skeletal form and appearance, with minimal associated morbidity. Longer follow-up is necessary to assess the full impact of growth in these cases
— id: 6075, year: 1999, vol: 103, page: 1361, 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,

Distraction osteogenesis of the mandible: a ten-year experience
McCarthy JG; Stelnicki EJ; Grayson BH
1999 Mar;5(1):3-8, Seminars in orthodontics
Mandibular distraction has been performed at the authors' institution for the past 10 years on a variety of craniofacial anomalies. This article reviews the experience with distraction and outlines the authors' treatment algorithms based on patient age and pathology. The roles of distraction versus conventional orthognathic surgery are reviewed. The need for preoperative surgical planning and postoperative orthodontic therapy is emphasized
— id: 56444, year: 1999, vol: 5, page: 3, stat: Journal Article,

Early decannulation with bilateral mandibular distraction for tracheostomy-dependent patients
Williams JK; Maull D; Grayson BH; Longaker MT; McCarthy JG
1999 Jan;103(1):48-57, Plastic & reconstructive surgery
Obstructive sleep apnea in the neonatal period may originate from a hypoplastic mandibular framework causing retroposition of the base of the tongue and an inadequate hypopharyngeal space. A tracheotomy in childhood is an effective treatment for obstructive sleep apnea, but it is associated with increased morbidity, management problems, and difficulties in social interaction. Tracheostomy-dependent pediatric patients who underwent mandibular distraction were reviewed to determine the effectiveness of this technique in achieving decannulation. A clinical review was completed to determine the status of the tracheostomy after external, unidirectional distraction in tracheostomy-dependent patients. Expansion of the mandibular framework was analyzed using traditional bony landmarks on predistraction and postdistraction lateral cephalograms. The area of the lower face was analyzed, and changes in the position of the hyoid bone were determined. Four patients with tracheostomies underwent an average of 21.3 mm and 20.8 mm of distraction on the left and right hemimandibles, respectively. The average age at the time of distraction was 2.7 years (range, 2.2 to 3.2 years). All patients underwent successful decannulation at an average of 3.8 months (range, 1.5 to 5.5 months) after completion of distraction. The area of the lower face increased 26.9 percent (range, 12.2 to 53.5 percent) after distraction, and the hyoid bone advanced an average of 14.5 mm (range, 8 to 25 mm). Bilateral mandibular distraction is an effective method of expanding the mandibular framework and concomitantly advancing the base of the tongue. The technique provides a tool for early intervention and decannulation in pediatric patients with indwelling tracheostomies secondary to mandibular deficiencies
— id: 7466, year: 1999, vol: 103, page: 48, 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,

Controlled multiplanar distraction of the mandible: device development and clinical application
McCarthy JG; Williams JK; Grayson BH; Crombie JS
1998 Jul;9(4):322-329, Journal of craniofacial surgery
Distraction osteogenesis has been shown to be an effective method of lengthening and augmenting endochondral bone. It has also been applied effectively in the reconstruction of the membranous bones of the craniofacial skeleton. With the accumulation of clinical experience in mandibular distraction, the differences between endochondral and membranous bone distraction have become apparent, especially in the limitations of uniplanar distraction for the three-dimensional reconstruction of the deficient mandible. Distraction of the mandible in a single plane cannot satisfy fully the functional and structural requirements of the patient with malocclusion as well as deficiency of the skeletal and soft tissue. This study reports the development and clinical use of a multiplanar mandibular distraction device with the ability to achieve linear distraction (Z-plane or sagittal), angular distraction (Y-plane or vertical), and transverse distraction (X-plane or coronal). The device contains two independent gear arrangements attached to two arms that extend from the central unit. Therefore, the trajectory of the regenerated bone may be changed during the distraction process. The device also allows manipulation of the various planes of movement independent of each other. Furthermore, the rotational points for the multiplanar distraction devices are located at a single point; therefore only a single osteotomy and two pin sites are required. The multiplanar distraction device allows the surgeon to customize and contour the dimensions of the distraction process by controlling the trajectory of the translation of the regenerated bone
— id: 57052, year: 1998, vol: 9, page: 322, 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,

Hypertrophy and asymmetry of the facial muscles: a previously unrecognized association
Staffenberg DA; McCarthy JG; Hollier LH; Grayson BH; Verdi G
1998 May;40(5):533-537, Annals of plastic surgery
We present 6 patients who do not satisfy the criteria for inclusion into any known diagnostic group, although they share similar physical findings. All had facial findings suggestive of either mild deformational plagiocephaly or craniofacial microsomia; however, hypertrophic and occasionally hyperactive muscles of the face appear to be the unifying and distinctive feature of the group. Contraction of hypertrophic postauricular muscles on the affected side resulted in movement and contraction of the pinna. Hypertrophy of the mentalis and masseter muscles was also frequently observed. Additionally, anomalous neck musculature was seen in 4 of the 6 patients. In 2 patients, the hypertrophy of certain of these muscles produced enough deformity to warrant excision. This is the first report of such an association in the literature. Possible explanations are discussed
— id: 57262, year: 1998, vol: 40, page: 533, 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,

Vector of device placement and trajectory of mandibular distraction [published erratum appears in J Craniofac Surg 1998 Jan;9(1):2]
Grayson BH; McCormick S; Santiago PE; McCarthy JG
1997 Nov;8(6):473-480, Journal of craniofacial surgery
The role of preoperative planning, the geometric changes, and the long-term effects of mandibular distraction have not been previously reported. This study included 10 patients who underwent unilateral (5 patients) or bilateral (5 patients) mandibular distraction. Preoperative, postdistraction, and yearly radiographs (panoramic, posteroanterior, and lateral cephalograms) were reviewed. Postdistraction follow-up ranged from 12 to 70 months. Postdistraction, the mandibles showed evidence of anticipated growth without relapse. This growth rate was variable and dependent on the genetic program of the native bone. Previously reported improvement in temporomandibular joint morphology was maintained in the long term. The resulting shape of the neomandible was most influenced by the vector of placement of the distraction device. When placed vertically, ramal elongation was observed. When placed horizontally, anterior projection of the mandibular body occurred. When placed obliquely, ramal and body elongation occurred with preservation of the gonial angle. After 2 to 5 years of follow-up, continued growth of the neomandible was observed
— id: 12155, year: 1997, vol: 8, page: 473, stat: Journal Article,

A CT scan technique for quantitative volumetric assessment of the mandible after distraction osteogenesis
Roth DA; Gosain AK; McCarthy JG; Stracher MA; Lefton DR; Grayson BH
1997 Apr;99(5):1237-1247, Plastic & reconstructive surgery
Distraction osteogenesis has become an accepted method of treatment for patients requiring reconstruction of hypoplastic mandibles. We present a quantitative analysis of volumetric changes after distraction osteogenesis in a series of 10 patients. Group I (n = 5 patients, 3 unilateral craniofacial microsomia, 1 Goldenhaar syndrome, and 1 bilateral craniofacial microsomia) underwent unilateral distraction of the mandible. Group II (n = 5 patients, 1 Nager syndrome, 1 bilateral craniofacial microsomia, 1 developmental micrognathia, and 2 Treacher Collins syndrome) underwent bilateral distraction of the mandible. Predistraction and postdistraction axial and three-dimensional computed tomographic (CT) scans were digitized and transferred to a computer for analysis with image-processing software to determine the changes in volume of the mandible and bony regenerate. The CT-derived volume method was validated by scanning three dry cadaver mandible specimens and comparing the volume data with those derived from a water-displacement method. The difference between the two methods was less than 5 percent. The mean distracted length, as recorded from the calibrated device, was 22.6 mm in the 10 patients. In the unilateral distraction group, the mean increase in hemimandibular bone volume was 2.8 cc, with a mean percentage increase of 27 percent in the distracted hemimandible. In the bilaterally distracted patients, the mean increase in total mandibular volume was 7.9 cc, with a mean percentage increase in bone volume of 25 percent. This study represents the first attempt to quantify the increase in bone volume resulting from distraction osteogenesis. Quantitative volumetric analysis of CT scans is an accurate method to measure the amount of bone regenerate in patients undergoing distraction osteogenesis of the mandible or the extremities. The concept and utility of quantifying the volumetric changes in bone following distraction osteogenesis may become more important as multiplanar devices are developed and used in other areas of the craniofacial skeleton
— id: 12341, year: 1997, vol: 99, page: 1237, 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,

Cranial suture biology; Growth factors, and dural-cranial interactions
Levine, J; Bradley, J; Roth, D; Sung, J; Santiago, P; Gianoutsos, M; Gold, L; Rosen, D; Blewitt, C; Krummel, T; Grayson, B; McCarthy, J; Longaker, M
1996 FEB ;75(2):1013-1013, Journal of dental research
— id: 53061, year: 1996, vol: 75, page: 1013, 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,

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,

Effect of mandibular distraction on the temporomandibular joint: Part 2, Clinical study
McCormick SU; Grayson BH; McCarthy JG; Staffenberg D
1995 Sep;6(5):364-367, Journal of craniofacial surgery
Mandibular lengthening by gradual distraction has been gaining popularity. However, the effect of osteodistraction on the temporomandibular joint has been evaluated in patients with craniofacial anomalies who underwent mandibular distraction. Five patients had unilateral expansion and five had bilateral expansion. The mandibles were expanded 1 mm per day until the pogonion was in the midline. Preoperative, immediate, 6-month, and 12-month panoramic and cephalometric radiographs were evaluated. In unilaterally expanded mandibles, the ipsilateral condyle increased in size and volume, became more upright, and was oriented in a more normal vertical axis. The contralateral unexpanded condyle did not show deformational changes. In those mandibles that were bilaterally expanded, both condyles increased in size and volume and became more symmetrical and upright. Osteodistraction appears to affect bone in both local and distant sites. The expanded condyles were stimulated to ensure a more nearly normal shape, size, and configuration
— id: 56776, year: 1995, vol: 6, page: 364, stat: Journal Article,

Effect of mandibular distraction on the temporomandibular joint: Part 1, Canine study
McCormick SU; McCarthy JG; Grayson BH; Staffenberg D; McCormick SA
1995 Sep;6(5):358-363, Journal of craniofacial surgery
The effect of osteodistraction on the temporomandibular joint was evaluated in a canine model. Eleven mongrel dogs were used in the study. An intraoral expansion device was placed after an osteotomy was made at the angle of the mandible via an intraoral approach. The mandibles were expanded either fully to 20 mm or partially to 10 mm. After expansion, nine animals were immediately killed; the remaining two were maintained in fixation for an additional 10 weeks. Cephalometric radiographs and computed tomographic scans obtained preoperatively and before killing were evaluated. No gross temporomandibular joint deformation or bodily movement was noted in the expanded or contralateral, unexpanded side. The temporomandibular joints were harvested en bloc for gross and microscopic evaluation. Flattening of the posterior aspect of the expanded condylar head was noted, with thinning of the condylar cartilage. New bone deposition was noted, which was evident as anterior lipping. Condyles maintained in 10 weeks fixation showed reparative changes. No evidence of avascular necrosis, microfracture, or cystic degeneration was noted. This study indicates that the force of distraction can induce bony changes in the temporomandibular joint and that these effects are minimal and reversible
— id: 56777, year: 1995, vol: 6, page: 358, stat: Journal Article,

Midface distraction advancement in the canine without osteotomies
Staffenberg DA; Wood RJ; McCarthy JG; Grayson BH; Glasberg SB
1995 May;34(5):512-517, Annals of plastic surgery
Midface hypoplasia, often associated with exorbitism and malocclusion, has been traditionally corrected by using Le Fort advancement osteotomies through wide surgical exposure. These procedures suffer the disadvantages of hemorrhage, unpredictable bone graft resorption, the need for retained hardware, and bone graft donor-site morbidity. We present an investigation of midface distraction in the canine without osteotomies. Five canines were the subjects of this study and were divided into two groups. At the time of placement of the lengthening devices, Group 1 animals were 10 weeks of age and Group 2 animals were 5 years of age. Under general anesthesia, four modified Hoffman bone distractors were mounted on 2-mm half pins placed individually across the nasofrontal and the zygomaticotemporal sutures on each side of the craniofacial skeleton. Distraction of all devices was begun on postoperative day 1 at the rate of 0.5 mm/day for 4 days and then 1.0 mm/day for 28 days, after which interval the devices were removed. The dogs were serially monitored and examined for 3 months. One dog in the first group served as a sham control. The results were assessed by standardized cephalograms, and craniofacial computed tomographic scans with three-dimensional reconstruction performed before device placement as well as after removal of the device. In one Group 1 animal, computed tomographic scanning was performed every 2 to 4 weeks for 3 months. Gross examination of the Group 1 animals demonstrated the development of enophthalmos, dolichocephaly, and a class II malocclusion-overbite.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 56713, year: 1995, vol: 34, page: 512, 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,

Lengthening the human mandible by gradual distraction [see comments]
McCarthy JG; Schreiber J; Karp N; Thorne CH; Grayson BH
1992 Jan;89(1):1-8, Plastic & reconstructive surgery
Lengthening of the mandible by gradual distraction was performed on four young patients (average age 78 months). The amount of mandibular bone lengthening ranged from 18 to 24 mm; one patient with Nager's syndrome underwent bilateral mandibular expansion. Following the period of expansion, the patients were maintained in external fixation for an average of 9 weeks to allow ossification. The patients were followed for a minimum of 11 months to a maximum of 20 months with clinical and dental examinations as well as photographic and radiographic documentation. The technique holds promise for early reconstruction of craniofacial skeletal defects without the need for bone grafts, blood transfusion, or intermaxillary fixation
— id: 13732, year: 1992, vol: 89, page: 1, 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,

The Le Fort III advancement osteotomy in the child under 7 years of age
McCarthy JG; La Trenta GS; Breitbart AS; Grayson BH; Bookstein FL
1990 Oct;86(4):633-646, Plastic & reconstructive surgery
This is a longitudinal study of 12 patients with craniofacial synostosis syndromes (Crouzon's, Apert's, Pfeiffer's) who underwent Le Fort III advancement under the age of 7 years (average age 5.1 years, range 4.0 to 6.7 years). The average follow-up was 5.0 years and included clinical, dental, and cephalometric examinations according to a prescribed protocol. The study demonstrated that the procedure could be safely performed in the younger child with an acceptable level of morbidity. There was a remarkable degree of postoperative stability of the maxillary segment. However, although vertical (inferior) growth or movement of the midfacial segment was demonstrated, there was minimal, if any, anterior or horizontal growth. Any occlusal disharmony developing during the period of follow-up could be attributed to anticipated mandibular development and could be corrected by orthognathic surgery. The roles of surgical overcorrection and anterior-pull headgear therapy after release of intermaxillary fixation are also discussed. The Le Fort III osteotomy is justifiably indicated during early childhood for psychological and physiologic reasons
— id: 19455, year: 1990, vol: 86, page: 633, stat: Journal Article,

Cephalometric analysis for the surgeon
Grayson BH
1989 Oct;16(4):633-644, Clinics in plastic surgery
A protocol for cephalometric analysis is presented to enable the clinician to evaluate the craniofacial skeleton for surgery. Cephalometric tracing and analysis are described and applied to a clinical case. The three-dimensional cephalometric method and analysis are discussed for application in planning the correction of craniofacial asymmetry
— id: 10461, year: 1989, vol: 16, page: 633, 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,

Mean tensor cephalometric analysis of a patient population with clefts of the palate and lip
Grayson BH; Bookstein FL; McCarthy JG; Mueeddin T
1987 Oct;24(4):267-277, Cleft palate journal
This study was designed to elucidate the net 'effect' of primary and secondary palatal clefts on the craniofacial skeleton as viewed in the lateral cephalogram. A tensor cephalometric analysis is reported for 144 patients with cleft lip, cleft palate, or both. The study involves 13 lateral landmarks located in the patients' cephalograms and in the Michigan normative means. The net deformity (total sample) is a reduction of size in all directions, but primarily in the horizontal dimension (ANS-PNS) at the palatal level. Lower face height is affected less than upper face height. The bilateral group shows a considerably greater amount of 'net' deformity in the cranial base and reduction in mandibular body length. The effect of cleft of the secondary palate alone is horizontal. The effect of an additional primary cleft is aligned instead vertically in the maxilla and intensifies the reduction of cranial base depth. These findings concur with the literature that attributes these syndromes to different mechanisms with different modes of inheritance
— id: 11354, year: 1987, vol: 24, page: 267, 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,

The mandible in mandibulofacial dysostosis: a cephalometric study
Grayson, B H; Bookstein, F L; McCarthy, J G
1986 May;89(5):393-398, American journal of orthodontics
The lower border of the mandible in mandibulofacial dysostosis is characteristic of the syndrome. Evaluation of the cephalograms by means of the medial axis analysis and inflectional tangents captures the shape deformity. Morphometric data from lateral cephalograms on seven patients, ages 3 through 20 years, are reported: a total of 22 observations on three males and four females. These forms were compared to normal mandibular forms from the University of Michigan University School Study. The curvature of the gonial angle in the study population is not distinguishable from the normal curvature. Relative to this apparently normal region, there is a marked downward displacement of the symphysis that results in the curvature typical of the lower mandibular border in this syndrome. These findings are not consistent with earlier reports
— id: 99058, year: 1986, vol: 89, page: 393, stat: Journal Article,

Basilar multiplane cephalometric analysis
Grayson, B H; LaBatto, F A; Kolber, A B; McCarthy, J G
1985 Dec;88(6):503-516, American journal of orthodontics
This article presents a method of cephalometric tracing and analysis using the basilar view cephalogram and discusses its role in diagnosis and treatment planning. Landmarks and structures found in each of three separate basilar planes are defined and instructions for tracings are presented. The analysis is applied to the study of orbital hypertelorism, craniofacial synostosis, and hemicraniofacial microsomia. The multiplane tracing technique is demonstrated to provide a three-dimensional concept of deformities in the craniofacial skeleton. A method to determine an anteroposterior midline construct from structures in the cranial base is described. As is practiced with the lateral cephalogram, presurgical tracings of the basilar film may be manipulated to simulate the skeletal changes anticipated in surgery
— id: 99059, year: 1985, vol: 88, page: 503, stat: Journal Article,

A comparative cephalometric study of the cranial base in craniofacial anomalies: Part I: Tensor analysis
Grayson, B H; Weintraub, N; Bookstein, F L; McCarthy, J G
1985 Apr;22(2):75-87, Cleft palate journal
The method of mean tensor analysis was used to study the cranial base in six craniofacial anomalies: Crouzon's disease, Apert's syndrome, Pfeiffer's syndrome, craniofacial microsomia (CFM), Treacher Collins (TC) syndrome, and frontonasal dysplasia (FND). The form was represented by five landmarks: the nasion (N), basion (Ba), sella (S), frontomaxillonasal suture (FMN), and sphenoethmoidal registration point (SE), and the deformities were computed as mean deformations from age- and sex-matched normal mean forms. The cranial base in CFM is normal in shape. The other five syndromes manifest four distinct patterns of shape variation. Only in TC and Pfeiffer's syndrome is the cranial-base angle distinctive. In Apert's and Crouzon's syndromes, point SE is displaced anteriorly upon a cranial base, small in size but otherwise normal in shape. In TC syndrome and FND, point SE is displaced posteriorly toward the sella
— id: 99063, year: 1985, vol: 22, page: 75, stat: Journal Article,

Early surgery for craniofacial synostosis: an 8-year experience
McCarthy JG; Epstein F; Sadove M; Grayson B; Zide B
1984 Apr;73(4):521-533, Plastic & reconstructive surgery
A prospective review is presented of 50 patients with one of the craniofacial synostosis syndromes who underwent early interventive craniofacial surgical correction (average age 7.6 months at time of surgery). The study has demonstrated the efficacy and safety of the techniques when employed in the infant. Satisfactory cranio-orbital form was achieved in the majority of the patients, although 10 patients required secondary surgery because of sutural refusion or the development of turricephaly or calvarial contour irregularities. Despite earlier hopes, this surgery did not result in the development of satisfactory occlusal relationships and midfacial form in the craniofacial dysostosis group (Crouzon's, Apert's, etc.). Based on this clinical experience, a surgical treatment plan is presented for the newborn with craniofacial synostosis
— id: 50608, year: 1984, vol: 73, page: 521, stat: Journal Article,

Le Fort III advancement osteotomy in the growing child
McCarthy JG; Grayson B; Bookstein F; Vickery C; Zide B
1984 Sep;74(3):343-354, Plastic & reconstructive surgery
A prospective clinical and cephalometric study was conducted on 12 patients under the age of 12 years undergoing Le Fort III advancement with the following findings: 1. There was a remarkable degree of postoperative skeletal stability of the midfacial segment. 2. Disharmony in jaw relationship (anterior crossbite) observed during the period of longitudinal postoperative study could be attributed to expected mandibular development. 3. In some patients, growth and development of the maxilla in a forward and downward direction were documented after Le Fort III advancement. The authors recommend that a Le Fort III advancement can be safely performed at approximately age 4 without a deleterious effect on midfacial development in the patient with craniofacial dysostosis
— id: 50607, year: 1984, vol: 74, page: 343, stat: Journal Article,

Unilateral craniofacial microsomia. Part I. Mandibular analysis
Grayson, B H; Boral, S; Eisig, S; Kolber, A; McCarthy, J G
1983 Sep;84(3):225-230, American journal of orthodontics
Various attempts to describe the skeletal characteristics of unilateral craniofacial microsomia have been made with the use of cephalometric and panoramic roentgenograms. Previous studies have been only descriptive in nature. To date, a detailed (quantitative) cephalometric analysis of the mandibular deformity has not been reported. The purpose of this study was to describe the skeletal jaw deformity by means of cephalometric landmarks in the lateral view. The patient population consisted of sixteen boys and eight girls who ranged in age from 6 to 16 years. They were compared to the University of Michigan normal control population for the following measures: gonial angle, mandibular plane angle, overall oblique length of the mandible, ramal height, and body length. The affected side showed a larger gonial angle and mandibular plane angle. The oblique length of the mandible (Cd-Gn) was decreased on both sides, as were ramal height and body length. Paradoxically, body length appeared shorter on the unaffected side than on the affected side. This paradoxical observation could be attributed to a shift of the mandible in relation to the midsagittal plane of the cranial base, the film cassette, and the path of the x-ray beam. Observation of the mandible in the basilar cephalogram explained the geometry of the projection error found in the lateral view. Similar projection errors exist for patients with other types of craniofacial asymmetry. It is suggested that two radiographic views, orthogonal to each other, should be used to define the x, y, and z planes for studies of craniofacial abnormality
— id: 99065, year: 1983, vol: 84, page: 225, stat: Journal Article,

Analysis of craniofacial asymmetry by multiplane cephalometry
Grayson, B H; McCarthy, J G; Bookstein, F
1983 Sep;84(3):217-224, American journal of orthodontics
A three-dimensional, multiplane cephalometric analysis is presented. This analysis permits visualization of skeletal midlines at selected depths of the craniofacial complex. When the midlines and associated anatomic structures are studied sequentially, the individual midlines may be combined conceptually into a warped midsagittal 'plane.' This localizes craniofacial asymmetry in the posteroanterior and basilar views. The study of structures in various coronal and transverse planes makes it possible to measure and record the three-dimensional relationships of anatomic structures to one another. A case of hemicraniofacial microsomia in which this analysis was used is presented
— id: 99066, year: 1983, vol: 84, page: 217, stat: Journal Article,

The relationship between the surgeon and the orthodontist in orthognathic surgery
McCarthy JG; Grayson B; Zide B
1982 Oct;9(4):423-442, Clinics in plastic surgery
— id: 50609, year: 1982, vol: 9, page: 423, stat: Journal Article,

Cephalometric analysis for mandibular surgery: Part III
Zide B; Grayson B; McCarthy JG
1982 Jan;69(1):155-164, Plastic & reconstructive surgery
— id: 50610, year: 1982, vol: 69, page: 155, stat: Journal Article,

Cephalometric analysis for upper and lower midface surgery: Part II
Zide B; Grayson B; McCarthy JG
1981 Dec;68(6):961-968, Plastic & reconstructive surgery
— id: 50611, year: 1981, vol: 68, page: 961, stat: Journal Article,

Cephalometric analysis: part I
Zide B; Grayson B; McCarthy JG
1981 Nov;68(5):816-823, Plastic & reconstructive surgery
A protocol for cephalometric analysis is presented to enable the clinician to evaluate the bony face by subdividing it into four components: 1. Vertical facial measurements 2. Horizontal midface measurements 3. Horizontal lower face measurements 4. Dental measurements. The clinician is encouraged to view the components alone and together. Caution is advised in deriving the treatment plans solely from the cephalometric analysis. Emphasis is placed on integrating the data derived from the cephalometric analysis with the clinical picture, history, dental model analysis, soft-tissue analysis, and patient desires
— id: 50612, year: 1981, vol: 68, page: 816, stat: Journal Article,

NEW FINDINGS IN CARNIOFACIAL SYNOSTOSIS SYNDROMES
Grayson, B; Kolber, A; Mccarthy, JG; Coccaro, PJ
1980 ;17(4):357-357, Cleft palate journal
— id: 27956, year: 1980, vol: 17, page: 357, stat: Journal Article,