Joseph G Mc Carthy, M.D.

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,

Parameters of Care for Craniosynostosis
McCarthy JG; Warren SM; Bernstein JM; Burnett W; Cunningham ML; Edmond JC; Figueroa AA; Kapp-Simon KA; Labow B; Peterson-Falzone S; Proctor M; Rubin M; Sze RW; Yemen T
2011 Jan;49 Suppl:1S-24S, Cleft palate-craniofacial journal
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— id: 138704, year: 2011, vol: 49 Suppl, page: 1S, stat: Journal Article,

"William Wei-Lien Shaw, MD, 1942 to 2010 OBITUARY"
McCarthy, Joseph G.
2011 FEB ;127(2):1026-1027, Plastic & reconstructive surgery
— id: 126438, year: 2011, vol: 127, page: 1026, stat: Journal Article,

Progenitor cell mobilization enhances bone healing by means of improved neovascularization and osteogenesis
Wang, Xiao Xia; Allen, Robert J Jr; Tutela, John Paul; Sailon, Alexander; Allori, Alexander C; Davidson, Edward H; Paek, Gina K; Saadeh, Pierre B; McCarthy, Joseph G; Warren, Stephen M
2011 Aug;128(2):395-405, Plastic & reconstructive surgery
BACKGROUND: : Although bone repair is a relatively efficient process, a significant portion of patients fail to heal their fractures. Because adequate blood supply is essential to osteogenesis, the authors hypothesize that augmenting neovascularization by increasing the number of circulating progenitor cells will improve bony healing. METHODS: : Bilateral full-thickness defects were created in the parietal bones of C57 wild-type mice. Intraperitoneal AMD3100 (n = 33) or sterile saline (n = 33) was administered daily beginning on postoperative day 3 and continuing through day 18. Circulating progenitor cell number was quantified by fluorescence-activated cell sorting. Bone regeneration was assessed with micro-computed tomography. Immunofluorescent CD31 and osteocalcin staining was performed to assess for vascularity and osteoblast density. RESULTS: : AMD3100 treatment increased circulating progenitor cell levels and significantly improved bone regeneration. Calvarial defects of AMD3100-treated mice demonstrated increased vascularity and osteoblast density. CONCLUSIONS: : Improved bone regeneration in this model was associated with elevated circulating progenitor cell number and subsequently improved neovascularization and osteogenesis. These findings highlight the importance of circulating progenitor cells in bone healing and may provide a novel therapy for bone regeneration
— id: 135582, year: 2011, vol: 128, page: 395, 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,

Creating a Virtual Surgical Atlas of Craniofacial Procedures: Part II. Surgical Animations
Flores, Roberto L; Deluccia, Nicholette; Oliker, Aaron; McCarthy, Joseph G
2010 Dec;126(6):2093-2101, Plastic & reconstructive surgery
BACKGROUND:: Craniofacial surgery can be challenging to teach and learn. To augment the intraoperative learning experience for surgical trainees and to provide a resource for practicing craniofacial surgeons to review uncommonly performed procedures before entering the operating room, a series of three-dimensional animations were created encompassing the most commonly performed craniofacial procedures. METHODS:: Previously created three-dimensional craniofacial digital models were used to create digital animations of craniofacial surgical procedures using Maya 8.5. Digital models were altered systematically within Maya to recreate the ordered steps of each craniofacial procedure. Surgical tools were imported into Maya for use in the animations using computer-aided manufacturing files obtained directly from the manufacturer. RESULTS:: Nine craniofacial procedures were animated: genioplasty, bilateral sagittal split osteotomy, intraoral vertical ramus osteotomy, Le Fort I osteotomy, unifocal mandibular distraction, mandibular transport distraction, fronto-orbital advancement with cranial vault remodeling, Le Fort III advancement/distraction, and monobloc advancement/distraction. All major surgical steps are demonstrated, including exposure, execution of the osteotomy, displacement of the bone composite, and the predicted morphologic changes to the craniofacial contour. Throughout the surgical animation, the view of the surgeon in the operating room is incorporated to reproduce the vantage of the surgeon, and the overlying tissue is rendered transparent to illustrate critical underlying anatomical relationships. CONCLUSIONS:: The first virtual surgical atlas of craniofacial procedures is presented. These animations should serve as a resource for trainees and practicing surgeons in preparation for craniofacial surgical procedures
— id: 114868, year: 2010, vol: 126, page: 2093, 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,

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,

The 30-year tale of a fellow P&S classmate: a journey along the path of craniosynostosis surgery
McCarthy, Joseph G
2009 Mar;20 Suppl 1:632-633, Journal of craniofacial surgery
— id: 102929, year: 2009, vol: 20 Suppl 1, page: 632, 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,

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 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,

Onlay frontal cranioplasty using wire reinforced methyl methacrylate
Greene, Arin K; Warren, Stephen M; McCarthy, Joseph G
2008 Apr;36(3):138-142, Journal of cranio-maxillo-facial surgery
INTRODUCTION: Methyl methacrylate is a biologically inert alloplastic material that is commonly used to rebuild the calvarial vault. Since methyl methacrylate does not permit tissue incorporation it is susceptible to displacement and/or fracture. In order to increase the tensile strength of methyl methacrylate onlay cranioplasties, we use wire reinforced masonry techniques. PATIENT: A 56-year-old female presents with forehead asymmetry due to displacement and fracture of a silicone alloplastic implant. This patient, treated with onlay wire reinforced methyl methacrylate, demonstrates the utility of this novel technique. RESULTS: Wire is passed through 2-mm outer cortex tunnels like spokes on a wheel, around the perimeter of the defect to form a rebar grid. Methyl methacrylate is poured onto the rebar grid and contoured after it solidifies. CONCLUSIONS: Wire reinforced methyl methacrylate is a simple technique to improve the tensile strength of calvarial alloplastic reconstructions
— id: 94242, year: 2008, vol: 36, page: 138, stat: Journal Article,

Microsurgical correction of facial contour deformities in patients with craniofacial malformations: a 15-year experience
Saadeh, Pierre B; Chang, Christopher C; Warren, Stephen M; Reavey, Patrick; McCarthy, Joseph G; Siebert, John W
2008 Jun;121(6):368e-378e, Plastic & reconstructive surgery
BACKGROUND: Since their first review of microsurgical correction of facial contour deformities in 19 patients with craniofacial malformations, the authors have treated an additional 74 patients (n = 93). The authors review indications, choices, safety, efficacy, complications, and technical refinements. A treatment algorithm is presented. METHODS: A retrospective chart review of all patients who underwent microvascular reconstruction of the face and all patients with craniofacial dysmorphology was performed. Between 1989 and 2004, a total of 93 patients with the following diagnoses were identified: craniofacial microsomia (n = 73), Treacher Collins syndrome (n = 8), and severe orbitofacial cleft (n = 12). All patients underwent microsurgical facial reconstruction with a superficial inferior epigastric, groin, or circumflex scapular flap. Flap revisions, complications, and non-free flap related surgery were reviewed. RESULTS: The mean age at microvascular reconstruction was 11 years (range, 4 to 27 years). Flap choices included the following: superficial inferior epigastric (n = 4), groin (n = 3), and circumflex scapular (n = 105). Seventy-six patients underwent unilateral and 17 patients underwent bilateral (one of 17 simultaneous) reconstructions. Postoperative complications included partial flap loss (n = 1), reexploration (n = 1), hematoma (n = 5), and cellulitis (n = 5). All patients had subjective improvement in facial contour, symmetry, skin tone, and color. Most patients underwent additional non-free flap procedures including mandibular distraction and ear reconstruction. CONCLUSIONS: Microsurgical flaps have markedly improved the authors' ability to restore craniofacial contour in patients with craniofacial malformations. In selected patients, the authors choose primary midface augmentation with free vascularized tissue to restore form and function. Microsurgical flaps in patients with craniofacial malformations are safe, effective, and reliable
— id: 79461, year: 2008, vol: 121, page: 368e, 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,

Uniaxial mechanical strain: an in vitro correlate to distraction osteogenesis
Bhatt, Kirit A; Chang, Eric I; Warren, Stephen M; Lin, Shin-E; Bastidas, Nicholas; Ghali, Shadi; Thibboneir, Aurelia; Capla, Jennifer M; McCarthy, Joseph G; Gurtner, Geoffrey C
2007 Dec;143(2):329-336, Journal of surgical research
BACKGROUND: Distraction osteogenesis is a valuable clinical tool; however the molecular mechanisms governing successful distraction remain unknown. We have used a uniaxial in vitro strain device to simulate the uniaxial mechanical environment of the interfragmentary distraction gap. MATERIALS AND METHODS: Using the Flexcell system, normal human osteoblasts were subjected to different levels of cyclical uniaxial mechanical strain. Cellular morphology, proliferation, migration, and the expression of angiogenic (vascular endothelial growth factor [VEGF] and fibroblast growth factor-2 [FGF-2]) and osteogenic (osteonectin, osteopontin, and osteocalcin) proteins and extracellular matrix molecules (collagen IalphaII) were analyzed in response to uniaxial cyclic strain. RESULTS: Osteoblasts exposed to strain assumed a fusiform spindle-shaped morphology aligning parallel to the axis of uniaxial strain and osteoblasts exposed to strain or conditioned media had a 3-fold increase in proliferation. Osteoblast migration was maximal (5-fold) in response to 9% strain. Angiogenic cytokine, VEGF, and FGF-2, increased 32-fold and 2.6-fold (P < 0.05), respectively. Osteoblasts expressed greater amounts of osteonectin, osteopontin, and osteocalcin (2.1-fold, 1.8-fold, 1.5-fold respectively, P < 0.01) at lower levels of strain (3%). Bone morphogenic protein-2 production increased maximally at 9% strain (1.6-fold, P < 0.01). Collagen I expression increased 13-, 66-, and 153-fold in response to 3, 6, and 9% strain, respectively. CONCLUSIONS: Uniaxial cyclic strain using the Flexcell device under appropriate strain parameters provides a novel in vitro model that induces osteoblast cellular and molecular expression patterns that simulate patterns observed in the in vivo distraction gap
— id: 75477, year: 2007, vol: 143, page: 329, 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,

The incidence of late cephalohematoma following craniofacial surgery
Ghali, Shadi; Knox, Kevin R; Boutros, Sean; Thorne, Charles H; McCarthy, Joseph G
2007 Sep 15;120(4):1004-1008, Plastic & reconstructive surgery
BACKGROUND: Cranial vault remodeling procedures are carried out for both syndromic and nonsyndromic craniosynostosis as well as to correct some acquired deformities of the cranial vault. These procedures improve not only cosmesis but also neurological symptoms. The purpose of this study was to determine the incidence of 'late' cephalohematoma, an underreported complication following these complex procedures. METHODS: A total of 113 patients underwent 127 cranial vault remodeling procedures using autogenous bone over a 6-year period. All patients who developed a late cephalohematoma 75 days or more after surgery were recorded. The time, size, and location of the cephalohematoma, the treatment performed, and the length of follow-up were also recorded. Ages at initial operation and postoperative follow-up were compared between patient groups for statistical differences. RESULTS: Of the 113 patients, 17 developed 18 late cephalohematomas. The incidence for this complication was 15 percent. The median age at operation for all patients was 10 months, and most late cephalohematomas occurred 208 days later (range, 77 to 1416 days), at 12 to 24 months of age. Fronto-orbital advancement was the most commonly performed procedure, and 83.3 percent of late cephalohematomas occurred in the frontal region. No cephalohematomas became infected or required any operative intervention, but they were aspirated. CONCLUSIONS: Surgeons should inform prospective parents of patients undergoing cranial vault remodeling procedures of this potential complication. This will improve parental awareness and possible avoidance strategies in future patients. Further evaluation and follow-up are required to determine the minimum length of postoperative time after which late cephalohematomas do not occur
— id: 74118, year: 2007, vol: 120, page: 1004, 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 atlas of craniofacial anatomy
Smith, Darren M; Oliker, Aaron; Carter, Christina R; Kirov, Miro; McCarthy, Joseph G; Cutting, Court B
2007 Nov;120(6):1641-1646, Plastic & reconstructive surgery
BACKGROUND: Head and neck anatomy is complex and represents an educational challenge to the student. Conventional two-dimensional illustrations inherently fall short in conveying intricate anatomical relationships that exist in three dimensions. A gratis three-dimensional virtual reality atlas of craniofacial anatomy is presented in an effort to address the paucity of readily accessible and customizable three-dimensional educational material available to the student of head and neck anatomy. METHODS: Three-dimensional model construction was performed in Alias Maya 4.5 and 6.0. A basic three-dimensional skull model was altered to include surgical landmarks and proportions. Some of the soft tissues were adapted from previous work, whereas others were constructed de novo. Texturing was completed with Adobe Photoshop 7.0 and Maya. The Internet application was designed in Viewpoint Enliven 1.0. RESULTS: A three-dimensional computer model of craniofacial anatomy (bone and soft tissue) was completed. The model is compatible with many software packages and can be accessed by means of the Internet or downloaded to a personal computer. As the three-dimensional meshes are publicly available, they can be extensively manipulated by the user, even at the polygonal level. CONCLUSIONS: Three-dimensional computer graphics has yet to be fully exploited for head and neck anatomy education. In this context, the authors present a publicly available computer model of craniofacial anatomy. This model may also find applications beyond clinical medicine. The model can be accessed gratis at the Plastic and Reconstructive Surgery Web site or obtained as a three-dimensional mesh, also gratis, by contacting the authors
— id: 79082, year: 2007, vol: 120, page: 1641, stat: Journal Article,

Marriage of hard and soft tissues of the face revisited: when distraction meets microsurgery
Spector, Jason A; Warren, Stephen M; Singh, Sunil P; McCarthy, Joseph G; Siebert, John W
2007 Jul;59(1):1-5, Annals of plastic surgery
BACKGROUND: Patients with craniofacial anomalies can have hard and soft tissue deficiencies. In some cases, distraction osteogenesis can restore the bony deficiencies, but the soft tissue contour defect remains problematic. For these patients, the union of distraction osteogenesis and microvascular free flaps (MVFF) can restore bone and soft tissue form and function. PATIENTS AND METHODS: A retrospective review of all patients treated with mandibular distraction osteogenesis between 1989 and 2005 was performed. A similar review of all patients treated with MVFFs was performed. These 2 cohorts were cross-referenced to identify all patients treated with both procedures. The indications, choices, safety, and efficacy of MVFF reconstruction of facial soft tissues following mandibular reconstruction are reviewed. RESULTS: Over a 16-year period, 141 patients underwent mandibular distraction osteogenesis; 8 patients treated with mandibular distraction osteogenesis subsequently underwent 12 MVFFs. Patient diagnoses included unilateral craniofacial microsomia (n = 2), bilateral craniofacial microsomia (n = 3), Goldenhar syndrome (n = 1), Nager syndrome (n = 1), and Treacher-Collins syndrome (n = 1). Free flap choices included 10 parascapular fasciocutaneous, 1 parascapular osteofasciocutaneous, and 1 fibular osteocutaneous flap. Four patients underwent staged bilateral free flaps. A single case of partial flap loss was the only complication. In all cases, facial contour was improved following MVFF transfer. CONCLUSIONS: In certain circumstances, facial rehabilitation may require the marriage of craniofacial and microsurgical techniques to restore both form and function. In these cases, mandibular distraction osteogenesis and MVFFs can be safely and effectively combined
— id: 94726, year: 2007, vol: 59, page: 1, 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,

Delayed degradation in a resorbable plating system
Mackool, Richard; Yim, Jun; McCarthy, Joseph G
2006 Jan;17(1):194-197, Journal of craniofacial surgery
Resorbable plating systems are used extensively for craniofacial reconstruction, particularly in children. The systems provide rigid fixation while potentially minimizing the long-term drawbacks of permanent plating systems such as plate 'migration,' bone growth restriction, and imaging artifact. However, the need for active plate resorption represents both the strength and weakness of these fixation systems. We present four patients who underwent cranial vault remodeling using a resorbable plating system, following which the plates were palpable and observable for at least 2 years postoperatively. All required surgical removal. On gross inspection, the plates had been replaced by an encapsulated spongy material containing yellow, grainy, cloudy liquid. The bone underlying the plates was depressed and irregular in contour when compared with the adjacent bone. Microscopic studies showed a giant cell foreign-body reaction with crystalline material present in the cell vacuoles
— id: 63804, year: 2006, vol: 17, page: 194, stat: Journal Article,

Simultaneous maxillo-mandibular distraction osteogenesis in hemifacial microsomia: A new technique using two distractors
McCarthy, JG
2006 APR 15 ;117(5):1542-1542, Plastic & reconstructive surgery
— id: 63855, year: 2006, vol: 117, page: 1542, 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,

Stem cells and distraction osteogenesis: endothelial progenitor cells home to the ischemic generate in activation and consolidation
Cetrulo, Curtis L Jr; Knox, Kevin R; Brown, Daniel J; Ashinoff, Russell L; Dobryansky, Michael; Ceradini, Daniel J; Capla, Jennifer M; Chang, Edward I; Bhatt, Kirit A; McCarthy, Joseph G; Gurtner, Geoffrey C
2005 Sep 15;116(4):1053-1064, Plastic & reconstructive surgery
BACKGROUND: Ischemia is a limiting factor during distraction osteogenesis. The authors sought to determine the extent of ischemia in the distraction zone and whether endothelial progenitor cells home to the distraction zone and participate in local vasculogenesis. METHODS: Laser Doppler imaging was used to assess the extent of blood flow in the distraction zone in gradually distracted, immediately distracted, and osteotomized rat mandibles during activation and consolidation. Animals (n = 50; 25 rats with unilateral gradual distraction and contralateral osteotomy as an internal control, and 25 rats with unilateral immediate distraction) were examined on postoperative days 4, 6, and 8 of activation, and after 1 and 2 weeks of consolidation. Endothelial progenitor cells isolated from human peripheral blood were labeled with fluorescent DiI dye, and 0.5 x 10 cells were injected intra-arterially under direct vision into each carotid artery at the start of activation in nude rats (n = 18) that then underwent the distraction protocol outlined above. RESULTS: Doppler flow analysis demonstrated relative ischemia during the activation period in the distraction osteogenesis group and increased blood flow in the osteotomized control group as compared with flow in a normal hemimandible [normal, 1 (standardized); distraction osteogenesis, 0.58 +/- 0.05; control, 2.58 +/- 0.21; p < 0.05 for both results]. We observed a significantly increased endothelial progenitor cell population at the generate site versus controls at midactivation and at 1 and 2 weeks of consolidation [25 +/- 1.9 versus 1 +/- 0.3 DiI-positive cells per high-power field (p < 0.05), 124 +/- 21 versus 8 +/- 4 DiI-positive cells per high-power field (p < 0.05), and 106 +/- 18 versus 9 +/- 3 DiI-positive cells per high-power field (p < 0.05), respectively]. CONCLUSIONS: These data suggest that the distraction zone becomes relatively ischemic during activation and that endothelial progenitor cells home to the ischemic generate site during the activation phase and remain during the consolidation phase. Selective expansion of these stem cells may be useful in overcoming ischemic limitations of distraction osteogenesis. Moreover, their homing capability may be used to effect site-specific transgene delivery to the generate
— id: 62600, year: 2005, vol: 116, page: 1053, stat: Journal Article,

Understanding the molecular basis of apert syndrome
Ibrahimi, Omar A; Chiu, Ernest S; McCarthy, Joseph G; Mohammadi, Moosa
2005 Jan;115(1):264-270, Plastic & reconstructive surgery
Apert syndrome, first described in 1906, is one of the most severe of the craniosynostosis syndromes and is further characterized by midface hypoplasia, syndactyly, and other visceral abnormalities. Affected individuals generally require lifelong management by a multidisciplinary team of health care specialists. Apert syndrome results almost exclusively from one or the other of two point mutations in fibroblast growth factor receptor 2. Tremendous scientific advances have been made recently in understanding the molecular basis for Apert syndrome through clinical genetic, biochemical, and structural approaches. In this review, the authors provide the clinician with a basic overview of these findings and their therapeutic implications
— id: 56112, year: 2005, vol: 115, page: 264, 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,

Bone morphogenic protein-2 gene therapy for mandibular distraction osteogenesis
Ashinoff, Russell L; Cetrulo, Curtis L Jr; Galiano, Robert D; Dobryansky, Michael; Bhatt, Kirit A; Ceradini, Daniel J; Michaels, Joseph 5th; McCarthy, Joseph G; Gurtner, Geoffrey C
2004 Jun;52(6):585-590, Annals of plastic surgery
Distraction osteogenesis (DO) requires a long consolidation period and has a low but real failure rate. Bone morphogenic proteins (BMPs) accelerate bone deposition in fractures and critical-sized bone defects, but their effects on mandibular DO are unknown. We investigated the effect of local delivery of adenovirus containing the gene for BMP-2 (Adbmp-2) on mandibular DO in a rat model. Rats (n = 54) were distracted to 3 mm over 6 days. At the start of consolidation (POD 10), Adbmp-2 or adenovirus containing the lacZgene (AdlacZ) was injected directly into the distraction zone. After 1, 2, and 4 weeks of consolidation, mandibles were evaluated for amount of bone deposition. Adbmp-2-treated specimens demonstrated an increased amount of new bone formation by radiographic, histologic, and histomorphometric analysis. This study demonstrates that local, adenovirally-mediated delivery of BMP-2 can increase bone deposition during DO, potentially shortening consolidation and enhancing DO in poorly healing mandibles, such as occurs postirradiation
— id: 44705, year: 2004, vol: 52, page: 585, stat: Journal Article,

Frank Hastings Hamilton: a pioneer American plastic surgeon
Baux, Germania S; Fischer, Edmund; McCarthy, Joseph G
2004 Oct;114(5):1240-1247, Plastic & reconstructive surgery
— id: 99031, year: 2004, vol: 114, page: 1240, stat: Journal Article,

Reconstruction of a large mandibular defect utilizing temporary zygomatic-ramal fixation and bilateral Risdon incisions
Derderian, Christopher A; Gurtner, Geoffrey C; McCarthy, Joseph G
2004 Jan;15(1):16-19, Journal of craniofacial surgery
Ameloblastoma is a benign, invasive, odontogenic tumor of the jaws that predominantly affects the mandible. Despite the benign nature of these lesions, there is a high rate of local recurrence after curettage, which usually requires resection. The traditional surgical approach for resection of ameloblastomas, via either mandibulotomy or mandibulectomy, has been through lower lip-splitting incisions, which are associated with significant functional and esthetic sequelae. A case is presented here in which less invasive Risdon and intraoral degloving incisions were used in combination with temporary zygomatic-ramal fixation to maintain occlusion after resection of a large mandibular ameloblastoma. The bilateral Risdon approach provided wide access to the mandible, allowing an angle-to-angle resection to be performed. This approach also provided adequate exposure for an osteocutaneous fibula free flap reconstruction to be performed, with 100% flap survival. At 1 year of follow-up, there were minimal functional and esthetic defects. This approach represents a less invasive alternative that provides access to the mandible for curative resection of benign tumors with minimal postoperative sequelae
— id: 42626, year: 2004, vol: 15, page: 16, 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,

Professor Ruyao Song, 1914 to 2003
McCarthy, Joseph G; Randall, Peter
2004 Jan;113(1):444-445, Plastic & reconstructive surgery
— id: 99032, year: 2004, vol: 113, page: 444, 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,

Predicting decannulation outcomes after distraction osteogenesis for syndromic micrognathia
Sorin, Alexander; McCarthy, Joseph G; Bernstein, Joseph M
2004 Oct;114(10):1815-1821, Laryngoscope
OBJECTIVES: To characterize the airway anatomy by upper endoscopy in children with syndromal mandibular hypoplasia and to determine whether predistraction endoscopy is predictive of the likelihood of successful outcomes after mandibular distraction. STUDY DESIGN: Retrospective chart review. METHODS: Assessment of the upper airway by subsites was qualitatively extrapolated into a devised 4-point scale. Upper airways were characterized and evaluated in patients on the basis of decannulation outcomes after distraction. RESULTS: Of the 20 patients, 12 were decannulated, and 6 remain tracheostomy dependent. The average compiled preoperative airway obstruction scores in decannulated patients (2.25) compared with those who failed decannulation (2.36) was not statistically significant (P =.291). A significant change after distraction was noted only at the levels of the oropharynx and supraglottis (P <.001). The average airway scores at these subsites in decannulated patients improved from a mean of 3.46 to 2.17 (P =.002). In patients who failed decannulation, the pre- and postdistraction scores also improved from 3.92 to 2.50 (P =.026). Analysis of the average postdistraction airway scores in decannulated patients (2.17) compared with failures (2.5) failed to reveal a significant difference (P =.375), suggesting that some patients remain tracheostomy dependent despite adequate mandibular expansion. Preoperative airway scores in the two groups were statistically equivocal and, therefore, not predictive of the likelihood of decannulation. CONCLUSIONS: Preoperative airway endoscopy alone is not predictive of the likelihood of successful decannulation after distraction osteogenesis. Comparison of the airway patency after distraction revealed statistically equivocal airway caliber, suggesting that some children fail to advance to decannulation despite adequate mandibular distraction
— id: 47844, year: 2004, vol: 114, page: 1815, stat: Journal Article,

The temporal sequence of periosteal attachment after elevation
Boutros, Sean; Bernard, Robert W; Galiano, Robert D; Addona, Tommaso; Stokes, Barry; McCarthy, Joseph G
2003 May;111(6):1942-1947, Plastic & reconstructive surgery
This study investigated the adherence of periosteum to bone after elevation to document the temporal sequence of healing at the periosteal/bone interface. There has been a lack of consensus among surgeons as to the time required for healing at this interface; some believe that the healing achieves significant strength in a few days, whereas others believe that the periosteum does not adhere to the bone for many weeks. The aim of this study was to document the time course for healing, completeness of the reattachment, and structural characteristics of the union of bone and periosteum.To test the hypothesis, scalp flaps were elevated in a subperiosteal plane and were reattached in 40 adult guinea pigs and controls. The individual groups were studied at 3, 6, 12, 30, and 90 days postoperatively. Postmortem study consisted of analysis of the mechanical and histologic findings. Strength of adherence was documented by measuring the force required for reverse avulsion of the flaps with an Instron Mini 44 tensiometer. The specimens were also submitted for electron microscopic examination. The mean tension recorded in the plateau phase of avulsion of the flaps was as follows: controls, 78 g; experimental at 3 and 6 days, not applicable (weak adherence not permitting exposure for reverse avulsion); 12 days, 39 g (p = 0.0001); 30 days, 58 g (p = 0.0012), and 90 days, 63 g (p = 0.0229). There was a significant difference between all groups and the controls. Electron microscopic study showed collagen deposition at the bone periosteal interface, which became progressively more organized in the groups studied at 30 and 90 days, with decreasing amounts of inflammation and inflammatory cells.This study demonstrated that healing at the bone/periosteal interface progresses at a rate consistent with healing of most other wounds, dispelling many widespread beliefs that the adherence at this interface was accelerated. The temporal sequence of healing at the periosteal bone interface should be considered in the various procedures in which periosteal flaps are elevated. For example, there is clinical relevance in subperiosteal brow lift procedures, in which the periosteum should be reattached by a fixation technique that will remain stable for a minimum of 30 days to allow adequate adherence between the bone and periosteum at the postoperative elevated brow position
— id: 99033, year: 2003, vol: 111, page: 1942, 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,

Distraction osteogenesis in accompanying obstructive correction of micrognathia sleep apnea syndrome
McCarthy, JG
2003 NOV ;112(6):1558-1559, Plastic & reconstructive surgery
— id: 46847, year: 2003, vol: 112, page: 1558, 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,

Transport distraction osteogenesis: a new method to heal adult calvarial defects
Bouletreau, Pierre J; Warren, Stephen M; Paccione, Michael F; Spector, Jason A; McCarthy, Joseph G; Longaker, Michael T
2002 Mar;109(3):1074-1084, Plastic & reconstructive surgery
Popularized by Gavril Ilizarov in the 1960s, monofocal distraction osteogenesis has become a well-established method of endogenous bone engineering. This revolutionary surgical technique has significantly augmented the available reconstructive orthopedic and craniomaxillofacial procedures. Bifocal distraction osteogenesis, or bone transportation, is a modification of monofocal distraction that involves moving a free segment of living bone to fill an intercalary bone defect. Bifocal distraction has been applied successfully to reconstruct complex mandibular and long bone defects. Because traumatic or postsurgical calvarial defects do not spontaneously heal in humans older than 18 to 24 months of age, we hypothesized that bifocal distraction osteogenesis could be applied to the skull to close critical size calvarial defects. Critical size (15 x 15 mm) calvarial defects were created in eight New Zealand White rabbits. Next, a 15-mm x 10-mm calvarial box osteotomy was created just anterior to the skull defect. This osteotomy created a free bone segment that could be transported. A custom-made transport distraction device was fixed into place and the skin incision was closed. After a 4-day latency period, the distraction device was activated (0.5 mm once daily for 30 days) in seven animals; the distraction device in one animal was not activated and served as a control. All animals underwent 30 days of consolidation and were then killed. Radiographs and computed tomographic scans were performed at the following time points: end of latency period (postoperative day 4), mid-distraction (postoperative day 19), and end of consolidation period (postoperative day 64). Gross and histologic analysis was performed to evaluate the quality of the bony regenerate. The control animal healed with a fibrous union. Complete closure of the skull defects was observed in five of seven rabbits at the end of the consolidation period. One animal was removed from the study because of an early loosening of the distraction device, and one was removed because of device failure. Of the remaining five animals that completed the distraction protocol, radiographs and computerized tomographic scans showed successful ossification in all five rabbits at the end of the consolidation period. This study suggests that transport distraction osteogenesis is a promising technique that may be applied to a variety of commonly encountered craniofacial problems such as nonhealing calvarial defects
— id: 69676, year: 2002, vol: 109, page: 1074, stat: Journal Article,

Mandibular distraction in neonates: A strategy to avoid tracheostomy - Discussion
Denny, A; Kalantarian, B; McCarthy, J
2002 MAR ;109(3):905-906, Plastic & reconstructive surgery
— id: 55320, year: 2002, vol: 109, page: 905, stat: Journal Article,

The use of intraoperative autotransfusion during cranial vault remodeling for craniosynostosis
Deva, Anand K; Hopper, Richard A; Landecker, Alan; Flores, Roberto; Weiner, Howard; McCarthy, Joseph G
2002 Jan;109(1):58-63, Plastic & reconstructive surgery
Intraoperative autotransfusion salvages blood shed during surgery for use in immediate resuscitation of the patient. The purpose of this study was to determine whether such autotransfusion decreases the volume of homologous blood transfused in patients undergoing primary cranial vault remodeling for craniosynostosis. The Cobe-Bret 2 autologous blood recovery system (Hemo Concepts, Union, N.J.) was used in 11 cases, and an equal number of consecutive cases did not receive intraoperative autotransfusion. There were no significant differences between the groups with respect to age, sex, and weight. Mean estimated blood loss was 43.2 ml/kg (range, 20.3 to 65.0 ml/kg) in the intraoperative autotransfusion group and 40.2 ml/kg (range, 6.8 to 72.3 ml/kg) in the control group (not statistically significant; p < 0.05). There was no significant difference in volume of homologous blood transfusion between the two groups. The autotransfusion group received 34.1 ml/kg of homologous blood (range, 0 to 60.7 ml/kg), and the control group received a mean of 32.7 ml/kg (range, 14.5 to 60.2 ml/kg). The autotransfusion group received a mean of 10.4 ml/kg of recovered autologous blood (range, 0 to 21.4 ml/kg). In four of the 11 autotransfusion patients, insufficient autologous blood was recovered intraoperatively to warrant transfusion. Results of this study suggest little benefit for the use of intraoperative autotransfusion in primary cranial vault remodeling for craniosynostosis in the young patient. It was hypothesized that this finding was a result of the following: (1) intraoperative autotransfusion blood was usually available only toward the end of the procedure, after homologous blood had already been administered, and (2) the volume of recovered intraoperative autotransfusion blood is minimal, compared with the homologous transfusion volume requirements during an extensive cranial vault remodeling and fronto-orbital advancement procedure. In the context of unproven cost benefit and increasing similar evidence from other comparative studies, emphasis should be directed to other medical and surgical strategies to minimize the need for perioperative blood transfusion
— id: 26509, year: 2002, vol: 109, page: 58, 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,

Calvarial bone distraction with a contractile bioresorbable polymer - Jose Guimaraes-Ferreira, MD, Ph.D., Fredrik Gewalli, MD, D DS, Ph.D., Lisa David, MD, Giovanni Maltese, MD, Harri Heino, M.Sc., and Claes!Lauritzen, MD, Ph.D. - Discussion
McCarthy, JG
2002 Apr;109(4):1332-1332, Plastic & reconstructive surgery
— id: 27512, year: 2002, vol: 109, page: 1332, stat: Journal Article,

Maxillo-mandibular distraction osteogenesis for hemifacial microsomia in children - Invited discussion
McCarthy, JG
2002 DEC ;49(6):578-579, Annals of plastic surgery
— id: 33285, year: 2002, vol: 49, page: 578, stat: Journal Article,

Hemangiomas of the nasal tip
McCarthy, Joseph G; Borud, Loren J; Schreiber, Jonathan S
2002 Jan;109(1):31-40, Plastic & reconstructive surgery
The treatment of nasal hemangiomas is controversial. Results of nonsurgical treatment methods have been disappointing. In a series of 42 patients with nasal hemangioma, 22 patients underwent early excision. The open rhinoplasty approach proved safe and effective and yielded satisfactory long-term results. The article discusses protocols for evaluation and guidelines for treatment
— id: 26510, year: 2002, vol: 109, page: 31, stat: Journal Article,

Hung span method of scaphocephaly reconstruction in patients with elevated intracranial pressure
McCarthy, Joseph G; Bradley, James P; Stelnicki, Eric J; Stokes, Tracey; Weiner, Howard L
2002 May;109(6):2009-2018, Plastic & reconstructive surgery
— id: 60244, year: 2002, vol: 109, page: 2009, stat: Journal Article,

Distraction osteogenesis of zygomatic bone grafts in a patient with Treacher Collins syndrome: a case report
McCarthy, Joseph G; Hopper, Richard A
2002 Mar;13(2):279-283, Journal of craniofacial surgery
Zygomatic aplasia in patients with Treacher Collins syndrome requires reconstruction with autogenous bone grafts. Serial bone grafting may be required if optimal malar projection is not achieved with the initial procedure. This report demonstrates the use of distraction osteogenesis in repositioning a previously bone-grafted zygoma in an adolescent patient with Treacher Collins syndrome, thus avoiding the need for repeat bone graft harvest. The limitations of this technique include difficulty in achieving the desired vector of distraction and the potential of graft devitalization. Nevertheless, the case report illustrates the versatility of distraction osteogenesis in skeletal augmentation/remodeling
— id: 32461, year: 2002, vol: 13, page: 279, 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,

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,

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

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,

Imaging the neonatal mandible for accurate distraction osteogenesis
Katzen JT; Holliday RA; McCarthy JG
2001 Jan;12(1):26-30, Journal of craniofacial surgery
The position of mandibular teeth is difficult to document in the neonatal patient. Panorex images are difficult to obtain in an uncooperative pediatric patient. The new technique presented by the authors uses computed tomographic data to create a curved, reformatted image of the mandible, and generates an image similar to a panorex image. This curved, reformatted mandibular image provides accurate visualization of the mandible and mandibular teeth. This technique allows for precise pin placement and osteotomy in distraction osteogenesis
— id: 20717, year: 2001, vol: 12, page: 26, stat: Journal Article,

Distraction osteogenesis of the craniofacial skeleton
McCarthy JG; Stelnicki EJ; Mehrara BJ; Longaker MT
2001 Jun;107(7):1812-1827, Plastic & reconstructive surgery
Distraction osteogenesis is becoming the treatment of choice for the surgical correction of hypoplasias of the craniofacial skeleton. Its principle is based on the studies of Ilizarov, who showed that osteogenesis can be induced if bone is expanded (distracted) along its long axis at the rate of 1 mm per day. This process induces new bone formation along the vector of pull without requiring the use of a bone graft. The technique also provides the added benefit of expanding the overlying soft tissues, which are frequently deficient in these patients. This article reviews the authors' 11-year clinical and research experience with mandibular distraction osteogenesis. It highlights the indications and contraindications of the technique and emphasizes the critical role that basic science research has played in its evolution
— id: 20628, year: 2001, vol: 107, page: 1812, stat: Journal Article,

Radiographic evaluation of bone formation in the pterygoid region after maxillary distraction with a rigid external distraction (RED) device - Discussion
McCarthy, JG
2001 MAR ;12(2):118-118, Journal of craniofacial surgery
— id: 54966, year: 2001, vol: 12, page: 118, stat: Journal Article,

Remodeling of the temporomandibular joint following mandibular distraction osteogenesis in the transverse dimension
Stelnicki EJ; Stucki-McCormick SU; Rowe N; McCarthy JG
2001 Mar;107(3):647-658, Plastic & reconstructive surgery
Transverse mandibular distraction osteogenesis involves moving the osteotomized segments of the mandible in either a varus or valgus direction. This maneuver allows for widening of the bigonial distance or for a lateral shift of an asymmetric mandibular midline. During this process, a significant amount of torque is placed on the mandibular condyles, because they act as the pivot point for the mandibular translation. Although standard linear distraction osteogenesis induces transient, reversible changes in the temporomandibular joint, it is not known what effect the varus and valgus stresses of transverse distraction have on the temporomandibular joint. We therefore designed a study to document the temporomandibular joint changes following various degrees of transverse distraction.Bilateral transverse mandibular distraction was performed on 10 adult, female mongrel dogs using an external, multiplanar mandibular distraction device. The distraction protocol was as follows: (1) complete osteotomy at the angle of the mandible, (2) 5-day latency period, (3) distraction rate of 1 mm/day, (4) rhythm of one turn per day, (5) linear activation 16 to 30 mm bilaterally, and (6) 8-week consolidation period. A variety of varus and valgus distraction vectors were applied to the mandible only after 10 mm of initial linear distraction had been achieved. Posteroanterior and lateral cephalograms were performed throughout the entire process. Pre-distraction and post-consolidation computed tomographic scans were also performed. Changes in mandibular conformation, axis of rotation, temporomandibular joint structure, and glenoid fossa changes were directly assessed by evaluating the postmortem craniofacial skeleton. The findings were compared with those of normal, age-matched mongrel dog skulls.Significant remodeling changes were observed in the temporomandibular joints of all animals involved in the study. The mandibular condyles demonstrated varying degrees of flattening and erosion at all contact points with the craniofacial skeleton. In some cases, the condyle became part of the distraction regenerate process and was hypertrophied in all dimensions. The condyles were frequently displaced out of the glenoid fossa, particularly on the side in the direction of varus distraction. When the latter occurred, a new fossa was created on the undersurface of the zygomatic arch. Varying degrees of mandibular rotation in the sagittal plane were also observed, which led to abnormal torquing of the condyles in the coronal plane, depending on whether the axis of rotation occurred primarily around the condyle or around the distraction regenerate zone.In conclusion, transverse mandibular distraction is an effective means of producing a varus or valgus shift in the gonion relative to the midsagittal plane. However, unlike linear or angular mandibular distraction, transverse distraction has a multitude of nontransient effects on the temporomandibular joint. Therefore it must be emphasized that in clinical practice, transverse distraction should be used cautiously. One must also be aware that such a maneuver in distraction can have negative effects on the temporomandibular joint
— id: 21201, year: 2001, vol: 107, page: 647, stat: Journal Article,

Craniofacial shortening by contraction osteogenesis: an experimental model
Castello JR; Olaso AS; Chao JJ; McCarthy JG; Molina F
2000 Feb;105(2):617-625, Plastic & reconstructive surgery
Application of gradual external forces to correct craniofacial deformities challenges many procedures in conventional craniomaxillofacial surgery. Distraction osteogenesis is replacing traditional osteotomies for correction of patients with craniomaxillofacial deficiencies. However, the reverse concept, contraction osteogenesis, has yet to be established for patients with craniomaxillofacial excesses. The purpose of this investigation is to demonstrate the contraction osteogenesis phenomenon applied in a controlled animal model during the craniofacial growth period. Twenty-six 26-day-old rabbits were assigned to one of four groups: 0, control; 1, pin control (pin insertion); 2, no contraction (pins and contraction device application, without active contraction); and 3, contraction (pin insertion, contraction device application, and active contraction). An external fixator was placed across the incisive-maxillary suture, and the effects after 4.5 weeks of contraction at a rate of 0.5 mm twice a week were compared with control groups. The results were assessed by craniometric and cephalometric measurements and by histologic examination. Gross alterations were evident in the contraction group, characterized by midface anteroposterior shortening, maxillary regression, snout deviation, and anterior crossbite. Histologic examination of the contraction group demonstrated a significant increase in osteoblastic activity. Contraction osteogenesis is a new treatment concept in craniofacial development and may offer therapeutic opportunities for shortening skeletal structures without the need of osteotomies, thus taking advantage of the potential of craniofacial growth and remodeling
— id: 27851, year: 2000, vol: 105, page: 617, stat: Journal Article,

"Pumping the regenerate": an evaluation of oscillating distraction osteogenesis in the rodent mandible
Greenwald JA; Luchs JS; Mehrara BJ; Spector JA; Mackool RJ; McCarthy JG; Longaker MT
2000 May;44(5):516-521, Annals of plastic surgery
Mandibular distraction osteogenesis (DO) has become an important technique to lengthen the hypoplastic mandible and to reconstruct osseous defects after ablative surgery. The hallmark of successful DO is the creation of new bone within the distraction gap. Several anecdotal reports have described alternating compressing and lengthening protocols (i.e., 'pumping the regenerate') to augment regenerate bone formation. The purpose of this experiment was to analyze formally the effects of an alternating compression/distraction protocol with a traditional distraction protocol. Ten adult male rats underwent unilateral mandibular osteotomy with placement of a custom distractor. After a latency period of 5 days, distraction was initiated at a rate of 0.25 mm twice daily. Animals in the control group (N = 5) were distracted to a length of 5.0 mm for 10 days at a rate of 0.25 mm twice daily. In contrast, animals in the experimental group (N = 5) were distracted to a length of 2.5 mm (at a rate of 0.25 mm twice daily) for 5 days, then compressed 1.0 mm for a 2-day period, and redistracted to a length of 5.0 mm. Regenerate cross-sectional area was evaluated by computed tomography performed after 5 weeks of consolidation. Gross examination and histological analysis were performed by a panel of experienced reviewers. Radiological as well as histological analysis of regenerate cross-sectional area demonstrated no significant differences between experimental (i.e., 'pumped') and control groups. Both groups demonstrated excellent regenerate bone formation with no evidence of fibrous union. This study represents the first attempt to investigate the anecdotal technique of pumping the mandibular regenerate. The authors have demonstrated that pumping the regenerate leads to no substantial differences in radiological or histological appearance of regenerate bone formation
— id: 11711, year: 2000, vol: 44, page: 516, 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,

Syndromes involving craniosynostosis and midface hypoplasia
Katzen JT; McCarthy JG
2000 Dec;33(6):1257-84, vi, Otolaryngologic clinics of North America
This article reviews a number of well-known syndromes involving craniofacial synostosis and associated midface deficiencies. Syndromes discussed include Apert's, Crouzon's, Saethre-Chotzen, and Carpenter's. Clinical characteristics and genetic defects are discussed. A general approach to surgical management is outlined
— id: 21123, year: 2000, vol: 33, page: 1257, stat: Journal Article,

Plastic surgery at the turn of the century: an opportunity for self-assessment
McCarthy JG
2000 Mar;105(3):1216-1221, Plastic & reconstructive surgery
— id: 11796, year: 2000, vol: 105, page: 1216, stat: Journal Article,

Sutural Expansion Osteogenesis for Management of the Bony-Tissue Defect in Cleft Palate Repair: Experimental Studies in Dogs
McCarthy JG
2000 May;105(6):2026-2027, Plastic & reconstructive surgery
— id: 99037, year: 2000, vol: 105, page: 2026, 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,

ZNF198-FGFR1 transforming activity depends on a novel proline-rich ZNF198 oligomerization domain
Xiao, S; McCarthy, J G; Aster, J C; Fletcher, J A
2000 Jul 15;96(2):699-704, Blood
An acquired chromosomal translocation, t(8;13)(p11;q11-12), observed in a distinctive type of stem cell leukemia/lymphoma syndrome, leads to the fusion of the 5' portion of ZNF198 and the 3' portion of FGFR1. ZNF198-FGFR1 fusion transcripts encode 4 to 10 zinc fingers, a proline-rich region, and the intracellular portion of the FGFR1 (fibroblast growth factor receptor 1) receptor tyrosine kinase. We demonstrate that the ZNF198 proline-rich region constitutes a novel self-association domain. When fused to the intracellular domain of FGFR1, the ZNF198 proline-rich region is sufficient to cause oligomerization, FGFR1 tyrosine kinase activation, and transformation of Ba/F3 cells to IL-3 independent growth. (Blood. 2000;96:699-704)
— id: 99038, year: 2000, vol: 96, page: 699, stat: Journal Article,

Increased IGF-I and IGF-II mRNA and IGF-I peptide in fusing rat cranial sutures suggest evidence for a paracrine role of insulin-like growth factors in suture fusion
Bradley JP; Han VK; Roth DA; Levine JP; McCarthy JG; Longaker MT
1999 Jul;104(1):129-138, Plastic & reconstructive surgery
Premature cranial suture fusion, or craniosynostosis, can result in gross aberrations of craniofacial growth. The biology underlying cranial suture fusion remains poorly understood. Previous studies of the Sprague-Dawley rat posterior frontal suture, which fuses at between 12 and 20 days, have suggested that the regional dura mater beneath the cranial suture directs the overlying suture's fusion. To address the dura-suture paracrine signaling that results in osteogenic differentiation and suture fusion, the authors investigated the possible role of insulin-like growth factors (IGF) I and II. The authors studied the temporal and spatial patterns of the expression of IGF-I and IGF-II mRNA and IGF-I peptide and osteocalcin (bone morphogenetic protein-4) protein in fusing posterior frontal rat sutures, and they compared them with patent coronal (control) sutures. Ten Sprague-Dawley rats were studied at the following time points: 16, 18, and 20 days of gestation and 2, 5, 10, 15, 20, 30, 50, and 80 days after birth (n = 110). Posterior frontal and coronal (patent, control) sutures were analyzed for IGF-I and IGF-II mRNA expression by in situ hybridization by using 35S-labeled IGF-I and IGF-II antisense riboprobes. Levels of IGF-I and IGF-II mRNA were quantified by counting the number of autoradiograph signals per cell. IGF-I and osteocalcin immunoreactivity were identified by avidin-biotin peroxidase immunohistochemistry. IGF-I and IGF-II mRNA were expressed in dural cells beneath fusing sutures, and the relative mRNA abundance increased between 2 and 10 days before initiation of fusion. Subsequently, IGF-I and IGF-II mRNA were detected in the suture connective tissue cells at 15 and 20 days during the time of active fusion. In contrast, within large osteoblasts of the osteogenic front, the expression of IGF-I and IGF-II mRNA was minimal. However, IGF-I peptide and osteocalcin protein were intensely immunoreactive within these osteoblasts at 15 days (during the period of suture fusion). These data suggest that the dura-suture interaction may be signaled in a paracrine fashion by dura-derived growth factors, such as IGF-I and IGF-II. These peptides, in turn, stimulate nearby osteoblasts to produce bone-promoting growth factors, such as osteocalcin
— id: 11906, year: 1999, vol: 104, page: 129, stat: Journal Article,

Cranial vault deformity and intracranial hypertension secondary to cephalic molding at delivery: a case and its management
Bradley JP; Hollier LH Jr; Weiner HL; McCarthy JG
1999 May;10(3):226-229, Journal of craniofacial surgery
Cephalic molding at birth has been traditionally felt to be benign, resulting in only a transient and self-correcting cranial deformity. However, we report a 6-month-old infant who presented with extensive cephalic molding at birth in combination with persistent brachyturricephaly from unilateral coronal synostosis and occipital deformation. Helmet therapy over a 3-month period failed despite patient compliance and numerous adjustments. Intracranial hypertension developed, as documented by multiple occipital bony erosions on computed tomographic scan and by an elevated direct intracranial pressure reading. The cranial vault asymmetry was corrected in two surgical stages: (1) occipital bar advancement, temporoparietal bone remodeling, and midline sagittal strip compression to reduce vertical height, followed in 3 months by (2) fronto-orbital advancement and remodeling
— id: 6224, year: 1999, vol: 10, page: 226, 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,

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,

Distraction of the craniofacial skeleton
McCarthy, Joseph G
New York : Springer, c1999,
— id: 599, year: 1999, vol: , page: , stat: ,

Rat mandibular distraction osteogenesis: II. Molecular analysis of transforming growth factor beta-1 and osteocalcin gene expression
Mehrara BJ; Rowe NM; Steinbrech DS; Dudziak ME; Saadeh PB; McCarthy JG; Gittes GK; Longaker MT
1999 Feb;103(2):536-547, Plastic & reconstructive surgery
Distraction osteogenesis is a powerful technique capable of generating viable osseous tissue by the gradual separation of osteotomized bone edges. Although the histologic and ultrastructural changes associated with this process have been extensively delineated, the molecular events governing these changes remain essentially unknown. We have devised a rat model of mandibular distraction osteogenesis that facilitates molecular analysis of this process. Such information has significant clinical implications because it may enable targeted therapeutic manipulations designed to accelerate osseous regeneration. In this study, we have evaluated the expression of transforming growth factor beta-1, a major regulator of osteogenesis during endochondral bone formation and development, and osteocalcin, an abundant noncollagenous extracellular matrix protein implicated in the regulation of mineralization and bone turnover. The right hemimandible of 36 adult male rats was osteotomized, and a customized distraction device was applied. Animals were allowed to recover and, after a 3-day latency period, were distracted at a rate of 0.25 mm twice daily for 6 days followed by a 2- or 4-week consolidation period. Distraction regenerate was harvested after the latency period, days 2, 4, or 6 of distraction, and after 2 or 4 weeks of consolidation and processed for Northern analysis (n = 4 at each time point) and immunohistochemical localization of TGF-beta1 (n = 2 at each time point). Six sham-operated animals (i.e., skin incision without osteotomy) were also killed (immediately postoperatively), and the mandibles were harvested and prepared in a similar fashion. Equal loading and transfer of RNA for Northern analysis was ensured by stripping and probing membranes with a probe against GAPDH (a housekeeping gene). Our results demonstrate that the spatial and temporal patterns of TGF-beta1 mRNA expression and protein production coincide with osteoblast migration, differentiation, and extracellular matrix synthesis. In addition, we demonstrate that TGF-beta1 production may be an important regulator of vasculogenesis during mandibular distraction osteogenesis. Finally, we have shown that osteocalcin gene expression coincides temporally with mineralization during rat mandibular distraction osteogenesis
— id: 7938, year: 1999, vol: 103, page: 536, stat: Journal Article,

Moebius syndrome: the new finding of hypertrophy of the coronoid process
Turk AE; McCarthy JG; Nichter LS; Thorne CH
1999 Jan;10(1):93-96, Journal of craniofacial surgery
The first detailed description of congenital facial paralysis was reported by Moebius in 1888. It is characterized by either unilateral or bilateral paralysis of the facial muscles and an associated abducens palsy. The present report is of two patients with Moebius syndrome, who were also diagnosed with trismus at birth. Each patient also demonstrated bilateral hypertrophy of the coronoid process of the mandible. In effect, the zygoma obstructed the excursion of the mandible because of a 'coronoid block.' A three-dimensional computed tomography scan demonstrated normal temporomandibular joints but bilateral hypertrophy of the coronoid processes and micrognathia. Both patients demonstrated less than 10 mm of oral excursion. Bilateral coronoidectomies were performed through an intraoral approach. The oral excursions after surgery increased to at least 20 mm. In each of these patients, the coronoid process was enlarged relative to the zygoma, which was of normal size and configuration. The trismus was associated with blocking of the coronoid by the anterior zygoma, preventing open or full excursion of the hypoplastic mandibles. Moebius syndrome can have a variable presentation at birth. In two patients, the authors describe a new finding of hypertrophy of the coronoid process and trismus secondary to obstruction of the coronoid by the hypertrophic zygomas during oral excursions. Each patient is described, and a review of the literature is discussed
— id: 7458, year: 1999, vol: 10, page: 93, 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,

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,

Use of a multiplanar distracter for the correction of a proximal interphalangeal joint contracture
Kasabian A; McCarthy J; Karp N
1998 Apr;40(4):378-381, Annals of plastic surgery
Proximal interphalangeal (PIP) joint contractures are common complications in hand injuries and conditions such as Dupuytren's contracture. Conventional treatment such as splinting and serial casting may result in inadequate improvement. Operative release of the contracture may be complicated by neurovascular overstretch with injury to the digital nerves or vascular compromise. Gradual distraction of the contracted joint may prevent this neurovascular injury. The multiplanar distracter was designed for three-dimensional distraction of the mandible. Distraction may be obtained in the X, Y, or Z planes. With this device, the angular relationship between two planes may be altered. A 22-year-old male with a PIP joint contraction following replantation failed conventional treatment for release. With the use of a multiplanar distracter, the flexion contraction was reduced from 95 degrees to a more functional 30 degrees using gradual angular distraction. The angle between the proximal and middle phalanges were gradually changed using the ability of the distracter to change the angular relationship in the X-Y plane. At 3 and 6 months postdistraction, the patient has maintained his 30-degree flexion angle. The multiplanar distracter is a simple technique that may be useful for the treatment of PIP joint contractures that fail conventional therapy
— id: 57175, year: 1998, vol: 40, page: 378, stat: Journal Article,

Studies in cranial suture biology: regional dura mater determines overlying suture biology
Levine JP; Bradley JP; Roth DA; McCarthy JG; Longaker MT
1998 May;101(6):1441-1447, Plastic & reconstructive surgery
The influence of dura mater on adjacent cranial sutures is significant. By better understanding the mechanisms of normal suture fusion and the role of the dura mater, it may be possible to delineate the events responsible for the premature suture fusion seen in craniosynostosis. In the Sprague-Dawley rat, the posterior frontal suture normally fuses between 12 and 20 days of postnatal life and has proved to be an excellent model to describe normal suture fusion. The purpose of this study was to document the critical role that the dura mater-suture complex may play on cranial suture biology. Forty Sprague-Dawley rats at 8 days of age were divided into two groups of 20 animals each. The control group (group A) had surgical disruption of the dura mater-calvarial interface. This was accomplished by elevating a strip of cranium inclusive of the posterior frontal and sagittal sutures and replacement of the cranial strip back to its anatomic position, all with the dura mater left intact. The experimental group (group B) had the same calvarial elevation (strip craniectomy), but the sutural anatomy/alignment was rotated 180 degrees. This rotation placed the posterior frontal suture into the sagittal suture's anatomic position and the sagittal suture into the posterior frontal suture's anatomic position. All of these procedures were accomplished by leaving the underlying dura mater intact. Animals were killed at 20, 30, 40, and 50 days (12, 22, 32, and 42 days postoperatively), and tissue sections were examined with hematoxylin and eosin staining. Group A (control) showed normal but delayed suture activity. The posterior frontal suture fused, and the sagittal suture remained patent. Fusion was delayed, not beginning before 20 days (12 days postoperative) and showing complete fusion between 30 and 40 days. Group B (180-degree calvarial rotation) demonstrated that the suture in the posterior frontal anatomic position (actual sagittal suture) fused between 20 and 40 days, whereas the suture in the sagittal anatomic position (actual posterior-frontal suture) remained patent throughout the study. This study demonstrates that the location of the dura mater-suture complex is important in determining either suture patency or closure in this model. Normal closure of the suture overlying the posterior frontal dura mater demonstrates that the dura mater itself, or forces derived in specific cranial locations, determines the overlying suture biology
— id: 7654, year: 1998, vol: 101, page: 1441, stat: Journal Article,

The combination of endoscopy and distraction osteogenesis in the development of a canine midface advancement model
Levine JP; Rowe NM; Bradley JP; Williams JK; Mackool RJ; Longaker MT; McCarthy JG
1998 Sep;9(5):423-432, Journal of craniofacial surgery
The requirements for reconstruction in patients with midface hypoplasia can be formidable: a bicoronal scalp incision, Le Fort III or monobloc skeletal advancement, harvesting and insertion of bone grafts, application of rigid (and occasionally intermaxillary) fixation, blood transfusions, and prolonged operative time and hospitalization. The introduction of the endoscope offers the possibility of minimally invasive surgery with improved visualization of the osteotomy sites. The development of distraction osteogenesis as a surgical technique allows controlled and gradual advancement of the osteotomized skeletal segment and associated soft tissue. The purpose of this study was to develop a canine model of an endoscopically assisted Le Fort III osteotomy with attendant midface distraction. Four mongrels (20 kg in weight) were study subjects. Three 2-cm skin incisions were made (two perpendicular to the zygomaticomaxillary suture and one perpendicular to the nasofrontal suture). The soft tissue and periosteum were evaluated bluntly. Retractors specially designed for the project created a space for endoscopic visualization. Bilateral zygomatic, nasofrontal, and medial orbital wall osteotomies, corticotomies, or both were performed under endoscopic visualization using a reciprocating saw; the medial orbital wall sectioning was specifically not completed (i.e., corticotomy) to avoid laceration of the mucosa and attendant bleeding. The pterygomaxillary osteotomy was completed with an osteotome and mallet. Finally, the nasal septum was only partially divided with an osteotome to avoid excessive blood loss. Four distraction devices were placed across the above-noted osteotomies (two across the nasofrontal osteotomy and one across each lateral osteotomy). The animals were distracted 1 mm per day for 16 to 40 days after surgery (16-40 mm of linear distraction). Cephalograms and computed tomography scans were obtained before and after distraction. The animals were killed after remaining in fixation for 4 to 6 weeks after distraction. All soft tissue was removed and the skull was examined. Photos were obtained throughout the experiment for documentation. The study demonstrated that Le Fort III osteotomies can be performed successfully via small incisions with endoscopic assistance in canine subjects with excellent visualization and minimal bleeding. The advancement of the midface segment can be achieved by activation of an external distraction device
— id: 7652, year: 1998, vol: 9, page: 423, 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,

Invited discussion
McCarthy, JG
1998 AUG ;41(2):155-155, Annals of plastic surgery
— id: 53397, year: 1998, vol: 41, page: 155, stat: Journal Article,

Rigid external distraction: Its application in cleft maxillary deformities - Discussion
McCarthy, JG
1998 OCT ;102(5):1373-1374, Plastic & reconstructive surgery
— id: 53695, year: 1998, vol: 102, page: 1373, stat: Journal Article,

Immunolocalization of basic fibroblast growth factor and fibroblast growth factor receptor-1 and receptor-2 in rat cranial sutures
Mehrara BJ; Mackool RJ; McCarthy JG; Gittes GK; Longaker MT
1998 Nov;102(6):1805-1817, Plastic & reconstructive surgery
Craniosynostosis is a common disorder with an unknown etiology. Recent genetic mapping studies have demonstrated a strong linkage between several familial craniosynostotic syndromes and mutations in fibroblast growth factor receptor 1 (FGF-R1) and 2 (FGF-R2). The purpose of this experiment was to investigate by immunohistochemistry the protein production of these receptors as well as of their most prevalent ligand, basic fibroblast growth factor (bFGF), before, during, and after sutural fusion in rat cranial sutures. The posterior frontal (normally fuses between postnatal days 12 and 22) and sagittal (remains patent) sutures of embryonic day 20 and neonatal days 6, 12, 17, 22, and 62 (n = 3 per group) were harvested, fixed, and decalcified. Five-micrometer sections were stained with polyclonal antibodies against bFGF, FGF-R1, and FGF-R2, and patterns of immunohistochemical staining were assessed by independent reviewers. Our results indicate that increased bFGF production correlates temporally with suture fusion, with increased staining of the dura underneath the fusing suture prior to fusion followed by increased staining within osteoblasts and sutural cells during fusion. FGF-R1 and, to a lesser extent FGF-R2 immunostaining revealed a different pattern of localization with increased immunostaining within the patent sagittal suture at these time points. These results implicate bFGF in the regulation of sutural fusion and may imply autoregulatory mechanisms in fibroblast growth factor receptor expression
— id: 7679, year: 1998, vol: 102, page: 1805, stat: Journal Article,

Studies in cranial suture biology: up-regulation of transforming growth factor-beta1 and basic fibroblast growth factor mRNA correlates with posterior frontal cranial suture fusion in the rat
Most D; Levine JP; Chang J; Sung J; McCarthy JG; Schendel SA; Longaker MT
1998 May;101(6):1431-1440, Plastic & reconstructive surgery
The mechanisms involved in normal cranial suture development and fusion as well as in the pathophysiology of craniosyostosis are not well understood. The purpose of this study was to investigate the expression of several cytokines--transforming growth factor-beta-1 (TGF-beta1), basic fibroblast growth factor (bFGF), and interleukin-6 (IL-6)--during cranial suture fusion. TGF-beta exists in three mammalian isoforms that are abundant in bone and stimulate calvarial bone formation when delivered locally. Other bone growth factors including basic fibroblast growth factor and the interleukins regulate bone growth and are mitogenic for bone marrow cells and osteoblasts. The involvement of growth factors in the pathophysiology of craniosynostosis is supported by recent genetics data linking fibroblast growth factor receptor mutations to syndromal craniosynostoses. In this experimental study, in situ hybridization was used to localize and quantify the gene expression of TGF-beta1, bFGF, and IL-6 during cranial suture fusion. In the Sprague-Dawley rat, the posterior frontal cranial suture normally undergoes fusion between 12 and 22 days of age, whereas all other cranial sutures remain patent. All in situ analyses of fusing posterior frontal sutures were compared with the patent, control, sagittal sutures. Posterior frontal and sagittal sutures, together with underlying dura, were harvested from rats at 8, 12, 16, and 35 days of postnatal life to analyze posterior frontal suture activity before, during, and after fusion. In situ hybridization was performed on frozen sections of these specimens using DNA probes specific for TGF-beta1, bFGF, and IL-6 mRNA. A negative control probe to IL-6 in the sense orientation was also used to validate the procedure. Cells expressing cytokine-specific mRNA were quantified (in cells positive per 10(-1) mm2) and analyzed using the unpaired Student's t test. Areas encompassing the fibrous suture and the surrounding bone plates were analyzed for cellular mRNA activity. IL-6 mRNA expression showed a minimal rise in the posterior frontal suture at days 12 and 16, with an average count of 10 and 6 cells per 10(-1) mm2, respectively. The sagittal suture remained negative for IL-6 mRNA at all time points. TGF-beta1 and bFGF analyses were most interesting, showing marked increases specifically in the posterior frontal suture during the time of active suture fusion. On postnatal day 8, a 1.5-fold increase in posterior frontal suture TGF-beta1 mRNA was found compared with sagittal sutures (p = 0.1890, unpaired Student's t test). This difference was increased 26-fold on day 12 in posterior frontal suture TGF-beta1 expression (p = 0.0005). By day 35, posterior frontal suture TGF-beta1 mRNA had nearly returned to prefusion levels, whereas TGF-beta1 mRNA levels in the sagittal suture remained low. A similar upregulation of bFGF mRNA, peaking at day 12, was observed in posterior frontal but not sagittal sutures (p = 0.0003). Furthermore, both TGF-beta1 and bFGF mRNA samples with intact dura showed an intense dural mRNA expression in the time preceding and during active posterior frontal suture fusion but not in sagittal tissues. Our data demonstrate that TGF-beta1 and bFGF mRNA are up-regulated in cranial suture fusion, possibly signaling in a paracrine fashion from dura to suture. TGF-beta1 and bFGF gene expression were dramatically increased both in and surrounding the actively fusing suture and followed the direction of fusion from endocranial to epicranial. These experimental data on bone growth factors support the recent human genetics data linking growth factor/fibroblast growth factor receptor deletions to syndromal craniosynostoses. The ultimate aim of these studies is to understand the underlying mechanisms regulating suture growth, development, and fusion so surgeons may one day manipulate the biology of premature cranial suture fusion
— id: 7967, year: 1998, vol: 101, page: 1431, stat: Journal Article,

Rat mandibular distraction osteogenesis: Part I. Histologic and radiographic analysis
Rowe NM; Mehrara BJ; Dudziak ME; Steinbreck DS; Mackool RJ; Gittes GK; McCarthy JG; Longaker MT
1998 Nov;102(6):2022-2032, Plastic & reconstructive surgery
The application of distraction osteogenesis to craniofacial surgery has altered the approach and treatment of congenital and acquired craniofacial defects. Although the histologic and ultrastructural changes associated with distraction osteogenesis have been described extensively, relatively little is known about the molecular regulation of this process. The elucidation of the molecular mechanisms of distraction osteogenesis has important clinical implications because it may facilitate the use of recombinant proteins or gene therapy to accelerate bone regeneration. Molecular analysis of distraction osteogenesis has been hindered by the use of large animal models in which only limited genetic information is available. In this study, a rat model of mandibular distraction osteogenesis is described. This report includes a pilot study (n = 50) to develop an appropriate distraction device and to determine the optimal placement of the osteotomy. The study subsequently included 80 animals, 35 of which were distracted at a rate of 0.25 mm per day for 6 days (1.5 mm total) and 35 that were distracted at a rate of 0.25 mm twice per day (3.0 mm total). These animals were killed at various time points (after latency and during the distraction and consolidation periods) and displayed histologic and radiographic findings of membranous bone distraction osteogenesis that were consistent with those in large ,animal and clinical models. In addition, five animals each were acutely lengthened 1.5 mm and 3.0 mm and demonstrated a fibrous nonunion. Furthermore, the utility of this model is demonstrated in the analysis of the molecular mechanisms of distraction osteogenesis by applying the polymerase chain reaction to total cellular RNA isolated from normal and distracted rat mandibles. In conclusion, it is believed that the rat model of distraction osteogenesis has significant advantages over traditional models, including decreased costs and facilitation of molecular analysis
— id: 7945, year: 1998, vol: 102, page: 2022, stat: Journal Article,

Airway management in children with major craniofacial anomalies
Sculerati N; Gottlieb MD; Zimbler MS; Chibbaro PD; McCarthy JG
1998 Dec;108(12):1806-1812, Laryngoscope
OBJECTIVES: Delineation of clinical characteristics affecting the airway in a cohort of craniofacially deformed children. What factors differ between patients requiring and those not requiring surgical airway intervention? What factors predispose to the need for tracheotomy? When can decannulation be expected if tracheotomy is required? What interventions aid decannulation? STUDY DESIGN: Five-year retrospective chart review at tertiary center. METHODS: Two hundred fifty-one patients met the following entry criteria: enrollment in the New York University Institute of Reconstructive and Plastic Surgery's Craniofacial Clinic and admission to Tisch Hospital in Manhattan for surgery from 1990 to 1994. Hospital, clinic, and departmental office records were reviewed. All patients had major craniofacial bony anomalies and underwent administration of general anesthesia at least once. RESULTS: Nearly 20% of all children required tracheotomy (47/251). Craniofacial synostosis patients (Crouzon, Pfeiffer, or Apert syndrome) had the highest rate of tracheotomy (48% [28/59]). Mandibulofacial dysostoses patients (Treacher Collins or Nager syndrome) had the next highest rate (41% [28/59]). Patients with oculo-auriculo-vertebral sequence were less likely to undergo tracheotomy (22% [9/41]). Children with craniosynostosis rarely required a surgical airway, unless there was marked associated facial dysmorphism (1% [1/72]). The duration of cannulation was related to the age at tracheotomy in a bimodal distribution. Generally, tracheotomies required before age 4 years remained for several years, whereas those placed after age 4 were removed after several weeks. The presence of a cleft palate correlated with reduced risk for tracheotomy, but the presence of a ventriculoperitoneal shunt correlated with an increased risk for tracheotomy. Procedures selectively used to improve the airway included midface advancement, mandibular expansion, tonsillectomy and adenoidectomy, uvulopalatopharyngoplasty, anterior tongue reduction, and endoscopic tracheal granuloma excision. CONCLUSIONS: The likelihood for surgical airway management is related to specific craniofacial diagnosis. The length of tracheal cannulation is greatest for infants and young children who manifest severe airway compromise, often because of nasal obstruction in combination with other anatomic factors. Early tracheotomy is advocated for these patients to promote optimal growth and development. Choanal atresia is often misdiagnosed in these infants; nasal obstruction is actually secondary to midface retrusion. Staged surgical interventions can allow eventual successful decannulation in nearly all cases of craniofacial syndromes
— id: 12052, year: 1998, vol: 108, page: 1806, 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,

In vitro prefabrication of human cartilage shapes using fibrin glue and human chondrocytes
Ting V; Sims CD; Brecht LE; McCarthy JG; Kasabian AK; Connelly PR; Elisseeff J; Gittes GK; Longaker MT
1998 Apr;40(4):413-420, Annals of plastic surgery
We report the first generation of human cartilage from fibrin glue using a technique of molding chondrocytes in fibrin glue developed in our laboratory. Human costal chondrocytes were suspended in cryoprecipitate and polymerized into a human nasal shape with bovine thrombin. After culture in vitro for 4 weeks, this construct was implanted subcutaneously into a nude mouse. The final construct harvested after 4 weeks in vivo demonstrated some preservation of its original features. Histological analysis showed features of native cartilage, including matrix synthesis and viable chondrocytes by nuclear staining. Biochemical analysis demonstrated active matrix production. Biomechanical testing was performed. To our knowledge this is the first reported creation of human cartilage from fibrin glue, and the first creation of human cartilage in vitro. This technique may become a promising means of engineering precisely designed autogenous cartilage for human reconstruction
— id: 57271, year: 1998, vol: 40, page: 413, 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,

Studies in cranial suture biology: regional dura mater determines in vitro cranial suture fusion
Bradley JP; Levine JP; McCarthy JG; Longaker MT
1997 Oct;100(5):1091-1099, Plastic & reconstructive surgery
Craniosynostosis results in alterations in craniofacial growth that create cosmetic abnormalities and functional deficits, yet the biology underlying cranial suture fusion remains unknown. The purpose of the present study was to show that regional dura mater can induce suture fusion while in an organ culture system in cranial sutures programmed to remain patient. To accomplish this, we studied mouse cranial sutures, since in this model the posterior frontal suture (analogous to the human metopic suture) fuses in both in vivo and in vitro environments while all other sutures remain patent. We demonstrated that when mouse sagittal sutures (programmed to remain patent) were rotated or translocated to overlie the posterior frontal dura then grown in organ culture systems, suture fusion occurred. Twenty-four-day-old CD-1 mice (time when the posterior frontal suture was patent) were divided into three groups of 50 (n = 165: three groups of 50 cultured and three groups of 5 uncultured controls). Group A (unrotated control group) was characterized by a strip of posterior frontal and sagittal suture with underlying dural tissue grown in organ culture systems for up to 30 days and resulted in persistent patency of the sagittal suture and fusion of the posterior frontal suture in an anterior-to-posterior direction. Group B (rotated experimental group) was characterized by 180-degree suture rotation while in vitro and resulted in patency of the posterior frontal suture over the sagittal dura and fusion of the sagittal suture over the posterior frontal dura in a posterior-to-anterior suture direction. Group C (translocated experimental group) was characterized by translocation or shifting of sutures while in vitro and resulted in patency of the posterior frontal suture over the sagittal dura and fusion of the sagittal suture over the posterior frontal dura in an anterior-to-posterior suture direction. These data from the in vitro rotation and translocation experiments indicate that the 'regional' posterior frontal dura determined in vitro cranial suture fusion. Molecular mechanisms behind this process are thought to involve inductive tissue interactions of the dural cells with the suture cells by means of growth factor-mediated signal pathways
— id: 7120, year: 1997, vol: 100, page: 1091, stat: Journal Article,

Histopathologic and biochemical changes in the muscles affected by distraction osteogenesis of the mandible
Fisher, E; Staffenberg, D A; McCarthy, J G; Miller, D C; Zeng, J
1997 Feb;99(2):366-371, Plastic & reconstructive surgery
Lengthening of the canine mandible using an intraoral distraction device was performed in order to study the effects of distraction on the associated muscles of mastication. Biopsies of the masseter and digastric muscles were taken after lengthening at four different time intervals to assess the temporal changes in the masticatory muscles of 10 dogs. Biopsies of the muscles on the contralateral side also were taken from 6 of these dogs before lengthening to establish a control group. Each biopsy was analyzed histologically and spectophotomerically for RNA, DNA and protein content. The digastric muscle underwent transient atrophy with initiation of distraction but regenerated completely after 48 days of fixation. The masseter muscle was unchanged initially but showed evidence of atrophy only after 20 mm of distraction it continued to exhibit evidence of atrophy during fixation. Protein synthesis was decreased significantly during periods of atrophy in the masseter; no such change was noted in the digastric. Unlike the masseter, the digastric fibers lie in a plane parallel to the vector of distraction. These findings suggest that any muscle affected by skeletal distraction in the same plane or vector (e.g., digastric) adapts with compensatory regeneration and hypertrophy. Moreover, those muscles lying in a different plane (e.g., masseter) show persistent evidence of atrophy with decreased protein synthesis
— id: 99041, year: 1997, vol: 99, page: 366, 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,

Bone morphogenetic protein promotes vascularization and osteoinduction in preformed hydroxyapatite in the rabbit
Levine JP; Bradley J; Turk AE; Ricci JL; Benedict JJ; Steiner G; Longaker MT; McCarthy JG
1997 Aug;39(2):158-168, Annals of plastic surgery
Early reconstruction of large osseous defects in children is often delayed due to limited availability of autogenous bone graft donor sites. With the advent of growth factors, osteoinductive proteins, and delivery matrices, it is possible to fabricate new bone at extraskeletal sites. Due to their own blood supply, adequate bony volume, and decreased resorption, vascularized bone flaps have demonstrated greater success in restoring large bony defects compared with nonvascularized bone grafts. The purpose of this study is to prefabricate a vascularized bone flap in the immature-age rabbit using the auricularis anterior muscle as a muscle pedicle. Sixteen female New Zealand White rabbits, 2.0 to 2.5 kg, were divided into two groups. Group 1 contained 8 animals that had T-shaped, 10 x 6 x 4-mm hydroxyapatite (HA) implants combined with 100-microgram bovine-derived bone morphogenetic protein (BMP) placed supraperiosteally and fixed deep to the auricularis anterior muscle. Implants with HA alone were placed in the same animal and secured to the contralateral auricularis anterior muscle. Group 2 contained 8 animals that had HA/BMP placed subperiosteally and fixed deep to the auricularis anterior muscle, while implants with HA alone were secured in the same animal to the contralateral auricularis anterior muscle. In each group, 4 animals were sacrificed at 4 and 8 weeks. The animals underwent randomized bilateral carotid artery injection with micropaque barium suspension just prior to sacrifice to help maintain vascularity. At harvest the implants and surrounding muscle and cranium were removed en bloc. New bone formation in the HA implants was examined by using routine histology and scanning electron microscopic backscattering image (quantitative) analysis. Microradiographs were performed on representative specimens. At 4 weeks postimplantation, backscattering analysis in the subperiosteal HA/BMP showed a mean 17.1% bone ingrowth vs. 11.3% of HA alone (p < 0.05). Supraperiosteal HA/BMP showed a mean 12.9% bone ingrowth vs. 0% of HA alone (p < 0.05). At 8 weeks, backscatter analysis of supraperiosteal HA/BMP showed a mean 19.33% bone ingrowth vs. 0% of HA alone (p < 0.05). Subperiosteal HA/BMP showed a mean 22% bone ingrowth vs. 20.85% of HA alone. This was the only group that did not have statistically significant results. Implant histology demonstrated woven bone within the interstices of HA/BMP placed either supra- or subperiosteally. In the HA-alone implants placed supraperiosteally, fibrovascular ingrowth was seen without any evidence of bone formation. In the HA-alone implant placed subperiosteally, woven bone was seen at the calvarium-implant junction. Microradiographs also demonstrated vascularization and bone formation similar to that seen on scanning electron microscopy. BMP-treated specimens appeared to have slightly greater vascularity than the nontreated specimens. The greatest bone formation occurred with the HA/BMP implant placed subperiosteally in the immature rabbit. Furthermore, these results demonstrate the potential prefabrication of vascularized bone flaps as early as 4 to 8 weeks. The clinical advantage of HA permits the surgeon to design osseous flaps that are customized in shape, fill all contour defects, and have little resorptive properties. Such prefabricated bone with an axial blood supply may allow for ultimate transfer as a pedicle or free flap to reconstruct osseous defects in children
— id: 7196, year: 1997, vol: 39, page: 158, stat: Journal Article,

Craniofacial microsomia. A primary or secondary surgical treatment program
McCarthy JG
1997 Jul;24(3):459-474, Clinics in plastic surgery
Craniofacial microsomia is a complex deformity involving the craniofacial skeleton and the overlying soft tissues. This article discusses treatment programs with consideration of the variability in several anatomic areas and the severity of the deformity. A classification system for mandibular pathology is described
— id: 7214, year: 1997, vol: 24, page: 459, stat: Journal Article,

Correction of the prominent ear with the converse tubing technique
McCarthy, J G
1997 Sep-Oct;17(5):339-339, Aesthetic surgery journal
— id: 99040, year: 1997, vol: 17, page: 339, stat: Journal Article,

Immunolocalization of transforming growth factor beta 1, beta 2, and beta 3 and insulin-like growth factor I in premature cranial suture fusion
Roth DA; Gold LI; Han VK; McCarthy JG; Sung JJ; Wisoff JH; Longaker MT
1997 Feb;99(2):300-309, Plastic & reconstructive surgery
The etiology of craniosynostosis remains unknown. The beta group of transforming growth factors (TGF-beta) and insulin-like growth factors (IGF-I and IGF-II) are known to induce new bone formation and, when added exogenously, cause accelerated closure of calvarial defects. The possible roles of these bone growth factors in premature cranial suture fusion in humans have not been explored. We analyzed a total of 20 cranial suture biopsy samples (10 synostotic and 10 normal) from 10 infants with single-suture craniosynostosis undergoing cranial vault remodeling. Using isoform-specific antibodies for TGF-beta 1, -beta 2, and -beta 3 and IGF-I, we demonstrated immunoreactivity of these growth factors were present in human cranial sutures; the TGF-beta 2 isoform was the most intensely immunoreactive. Most importantly, the TGF-beta isoforms and IGF-I showed more intense immunoreactivity in the actively fusing craniosynostotic sutures compared with the control patent sutures. Specifically, the TGF-beta isoforms and IGF-I were intensely localized in the osteoblasts synthesizing new bone at the suture margin. It is noteworthy that although the patent sutures were less immunoreactive for TGF-beta isoforms than fused sutures, there was a distinct pattern of the TGF-beta 3 isoform that was immunolocalized to the margin of the normal patent sutures. This suggests a possible role for TGF-beta 3 in maintaining cranial suture patency. The increased immunoreactivity of both TGF-beta 2 and IGF-I in the actively fusing sutures compared with the patent control sutures indicates that these growth factors may play a role in the biology underlying premature suture closure. To our knowledge, this is the first study showing the presence of TGF-beta 1, -beta 2, and -beta 3 and IGF-I in prematurely fusing human cranial sutures. In the future, manipulating the local expression of these growth factors at the suture site may enable plastic surgeons to modulate premature suture fusion
— id: 34714, year: 1997, vol: 99, page: 300, 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,

Studies in cranial suture biology: Part I. Increased immunoreactivity for TGF-beta isoforms (beta 1, beta 2, and beta 3) during rat cranial suture fusion [see comments]
Roth DA; Longaker MT; McCarthy JG; Rosen DM; McMullen HF; Levine JP; Sung J; Gold LI
1997 Mar;12(3):311-321, Journal of bone & mineral research
The mechanisms involved in normal cranial suture development and fusion as well as the pathophysiology of craniosynostosis, a premature fusion of the cranial sutures, are not well understood. Transforming growth factor-beta isoforms (TGF-beta 1, beta 2, and beta 3) are abundant in bone and stimulate calvarial bone formation when injected locally in vivo. To gain insight into the role of these factors in normal growth and development of cranial sutures and the possible etiology of premature cranial suture fusion, we examined the temporal and spatial expression of TGF-beta isoforms during normal cranial suture development in the rat. In the Sprague-Dawley rat, only the posterior frontal cranial suture undergoes fusion between 12 and 22 days of age, while all other cranial sutures remain patent. Therefore, immunohistochemical analysis of the fusing posterior frontal suture was compared with the patent sagittal suture at multiple time points from the fetus through adult. Whereas the intensity of immunostaining was the same in the posterior frontal and sagittal sutures in the fetal rat, there was increased immunoreactivity for TGF-beta isoforms in the actively fusing posterior frontal suture compared with the patent sagittal suture starting 2 days after birth and continuing until approximately 20 days. There were intensely immunoreactive osteoblasts present during fusion of the posterior frontal suture. In contrast, the patent sagittal suture was only slightly immunoreactive. A differential immunostaining pattern was observed among the TGF-beta isoforms; TGF-beta 2 was the most immunoreactive isoform and was also most strongly associated with osteoblasts adjacent to the dura and the margin of the fusing suture. Since the increased expression of TGF-beta 2 during suture fusion suggested a possible regulatory role, recombinant TGF-beta 2 was added directly to the posterior frontal and sagittal sutures in vivo to determine if suture fusion could be initiated. Exogenously added TGF-beta 2 stimulated fusion of the ectocranial surface of the posterior frontal suture. These data provide evidence for a regulatory role for these growth factors in cranial suture development and fusion. Additionally, the intense immunostaining for TGF-beta 2 in the dura mater underlying the fusing suture supports a role for the dura mater in suture fusion. It is possible that premature or excessive expression of these factors may be involved in the etiopathogenesis of craniosynostosis and that modulation of the growth factor profile at the suture site may have potential therapeutic value
— id: 12370, year: 1997, vol: 12, page: 311, stat: Journal Article,

Blood supply of the Le Fort I maxillary segment: an anatomic study
Siebert JW; Angrigiani C; McCarthy JG; Longaker MT
1997 Sep;100(4):843-851, Plastic & reconstructive surgery
The vascular supply of the Le Fort I osteotomy segment was studied by utilizing standard latex injection techniques. Anatomic dissections in 10 fresh cadavers demonstrated interruption of the descending palatine arteries with preservation of the ascending palatine branch of the facial artery and the anterior branch of the ascending pharyngeal artery within the attached posterior palatal soft-tissue pedicle in all specimens following Le Fort I maxillary osteotomy. These ascending arterial branches entered the soft palate at a position approximately 1 cm posterior to the pterygomaxillary junction, which was disrupted during the Le Fort I maxillary osteotomy. Separate ink injections of total maxillary osteotomy segments confirmed vascular perfusion of the ipsilateral hemimaxillary segment by the ascending palatine artery. Thus vascular supply of the mobilized Le Fort I maxillary segment is by means of the ascending palatine branch of the facial artery and the anterior branch of the ascending pharyngeal artery in addition to the rich mucosal alveolar anastomotic network overlying the maxilla
— id: 7260, year: 1997, vol: 100, page: 843, stat: Journal Article,

Intracranial hypertension in a patient with craniofacial synostosis and patent sutures
Williams, J K; Longaker, M T; Wisoff, J; McCarthy, J G
1997 Sep;8(5):373-378, Journal of craniofacial surgery
Craniosynostosis is often associated with restrictive cranial vault deformities, diminished intracranial volume, and intracranial hypertension. Advances in imaging techniques have provided a method of intracranial volume analysis that has demonstrated a more complicated relationship between craniofacial abnormalities and elevated intracranial pressures. Studies have confirmed a decrease in intracranial volume in the presence of craniosynostosis, but this association is not found in every patient. We report an unusual case of elevated intracranial pressure in a patient with the clinical stigmata of Crouzon's syndrome but with patent cranial vault sutures
— id: 99039, year: 1997, vol: 8, page: 373, stat: Journal Article,

Studies in cranial suture biology: in vitro cranial suture fusion
Bradley JP; Levine JP; Blewett C; Krummel T; McCarthy JG; Longaker MT
1996 Mar;33(2):150-156, Cleft palate-craniofacial journal
The biology underlying craniosynostosis remains unknown. Previous studies have shown that the underlying dura mater, not the suture itself, signals a suture to fuse. The purpose of this study was to develop an in vitro model for cranial-suture fusion that would still allow for suture-dura interaction, but without the influence of tensional forces transmitted from the cranial base. This was accomplished by demonstrating that the posterior frontal mouse cranial suture, known to be the only cranial suture that fuses in vivo, fuses when plated with its dura in an organ-culture system. In such an organ-culture system, the sutures are free from both the influence of dural forces transmitted from the cranial base and from hormonal influences only available in a perfused system. For the cranial-suture fusion in vitro model study, the sagittal sutures (controls that remain patent in vivo) and posterior frontal sutures (that fuse in vivo) with the underlying dura were excised from 24-day-old euthanized mice, cut into 5 x 4 x 2-mm specimens, and cultured in a chemically defined, serum-free media. One hundred sutures were harvested at the day of sacrifice, then every 2 days thereafter until 30 days in culture, stained with H & E, and analyzed. A subsequent cranial-suture without dura in vitro study was performed in a similar fashion to the first study, but only the calvariae with the posterior frontal or sagittal sutures (without the underlying dura) were cultured. Results from the cranial-suture fusion in vitro model study showed that all sagittal sutures placed in organ culture with the underlying dura remained patent. More importantly, the posterior frontal sutures with the underlying dura, which were plated-down as patent at 24 days of age, demonstrated fusion after various growth periods in organ culture. In vitro posterior frontal mouse-suture fusion occurred in an anterior-to-posterior direction but in a delayed fashion, 4 to 7 days later than in vivo posterior frontal mouse-suture fusion. In contrast, the subsequent cranial-suture without dura in vitro study showed patency of all sutures, including the posterior frontal suture. These data from in vitro experiments indicate that: (1) mouse calvariae, sutures, and the underlying dura survive and grow in organ-culture systems for 30 days; (2) the local dura, free from external influences transmitted from the cranial base and hormones from distant sites, influences the cells of its overlying suture to cause fusion; and (3) without dura influence, all in vitro cranial sutures remained patent. By first identifying the factors involved in dural-suture signaling and then regulating these factors and their receptors, the biologic basis of suture fusion and craniosynostosis may be unraveled and used in the future to manipulate pathologic (premature) suture fusion
— id: 6891, year: 1996, vol: 33, page: 150, stat: Journal Article,

Studies in cranial suture biology: IV. Temporal sequence of posterior frontal cranial suture fusion in the mouse
Bradley JP; Levine JP; Roth DA; McCarthy JG; Longaker MT
1996 Nov;98(6):1039-1045, Plastic & reconstructive surgery
The biology underlying normal and premature cranial suture fusion remains unknown. To develop a model for normal cranial suture fusion, the temporal sequence of the posterior frontal cranial suture fusion in the mouse was determined. To do this, all the cranial sutures of three distinct strains of mice (CD-1, CF-1, and C57bl-6) were studied histologically for fusion at sequential time points. Two studies were set up using group A mice (n = 72, all sutures studied) and group B mice (n = 78, only the posterior frontal suture studied, but more precisely along its anatomic length). In the group A cranial suture study, mice were sacrificed starting at newborn age and then every 5 days until age 50 days. In addition, two mature mice (250 days old) from each strain were sacrificed. In all three mouse strains, histologic examinations showed that the anterior frontal, sagittal, coronal, lambdoid, and occipitointerparietal sutures remained patent at up to 50 days of age and were patent in the 250-day mature mice. However, examination of the midpoint of the posterior frontal suture showed patency at 30 days, partial fusion at 35 days, and complete fusion by 40 days. These data prompted the posterior frontal suture fusion study. In the group B posterior frontal suture fusion study, mice were sacrificed at age 23 days and then every 2 days until 47 days of age. The anterior, midpoint, and posterior aspects of the posterior frontal suture were examined: The anterior aspect fused between 25 and 29 days; the midpoint fused between 31 and 37 days; and the posterior aspect fused between 39 and 45 days. These data indicate that fusion of the posterior frontal cranial suture in the mouse proceeds in a defined temporal sequence from an anterior to posterior direction in three distinct strains of mice, while in the same mice all other cranial sutures remain patent. By describing and understanding the fusion of the normal posterior frontal suture, a biologic basis of normal suture development and fusion can be established and used as a comparison for murine cranial sutures altered surgically, biochemically (with growth factors), or genetically (with craniosynostotic phenotypes)
— id: 12501, year: 1996, vol: 98, page: 1039, stat: Journal Article,

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

The histomorphologic changes in vascularized bone transfer and their interrelationship with the recipient sites: a 1-year study
Gosain AK; McCarthy JG; Staffenberg D; Glat PM; Simmons DJ
1996 Apr;97(5):1001-1013, Plastic & reconstructive surgery
In 13 New Zealand White rabbits with a mean age of 6 months, vascularized bone transfers incorporated as paired auricular anterior myo-osseous flaps were harvested; they were placed in either an inlay or an onlay position relative to the zygomatic arch. The onlay bone transfers were placed either in full contact or in partial contact with the zygomatic arch. The animals were sacrificed 1 year after transfer. At 1 year, the inlay transfer simulated the adjacent zygoma in width and thickness. Onlay full contact transfers maintained significant aug mentation in thickness of the zygoma, while the onlay partial contact transfers did not; the thickness of the augmented zygoma in the onlay full contact subgroup was significantly greater than that in the onlay partial contact transfers. The onlay partial contact grafts had remodeled into the zygoma in bone contact, where the orientation of mismatched osteons within the bone transfers had transformed to match that of the native zygoma. In areas of bone contact between the onlay and the host bone, full-thickness conversion from a cortical to a trabecular architecture had occurred in both the transfer and host bones. These findings have numerous implications regarding mechanisms that could be exploited clinically to optimize the survival of a bone transfer; they also raise questions regarding alteration of the recipient bed after placement of an onlay bone transfer
— id: 56872, year: 1996, vol: 97, page: 1001, stat: Journal Article,

Morbidity associated with increased intracranial pressure in Apert and Pfeiffer syndromes: the need for long-term evaluation
Gosain AK; McCarthy JG; Wisoff JH
1996 Feb;97(2):292-301, Plastic & reconstructive surgery
Although the incidence of elevated intracranial pressure is increased in patients with the craniosynostosis syndromes, the significance of these findings and their impact on clinical practice remain unclear. The morbidity related to elevated intracranial pressure in patients with Apert and Pfeiffer syndromes was reviewed. Sixty-seven patients with Apert syndrome and 39 patients with Pfeiffer syndrome were identified. The morbidity in 5 of the 106 patients (4.7 percent) was felt to be directly related to persistently elevated intracranial pressure. These included 2 deaths, 1 due to brainstem herniation after an elective subcranial Le Fort III advancement and 1 following removal of a lumboperitoneal shunt during the surgical release of syndactyly. The remaining 3 complications included bilateral papilledema detected 3.5 years after cranial vault remodeling in 1 patient and venous hypertension with excessive bleeding detected during elevation of the bicoronal flap in 2 patients, resulting in delay of a planned Le Fort III advancement. Patients with the syndromal craniosynostoses are at risk for complications resulting from elevated intracranial pressure from infancy through adulthood despite surgical attempts to increase cranial capacity in infancy. Clinical guidelines are proposed by which these patients should be evaluated beyond infancy in a regular fashion so as to reduce morbidity from unrecognized elevations in intracranial pressure
— id: 56817, year: 1996, vol: 97, page: 292, stat: Journal Article,

A prospective study of the relationship between strabismus and head posture in patients with frontal plagiocephaly
Gosain AK; Steele MA; McCarthy JG; Thorne CH
1996 Apr;97(5):881-891, Plastic & reconstructive surgery
A prospective study was performed on 16 unoperated patients with frontal plagiocephaly to characterize the relationship between strabismus and abnormal head posture. Serial eye examinations were performed preoperatively and for 24 to 46 months following fronto-orbital advancement. In 14 patients (88 percent), preoperative clinical examination and CT scan indicated coronal plagiocephaly (synostotic); unicoronal synostosis was documented during fronto-orbital advancement in all these patients. Ten patients had abnormal head posture on preoperative examination, 9 of whom had strabismus at some time during the study. These 9 patients all had unicoronal synostosis with ipsilateral strabismus and a contralateral head tilt. All had eye muscle findings consistent with superior oblique paresis, although in 2 patients these signs first developed following fronto-orbital advancement. Strabismus resolved spontaneously in 2 patients between 2 and 8 months following fronto-orbital advancement; the remaining 7 patients underwent extraocular muscle surgery following fronto-orbital advancement, with early resolution of strabismus in all cases. The head tilt resolved or improved significantly in all 9 patients following resolution of the strabismus. Two patients had recurrent superior oblique paresis following surgical correction, necessitating secondary strabismus surgery. The present study indicates that extraocular muscle dysfunction is the major cause of abnormal head posture in patients with coronal plagiocephaly and emphasizes the need for long-term ophthalmologic surveillance in these patients
— id: 7000, year: 1996, vol: 97, page: 881, 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,

Step expansion of the frontal bar: correction of trigonocephaly
McCarthy JG; Bradley JP; Longaker MT
1996 Sep;7(5):333-335, Journal of craniofacial surgery
In severe trigonocephaly, metopic suture synostosis extends inferiorly to involve the frontoethmoid suture, resulting in orbital hypotelorism. To correct this growth disturbance, a nasofrontal osteotomy with bone graft interposition has been advocated. We describe an alternative procedure, supraorbital bar step expansion, which does not require a bone graft or metallic miniplate fixation. The supraorbital bar step expansion avoids donor site morbidity and the potential for plate migration. This procedure not only corrects orbital distopia, but also improves the anterolateral position of the brows, lateral canthus, and temporal regions
— id: 12541, year: 1996, vol: 7, page: 333, stat: Journal Article,

Cirugia plastica : la cara = Plastic surgery. The face (pt. 2 v. 3)
McCarthy, Joseph G; Aston, Sherrell J; et al
Buenos Aires : Medica Panamerica, 1996,
— id: 1882, year: 1996, vol: , page: , stat: ,

History of the American Association of Plastic Surgeons, 1921-1996
Randall P; McCarthy JG; Wray RC
1996 May;97(6):1254-1298, Plastic & reconstructive surgery
— id: 57411, year: 1996, vol: 97, page: 1254, stat: Journal Article,

Fathers' perceptions of how they were parented
Riesch, S K; Kuester, L; Brost, D; McCarthy, J G
1996 ;13(1):13-29, Journal of community health nursing
The purpose of this article is to report how a group of 391 well-educated, White, midwestern American married fathers of young adolescents (11 to 14 years) described their perceptions of how they were raised. The question 'Describe how your parents parented you' was asked as part of a larger quasi-experimental study to test the outcomes of communication skills training among a sample of families in a community. The fathers' short-answer descriptions were succinct yet substantive. Using content analysis procedures, 6 themes were identified. Four reflected the men's perceptions of specific strategies used by their parents. The themes were labeled establishing boundaries, parental presence, adhering to guidelines, and communication techniques. A 5th theme, labeled family size, indicated that some men perceived that the structure influenced how they were parented. The 6th theme, evaluation of their parents' parenting, encompassed the men's opinions of how successful they perceived their parents were at raising them. The men's perceptions are discussed within the context of fathering roles. The themes are offered as a framework to define parenting, and implications for nursing practice and research are proposed
— id: 99042, year: 1996, vol: 13, page: 13, stat: Journal Article,

Studies in cranial suture biology: part II. Role of the dura in cranial suture fusion
Roth DA; Bradley JP; Levine JP; McMullen HF; McCarthy JG; Longaker MT
1996 Apr;97(4):693-699, Plastic & reconstructive surgery
The biology underlying normal and premature cranial suture fusion remains unknown. The purpose of this study was to investigate the role of the dura mater in cranial suture fusion. In the Sprague Dawley rat model, the posterior frontal cranial suture fuses between 10 and 20 days of postnatal life. The effect of separating the posterior frontal cranial suture from its underlying dura mater with an intervening silastic sheet was studied. Sixty rat pups, age 8 days, were divided into four groups of 15. Group A served as unoperated controls. Group B, the experimental group, underwent craniotomy, dural elevation, and insertion of a silicone sheet between the posterior frontal cranial suture and the underlying dura. Two operative sham groups were included. Group C underwent craniotomy and dural deflection only. Group D underwent craniotomy alone without dural deflection. The rats were sacrificed at 15, 22, and 30 days of age. The results showed that the unoperated animals (group A) demonstrated normal initiation of suture fusion at 15 days and complete fusion by 22 days. Group B animals, with silicone sheet barriers placed, showed persistent patency of sutures at 22 days. Initiation of suture fusion was delayed until 30 days. Sham group C, animals with craniotomy and dural deflection, showed that initiation of fusion was delayed until 22 days with complete fusion by 30 days of age. Sham group D, craniotomy alone, had the same normal temporal sequence of suture fusion as the unoperated control group A. These data indicate that normal cranial suture fusion is delayed when the suture-dural interaction is interrupted by a surgically place barrier or by simple dural deflection. Furthermore, interaction between the dura and the overlying suture appears to direct suture fusion
— id: 7911, year: 1996, vol: 97, page: 693, stat: Journal Article,

The "back to sleep campaign" and deformational plagiocephaly: is there cause for concern?
Turk AE; McCarthy JG; Thorne CH; Wisoff JH
1996 Jan;7(1):12-18, Journal of craniofacial surgery
In April 1992, the American Academy of Pediatrics recommended back or side sleeping for healthy newborns to reduce the risk of sudden infant death syndrome. Subsequently, the US Public Health Service organized a health care coalition to promote a 'Back to Sleep Campaign' to advocate back or side sleeping for infants. Since 1992, our craniofacial anomalies center has witnessed a marked increase in the incidence of infants with defomational changes of the cranium and face. The purpose of this project was to study the etiologies of deformational plagiocephaly and possible correlation with infant head position. We reviewed 52 consecutive patients presenting with deformational plagiocephaly from January 1992 to December 1994. A diagnosis of deformational plagiocephaly was determined by (1) history (date when head shape change was first noted), (2) clinical examination (occipital flattening, contralateral forehead flattening, lowering of the eyebrow, and ear shearing), and (3) skull radiographs (patent cranial sutures). All infants had medical photography to document baseline craniofacial morphology and any follow-up changes after nonsurgical therapy. Cranial asymmetry was first noted after birth at a mean time of 3.6 months. All infants were initially positioned on their back/side. In 52 patients, 61% had right-sided flattening of the occiput (vs 39% left-sided). All infants had flattening of the occiput, contralateral brow lowering or inferior displacement of the brow, contralateral forehead flattening, and posterioinferior displacement of the ear. All skull radiographs demonstrated patent sutures. Follow-up of patients ranged from 3 to 22 months with a mean of 10.5 months. Follow-up clinical examination and photography demonstrated significant improvement of cranial form in all patients with recommended frequent head turning (73%), helmet molding (23%), and surgery (4%). Our unit has seen an increase in the number of infants with deformational plagiocephaly over the last three years. All of the affected infants in this study had been managed according to the officially recommended protocol of back/side positioning. These findings suggest a possible relationship between this type of infant positioning and the development of a deformational plagiocephaly. However, cranial asymmetry in this group of patients decreased significantly with nonsurgical therapy. We have not recommended cranial vault remodeling surgery for the mild and moderate types of this deformity. However, if there is evidence of increasing asymmetry of deformational plagiocephalic infants during follow-up and evidence of severe variants of these deformities, surgical correction of the cranial vault is recommended
— id: 12656, year: 1996, vol: 7, page: 12, stat: Journal Article,

Acid and alkaline phosphatase activity levels in a mouse cranial suture organ culture system
Winograd, Jonathan M.; Levine, Jamie P.; Sung, Joanne J.; Glat, Paul M.; Im, Michael; Vander Kolk, Craig; McCarthy, Joseph G.; Longaker, Michael T.
1996 ;47(0):728-730, Surgical forum
— id: 98801, year: 1996, vol: 47, page: 728, stat: Journal Article,

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

A study of intracranial volume in Apert syndrome
Gosain AK; McCarthy JG; Glatt P; Staffenberg D; Hoffmann RG
1995 Feb;95(2):284-295, Plastic & reconstructive surgery
The present study was undertaken to characterize the intracranial volume in patients with Apert syndrome. Radiographic and CT-based techniques for measuring intracranial volume were found to show close correlation when validated in dry normal adult skulls. A standard-deviation score of intracranial volume, determined from CT scans in 20 patients with Apert syndrome from birth to 30 years of age, was calculated with reference to a normative database of age- and sex-matched controls. Analysis of the data showed no significant difference in standard-deviation score between Apert patients with or without ventriculomegaly, before or after cranial vault surgery, or between male and female patients. The mean standard-deviation score among all Apert CT scans compared with normative data was 3.1, which was highly significant (p < 0.001). However, the growth curves showed no significant difference in intracranial volume between Apert and normal patients below 3.5 months of age. In summary, intracranial volume in Apert syndrome is within normal range at birth but increases to greater than 3 standard deviations above normal after 3.5 months of age, a finding independent of cranial vault surgery
— id: 56646, year: 1995, vol: 95, page: 284, 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,

SKELETAL DISTRACTION OF THE HYPOPLASTIC MANDIBLE - INVITED DISCUSSION
MCCARTHY, JG
1995 FEB ;34(2):136-137, Annals of plastic surgery
— id: 87414, year: 1995, vol: 34, page: 136, 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,

Multidimensional distraction osteogenesis: the canine zygoma
Glat, P M; Staffenberg, D A; Karp, N S; Holliday, R A; Steiner, G; McCarthy, J G
1994 Nov;94(6):753-758, Plastic & reconstructive surgery
The principle of distraction osteogenesis, well-established in the enchondral bones of the axial skeleton, has recently been applied to the membranous bones (mandible, cranium) of the craniofacial skeleton in the experimental animal and in the human. In the craniofacial skeleton, however, the technique has been used only to lengthen bone in a direction along its major axis, i.e., unidimensional distraction. A canine model is presented to demonstrate the feasibility of distracting membranous bone away from its dominant axis, i.e., multidimensional distraction. Four mongrel dogs, 5 months of age, were the subjects of this study. Two osteotomies were made in the zygomatic arch, and the bone-lengthening device was fixed to the zygoma. After 7 days of external fixation, the osteotomized segment was lengthened 1 mm/day away from the long axis of the bone for 15 days. External fixation was then maintained for a minimum of 4 weeks, after which the dogs were sacrificed. Craniofacial CT with three-dimensional reconstruction documented multidimensional bone lengthening, and histologic analysis of the specimen confirmed the presence of new cortical bone in the expanded areas. Refinement in technique and miniaturization and internalization of the bone-lengthening device may allow for more precise changes in the amount and direction of lengthening, thus making distraction osteogenesis more widely applicable for use in the human craniofacial skeleton
— id: 99043, year: 1994, vol: 94, page: 753, stat: Journal Article,

Cervicovertebral anomalies and basilar impression in Goldenhar syndrome
Gosain AK; McCarthy JG; Pinto RS
1994 Mar;93(3):498-506, Plastic & reconstructive surgery
Although previously unreported, neurologic compromise may occur secondary to anomalies of the cervical spine in the oculoauriculovertebral spectrum. Medical records and cephalograms were reviewed from 18 patients with classic Goldenhar syndrome and from 18 normal adults. One patient, a 22-year-old man, had experienced a 5-year history of progressive neurologic compromise from basilar impression; the remaining 17 patients were asymptomatic. Radiographic evidence of cervicovertebral fusion was documented in 11 of 18 patients (61 percent). Fusion occurred at every cervical level other than the atlantoaxial joint. Radiographic indices that characterize the cranial base were not significantly different between asymptomatic Goldenhar patients and normal adults. Posterior inclination of the odontoid with respect to the foramen magnum appears to be the best indicator that a patient is at risk for basilar impression. Careful radiographic evaluation may indicate which patients require more careful surveillance with periodic neurologic examination and CT and/or MRI scans
— id: 56537, year: 1994, vol: 93, page: 498, stat: Journal Article,

The effects of facial nerve ablation on craniofacial skeletal development in neonatal rabbits
Hoffman, W Y; McCarthy, J G
1994 May;93(6):1236-1240, Plastic & reconstructive surgery
The effects of unilateral facial nerve ablation on craniofacial development in the rabbit were examined. In this experimental model, 10 newborn rabbits 12 days of age underwent unilateral resection and cautery of the facial nerve. They were allowed to grow to skeletal maturity and were sacrificed at 6 months. Analysis of variance was used to compare direct measurements of prepared skulls in the experimental animals with 3 unoperated control litter mates and with 5 litter mates who underwent a sham procedure (exposure of the facial nerve without section). The animals with facial nerve resection demonstrated an average snout deviation toward the side of injury of 8.3 degrees, apparently due to shortening of the maxilla and mandible on the affected side. This study provides new data regarding the role of the functional matrix in the modulation of craniofacial growth and development
— id: 99044, year: 1994, vol: 93, page: 1236, stat: Journal Article,

TGF-beta-1, -beta-2, -beta-3, and IGF-1 localization in rat cranial suture development and fusion
Longaker, Michael T.; Roth, Douglas A.; McMullen, Heather F.; Breitbart, Arnold S.; Wisoff, Jeffrey H.; Han, Victor K.; Gold, Leslie I.; McCarthy, Joseph G.
1994 ;45(0):589-591, Surgical forum
— id: 98811, year: 1994, vol: 45, page: 589, stat: Journal Article,

The role of distraction osteogenesis in the reconstruction of the mandible in unilateral craniofacial microsomia
McCarthy JG
1994 Oct;21(4):625-631, Clinics in plastic surgery
Laboratory and clinical studies have shown that mandibular distraction is an effective and powerful reconstructive surgical technique. It is safely performed without the need for blood transfusion or bone graft. Because of concomitant expansion of the functional matrix (the associated skin, subcutaneous fat, and muscles of mastication), there is a multidimensional expansion of the lower jaw with minimal, if any, evidence of relapse. Moreover, the surgical reconstruction can be commenced by 2 years of age, and the vector of distraction can be controlled by preoperative design. Finally, the increase in resulting mandibular bone stock will provide more reconstructive options in the future for traditional orthognathic surgical techniques. The technique has been criticized, either for the cutaneous incision for the approach to the mandible or for the scar resulting from the path of the distracting screws. However, with careful placement of the device, the resulting scar can be placed in the lines of minimal tension with a resulting satisfactory scar. It has been assumed that the osteotomy results in interruption of the inferior alveolar nerve. However, questioning of the older patients has failed to detect any change in sensation of the lower lip. The status of the inferior alveolar nerve in the hypoplastic mandible has also never been studied. Insertion of the screws required an area of bone stock that is edentulous, and this finding can make application of the device difficult in some patients. The length of treatment has been criticized--approximately 3 months. However, this is offset by the ease of treatment, the degree of safety, and the reduction in hospital time without the need for blood transfusion or bone graft. The results to date indicate that the technique can be applied to the correction of the milder mandibular deficiencies.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 6688, year: 1994, vol: 21, page: 625, stat: Journal Article,

DISTRACTION OSTEOGENESIS
MCCARTHY, JG
1994 NOV ;31(6):481-482, Cleft palate-craniofacial journal
— id: 52302, year: 1994, vol: 31, page: 481, stat: Journal Article,

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

The role of the dura in cranial bone regeneration in the immature animal
Hobar PC; Schreiber JS; McCarthy JG; Thomas PA
1993 Sep;92(3):405-410, Plastic & reconstructive surgery
In an animal model, the effect of transferring mature pericranial tissues to immature animals with cranial bone defects was tested. Isogeneic guinea pigs of different ages were used: 'infants' (3-4 weeks) and 'adults' (> 18 months). Bilateral parietal cranial defects were made in infant guinea pigs and the guinea pigs were divided into three groups. In group 1 (n = 6), the infant periosteum was resected and replaced as an autograft on one side (control), and adult periosteum was transplanted as an isograft on the other (experiment). In group 2 (n = 5), dura was used as the variable. In group 3 (n = 5), combined dura and periosteum were the variables. After 8 weeks, there was complete or near complete bone regeneration in all animals in which infant dura was present. There was minimal to no bone regeneration in defects in which adult dura was present. Unlike dura, periosteum had little influence on the capacity of the bone to regenerate
— id: 13081, year: 1993, vol: 92, page: 405, stat: Journal Article,

A structural analysis of the bent kinetoplast DNA from Crithidia fasciculata by high resolution chemical probing
McCarthy, J G; Frederick, C A; Nicolas, A
1993 Jul 11;21(14):3309-3317, Nucleic acids research
The chemical probes potassium permanganate (KMnO4) and diethylpyrocarbonate (DEPC) have been used to study the conformation of bent kinetoplast DNA from Crithidia fasciculata at different temperatures. Chemical reactivity data shows that the numerous short A-tracts of this bent DNA adopt a similar structure at 43 degrees C. This conformation appears to be very similar to the conformation of A-tracts in DNA exhibiting normal gel mobility. The A-tract structure detected by chemical probing is characterized by a high degree of base stacking on the thymine strand, and by an abrupt conformational change at the 3' end of the adenine strand. In general, no major alteration of this A-tract specific structure was detected between 4-53 degrees C. However, probing with KMnO4 revealed two unusual features of the C. fasciculata sequence that may contribute to the highly aberrant gel mobility of this DNA: 1) the B DNA/A-tract junction 5' dC/A3-6 3'. 5' dT3-6/G 3' is disproportionately represented and is conformationally distinct from other 5' end junctions, and 2) low temperature favors a novel strand-specific conformational distortion over a 20 base pair region of the bent kinetoplast DNA. Presence of the minor groove binding drug distamycin had little detectable effect on the A-tract conformation. However, distamycin did inhibit formation of the novel KMnO4 sensitive low temperature structure and partially eliminated the anomalous gel mobility of the kinetoplast DNA. Finally, we describe a simple and reproducible procedure for the production of an adenine-specific chemical DNA sequence ladder
— id: 99045, year: 1993, vol: 21, page: 3309, stat: Journal Article,

Membranous bone lengthening: a serial histological study
Karp NS; McCarthy JG; Schreiber JS; Sissons HA; Thorne CH
1992 Jul;29(1):2-7, Annals of plastic surgery
Bone lengthening using the process of corticotomy and gradual distraction of callus is applicable to the membranous bone of the canine mandible. In this study the precursors to bone formation, in the area between the distracted bone edges, are analyzed in an attempt to determine the mechanism of bone formation. Ten mongrel dogs 5 months of age were studied. A unilateral, periosteal-preserving angular corticotomy was performed, and an external bone-lengthening device was fixed to the mandible. After 10 days of external fixation, the mandible was lengthened 1 ml per day for 20 days and then held in external fixation for 8 weeks. The dogs were killed for histological and microradiographic study at 10 and 20 days of distraction, and at 14, 28, and 56 days after the completion of distraction. It was observed that the gap between the distracted bone edges is first occupied by fibrous tissue. As distraction proceeds, the fibrous tissue becomes longitudinally oriented in the direction of distraction. Early bone formation advances along the fibrous tissue, starting from the cut bone ends. Eventually the area is converted to mature cortical bone. Bone is formed predominantly by intramembranous ossification. This mechanism is similar to that of bone formation during long bone lengthening
— id: 13540, year: 1992, vol: 29, page: 2, 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,

The role of research in craniofacial surgery
McCarthy, J G
1992 Jul;3(1):3-7, Journal of craniofacial surgery
— id: 99046, year: 1992, vol: 3, page: 3, stat: Journal Article,

Cirugia plastica : la cara II = Plastic surgery. The face (pt. 2 v. 3)
McCarthy, Joseph G; Manrique, Jorge; Aston, Sherrell J
Madrid : Medica Panamerica, 1992,
— id: 1881, year: 1992, vol: , page: , stat: ,

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,

A surgical system for the correction of bony chin deformity
McCarthy JG; Ruff GL; Zide BM
1991 Jan;18(1):139-152, Clinics in plastic surgery
Because the chin, like the nose, occupies a prominent position in the face, it must also be assessed in planning any changes in the facial profile. For example, a large nose associated with a microgenia does not appear as large when the chin is augmented. A chin increased in the vertical dimension confers an excessively long appearance to the face. Finally, a microgenia is associated with the stereotype of a sluggish personality, and a large chin in women connotes a masculine personality. The authors provide guidelines for assessing these variables and including them in surgical plan
— id: 14166, year: 1991, vol: 18, page: 139, stat: Journal Article,

MICROGNATHIA ASSOCIATED WITH MINOR EAR ANOMALIES - A NEW DOMINANTLY INHERITED SYNDROME
REICH, E; WISHNICK, M; MCCARTHY, J
1991 OCT ;49(4):158-158, American journal of human genetics
— id: 51528, year: 1991, vol: 49, page: 158, stat: Journal Article,

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

Bone lengthening in the craniofacial skeleton
Karp, N S; Thorne, C H; McCarthy, J G; Sissons, H A
1990 Mar;24(3):231-237, Annals of plastic surgery
The process of bone lengthening by cortical fracture and gradual distraction of callus has become well established in the enchondral bones of the extremities. In this study the principles of bone lengthening were applied to the membranous bone of the craniofacial skeleton using the growing dog mandible as a model. Six mongrel dogs five months of age were studied. A unilateral, periosteal-preserving angular corticotomy was performed, and an external minilengthening device was fixed to the mandible perpendicular to the corticotomy. After 10 days of external fixation, the mandible was lengthened 1 mm/day for 20 days and then held in external fixation for 56 days (8 weeks) after which all dogs were killed. Anthropometric measurements and histological analysis of the specimens confirmed that bone lengthening had occurred and that new cortical bone was formed in the expanded areas
— id: 99050, year: 1990, vol: 24, page: 231, stat: Journal Article,

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

The effect of early fronto-orbital advancement on frontal sinus development and forehead aesthetics
McCarthy JG; Karp NS; LaTrenta GS; Thorne CH
1990 Dec;86(6):1078-1084, Plastic & reconstructive surgery
The frontal sinuses make an important contribution to normal forehead and glabellar contour. This study was designed to test our clinical impression that early fronto-orbital ('frontal bone') advancement could have an adverse effect on frontal sinus development and consequently on forehead aesthetics. A retrospective study was conducted on 11 patients who had undergone fronto-orbital advancement and also had a long period of follow-up at the Institute of Reconstructive Plastic Surgery at New York University. The longitudinal cephalometric data were compared with unoperated controls. With one exception, no patient who underwent bilateral fronto-orbital advancement developed a frontal sinus, and all such patients had a flattened brow contour when compared with unoperated patients, of whom 82 percent developed at least one frontal sinus. Of the three patients who underwent unilateral fronto-orbital advancement for plagiocephaly (flattened forehead), two developed a frontal sinus but only on the unoperated side and one developed bilateral frontal sinuses. The two patients with unilateral frontal sinus development had a particularly obvious deformity resulting from normal glabellar projection on the unoperated side and a flattened contour on the operated side. Fronto-orbital advancement affects forehead aesthetics and should be performed only in infant patients with moderate to severe deformities. patients with plagiocephaly whose deformity is sufficiently severe to warrant surgery should preferably undergo bilateral fronto-orbital advancement (by the technique described) rather than unilateral advancement in order to avoid the brow asymmetry that results from unilateral frontal sinus development
— id: 14259, year: 1990, vol: 86, page: 1078, 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,

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

"THOMPSON,NOEL 1914-1989"
Mccarthy, JG
1990 Apr;85(4):653-654, Plastic & reconstructive surgery
— id: 32005, year: 1990, vol: 85, page: 653, stat: Journal Article,

Plastic surgery
McCarthy, Joseph G.; May, James W.; Littler, J. William
Philadelphia : Saunders, 1990,
— id: 268, year: 1990, vol: , page: , stat: ,

Fetal wound healing: a biochemical study of scarless healing
Siebert, J W; Burd, A R; McCarthy, J G; Weinzweig, J; Ehrlich, H P
1990 Apr;85(4):495-502, Plastic & reconstructive surgery
Human fetal surgery is being successfully performed today in a small number of highly selected patients for conditions that may lead to irreversible damage to the fetus and threaten the viability of the newborn. Following surgical repair, fetal wounds heal without scarring. This study was initiated to characterize fetal wounds both histologically and biochemically. Gore-Tex tubing was implanted into the subcutaneous tissue of the back of fetal, newborn, and adult New Zealand white rabbits. Light microscopic examination of healed wounds revealed no evidence of scar formation. Electron microscopy demonstrated a striated fibrillar structure suggestive of collagen within the lumen of the Gore-Tex tubing implants. Amino acid analysis (sensitivity 40 pmol) confirmed the presence of hydroxylysine and hydroxyproline within the Gore-Tex wound chambers indicating the presence of collagen in fetal wounds. The small amount of collagen precluded the typing of the collagen using cyanogen bromide peptide analysis. The absence of scarring and the small amounts of detectable collagen suggest a high degree of reorganization of the connective tissues involved in repair. The fetal wound matrix is rich in hyaluronic acid. Topical hyaluronic acid has been associated experimentally with a reduced amount of scarring in postnatal wound healing. Hyaluronic acid extracted from human skin and scar tissue is associated with collagen and other proteins. We propose that a hyaluronic acid-collagen-protein complex may play a role in fetal wound healing
— id: 99049, year: 1990, vol: 85, page: 495, stat: Journal Article,

Crouzon's syndrome associated with acanthosis nigricans: ramifications for the craniofacial surgeon
Breitbart AS; Eaton C; McCarthy JG
1989 Apr;22(4):310-315, Annals of plastic surgery
Crouzon's syndrome is one of many disorders that have been associated with acanthosis nigricans. Previously reported cases documenting this association have been reviewed, and additional cases that have been treated at the Institute of Reconstructive Plastic Surgery at New York University Medical Center have been added. Recommendations for the surgical management of this unique group of patients are presented
— id: 10684, year: 1989, vol: 22, page: 310, stat: Journal Article,

The role of rigid skeletal fixation in bone-graft augmentation of the craniofacial skeleton
LaTrenta GS; McCarthy JG; Breitbart AS; May M; Sissons HA
1989 Oct;84(4):578-588, Plastic & reconstructive surgery
The type of fixation (rigid skeletal vs. wire) was assessed against embryologic origin (membranous vs. endochondral) and recipient site (depository vs. resorptive) as variables affecting inlay and onlay bone-graft survival in 20 mature dogs. Wet weight and volume measurements were made at operation and at sacrifice (16 weeks). The results were as follows: (1) Rigid skeletal fixation increased bone-graft volume survival over wire fixation (p less than 0.05). (2) Fixation (i.e., rigid skeletal) and embryologic origin (i.e., membranous) were equal determinants of bone-graft volume survival (p less than 0.001); the recipient site was not significant for onlay bone graft survival. (3) Embryologic origin was the only significant determinant of weight survival (p less than 0.001). (4) Inlay bone grafts demonstrated greater weight and volume survival than onlay bone grafts (p less than 0.05). (5) Histologic and microradiographic studies demonstrated bony union of bone grafts fixed with rigid skeletal fixation, while fibrous union predominated in bone grafts fixed with wire technique
— id: 10468, year: 1989, vol: 84, page: 578, stat: Journal Article,

The mentalis muscle: an essential component of chin and lower lip position
Zide BM; McCarthy J
1989 Mar;83(3):413-420, Plastic & reconstructive surgery
The soft-tissue chin may become ptotic following surgery in this area. The mentalis muscles which are responsible for proper central lip motion and chin point position may be affected. The mentalis muscle origin may require resuspension at a proper level. This reattachment may be performed by means of an intraoral approach. Non-absorbable sutures are used to hold the soft-tissue chin upward. The exact method involves placing drill holes through the alveolar bone, into which sutures are passed. These sutures are then placed through the lower mentalis muscles and tightened. Chin and lip position may be corrected in certain cases. Ancillary procedures are required to correct vestibular scarring and submental scars
— id: 10709, year: 1989, vol: 83, page: 413, stat: Journal Article,

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

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

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

The chin
McCarthy JG; Ruff GL
1988 Jan;15(1):125-137, Clinics in plastic surgery
The aesthetic aspects of the chin necessitate its evaluation in the context of the nose, mouth, and, to a lesser extent, the neck. Functional consideration must be given to the dental occlusion and the perioral muscular sphincter, and planning should acknowledge the sociologic implications of a strong versus a weak chin. After thorough skeletal and soft-tissue examination, the appropriate type of surgical intervention can be selected. Among the various procedures, chin implant remains the most commonly used, but the osteotomy offers the greatest flexibility, reliability, and potential for significant modification of chin form
— id: 11231, year: 1988, vol: 15, page: 125, stat: Journal Article,

Sensitive homologous recombination strand-transfer assay: partial purification of a Drosophila melanogaster enzyme and detection of sequence effects on the strand-transfer activity of RecA protein
McCarthy, J G; Sander, M; Lowenhaupt, K; Rich, A
1988 Aug;85(16):5854-5858, Proceedings of the National Academy of Sciences of the United States of America
A sensitive homologous recombination strand-transfer assay is described that employs short radiolabeled double-stranded DNA fragments from the lac/polylinker region of plasmid pUC18 and (+)viral M13mp18 single-stranded DNA as substrates. Substitution of a short radiolabeled double-stranded fragment for full-length linear M13 double-stranded DNA results in an assay whose sensitivity is improved greater than 8-fold. In addition, it is less sensitive to interference from nucleases or ligases than previous assays. The assay was used to partially purify an ATP-independent strand-transfer activity from a crude nuclear extract of Drosophila melanogaster embryos. We have also tested the efficiency with which various short double-stranded DNA segments are assembled into plectonemic joints by RecA protein with this assay and found 5- to 10-fold differences. These results are interpreted as evidence for DNA sequence-specific effects in RecA-mediated homologous pairing in vitro
— id: 99052, year: 1988, vol: 85, page: 5854, stat: Journal Article,

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

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

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

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,

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

Outbreak of severe hepatitis due to delta and hepatitis B viruses in parenteral drug abusers and their contacts
Lettau, L A; McCarthy, J G; Smith, M H; Hadler, S C; Morse, L J; Ukena, T; Bessette, R; Gurwitz, A; Irvine, W G; Fields, H A
1987 Nov 12;317(20):1256-1262, New England journal of medicine
We investigated an unusually large and severe outbreak of hepatitis B, primarily involving parenteral drug abusers and their sexual contacts, in Worcester, Massachusetts, over a 21-month period from 1983 to 1985. Of 135 patients with drug-related acute hepatitis B, 81 percent were parenteral drug abusers and 19 percent had sexual contact with drug abusers; 13 fulminant cases resulted in 11 deaths. Among the patients with hepatitis B, evidence of delta virus infection was found in 54 percent of drug abusers, 33 percent of their sexual contacts, and 9 percent of other patients with acute hepatitis B (P less than 0.001). Most of the delta infections (86 percent) were coinfections with hepatitis B virus; the balance were superinfections. Delta infection was strongly associated with fulminant hepatitis: 91 percent of patients with a fulminant outcome had delta infection, as compared with 45 percent of less severely ill drug abusers and their contacts (P = 0.0037). Alcohol, other drugs, and other hepatitis viruses could not be implicated as hepatotoxic cofactors for fulminant disease. This outbreak appeared to result from the concurrent spread of hepatitis B and delta viruses among new drug users. Control measures included the distribution to physicians of guidelines on prophylaxis in contacts of patients with hepatitis B, health education for drug abusers, and a hepatitis B vaccination program. Despite these efforts, the outbreak continued unabated until the number of new cases began to decline slowly in late 1986
— id: 99053, year: 1987, vol: 317, page: 1256, stat: Journal Article,

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

A long polypyrimidine/polypurine tract induces an altered DNA conformation on the 3' coding region of the adjacent myosin heavy chain gene
McCarthy, J G; Heywood, S M
1987 Oct 12;15(19):8069-8085, Nucleic acids research
A long (147 base pairs), natural A.T rich polypyrimidine/polypurine tract has been found 55 base pairs downstream of a chicken embryonic myosin heavy chain (MHC) gene. Analysis at the nucleotide level of nicks induced by S1 and Neurospora crassa nucleases indicate that this long interrupted polypyrimidine/polypurine tract exists in an alternate DNA structure in vitro at pH 4.5 and pH 7.5 in both supercoiled and linear plasmid DNA. The polypyrimidine/polypurine tract induces this alternate structure upon at least 200 base pairs of its 5' flanking DNA, and thus extends into the 3' coding and non-coding regions of the neighboring MHC gene. The different nicking patterns induced by the nucleases S1 and N. crassa on each strand of this alternate structure suggests that the polypyrimidine/polypurine tract may form heteronomous DNA. When this long polypyrimidine/polypurine tract is present in a supercoiled plasmid at low pH, a new and as yet undefined S1 hypersensitive DNA alteration was detected near the center of this tract
— id: 99054, year: 1987, vol: 15, page: 8069, stat: Journal Article,

Spontaneous mutation and parental age in humans
Risch N; Reich EW; Wishnick MM; McCarthy JG
1987 Aug;41(2):218-248, American journal of human genetics
A statistical analysis of parental age and the incidence of new mutation has been performed. Some new data on Apert, Crouzon, and Pfeiffer syndromes is presented and combined with all available data from the literature on parental age and new mutation. Significant heterogeneity among syndromes for the rate of increase in incidence with parental age was found. A parsimonious conclusion is that mutations fall into two groups, one with a high rate of increase with age and the other with a low rate of increase with age. For the high-rate-of-increase group, a linear model relating incidence to age is rejected, while an exponential model is not. In addition, for this group, increased paternal age cannot account for the observed increase in maternal age--that is, increased maternal age also contributes to the incidence of new mutations. For the low-rate-of-increase group, increased paternal age alone can account for the observed increase in maternal ages; also, either a linear or exponential model is acceptable. In addition, there is no evidence for a mixture of parental age-independent cases with parental age-dependent cases for any of the syndromes examined. The curves reflecting incidence of new mutation and paternal age for two syndromes, Apert and neurofibromatosis, have an anomalous shape. In both cases the curve increases up to age 37 and drops at age 42 before increasing again at age 47. The usual explanation for the effect of parental age on new mutations is the mechanism of 'copy-error' at mitotic division in male sperone that specifies an increased probability of mutation with time spent by a spermatozoon or ovum in a haploid state, a period of time that may also increase with age of the parent. A firm answer to the question of parental age and new mutation awaits identification of the molecular defect underlying some of these syndromes; we will then be in a position to determine in which parent the mutation occurred and at what age it did so
— id: 23401, year: 1987, vol: 41, page: 218, stat: Journal Article,

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

Review of the morbidity of 300 free-flap donor sites
Colen, S R; Shaw, W W; McCarthy, J G
1986 Jun;77(6):948-953, Plastic & reconstructive surgery
Donor-site morbidity in 300 consecutive free flaps was reviewed to identify their etiologies and potentially prevent their recurrence in future cases. An overall morbidity rate of 20 percent was seen in this series. Secondary surgical procedures specific for donor-site problems were required in 7.7 percent of patients. Major complications occurred in 2.3 percent of the donor sites. From this review it is apparent that major donor-site morbidity is uncommon and most donor-site problems could probably have been avoided. Our recommendations are as follows: closure of the donor site to avoid excessive tension must be carefully planned preoperatively, donor-site anatomy and flap elevation techniques must be precisely understood, surgical retractors must be carefully placed to avoid injury to nearby structures, the donor site should be closed immediately following pedicle division, thus minimizing wound exposures, and complete surgical hemostasis is mandatory
— id: 99057, year: 1986, vol: 77, page: 948, 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,

ANATOMIC BASIS FOR VASCULARIZED OUTER-TABLE CALVARIAL BONE FLAPS - VASCULARIZED OUTER-TABLE CALVARIAL BONE FLAPS
MCCARTHY, JG
1986 SEP ;78(3):318-319, Plastic & reconstructive surgery
— id: 41369, year: 1986, vol: 78, page: 318, stat: Journal Article,

THE TEMPORALIS MYO-OSSEOUS FLAP - AN EXPERIMENTAL-STUDY - DISCUSSION
MCCARTHY, JG
1986 MAR ;77(3):414-415, Plastic & reconstructive surgery
— id: 41504, year: 1986, vol: 77, page: 414, 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,

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

The postresidency fellowship in plastic surgery: its evolution and future
McCarthy, J G
1985 Nov;76(5):790-793, Plastic & reconstructive surgery
— id: 99060, year: 1985, vol: 76, page: 790, stat: Journal Article,

The calvarial donor site: an anatomic study in cadavers
Pensler, J; McCarthy, J G
1985 May;75(5):648-651, Plastic & reconstructive surgery
In a study of 200 fresh adult cadavers, calvarial thickness was measured at selected points. The variables of age, height, weight, sex, and race were subjected to multiple regression analysis to determine which were significant in the determination of skull thickness. The results indicate that weight, race, and sex are the most important variables. However, the magnitude of the effects of these variables is minimal when considered in relation to clinical requirements. The study provides the clinician with a reasonable basis to obtain preoperative estimation of the thickness of calvarial grafts in the adult at four commonly utilized points
— id: 99061, year: 1985, vol: 75, page: 648, stat: Journal Article,

Isoflurane in paediatric anaesthesia. Induction and recovery from anaesthesia
Wren, W S; McShane, A J; McCarthy, J G; Lamont, B J; Casey, W F; Hannon, V M
1985 Apr;40(4):315-323, Anaesthesia
The characteristics of induction with and recovery from isoflurane anaesthesia were studied in 248 children. The mean time to loss of consciousness was 1.5 min (SD 0.5). Tracheal intubation, without interruption of spontaneous ventilation, was accomplished in a mean time of 4.2 min (SD 54 seconds). Movement and excitement, of 20-30 seconds duration, occurred in 23.9% children and 22 patients coughed during induction; 15 (12.6%) during the first 124 inductions; 7 (5.6%) subsequently. The mean half-times of reduction of alveolar isoflurane concentrations in 28 children whose lungs were ventilated with isoflurane and in 13 children who breathed isoflurane spontaneously during anaesthesia were: 45 sec after exposure for one hour, 70 sec after exposure of 2-3 hours and 110 seconds following exposures of 4-8 hours. The mean recovery times of the three groups were 6.5, 9.5 and 11.5 min respectively. In two further groups of nine children the mean half times of elimination of halothane and isoflurane were 220 seconds and 54 seconds respectively; recovery from isoflurane was markedly faster. Isoflurane is well accepted by children; induction is more rapid than with halothane, and the marked flexibility in the control of its effects are due to its relative insolubility. It has wide application in paediatric anaesthesia
— id: 99062, year: 1985, vol: 40, page: 315, stat: Journal Article,

Intracranial lipomas, hydrocephalus and other CNS anomalies in oculoauriculo-vertebral dysplasia (Goldenhar-Gorlin syndrome)
Aleksic, S; Budzilovich, G; Greco, M A; McCarthy, J; Reuben, R; Margolis, S; Epstein, F; Feigin, I; Pearson, J
1984 ;11(5):285-297, Child's brain
13 cases of Goldenhar-Gorlin syndrome are presented in which numerous central nervous system anomalies have been found. These include occipital encephalocele, hydrocephalus, aqueductal stenosis, agenesis of corpus callosum, multiple congenital lipomas and many others. Pertinent literature has been reviewed. It is concluded that any part of the central nervous system can be involved in this condition and that careful evaluation is indicated in order to rule out a treatable intracranial anomaly
— id: 117276, year: 1984, vol: 11, page: 285, stat: Journal Article,

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

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,

Rare caraniofacial clefts
McCarthy JG; Zide BM
Pediatric plastic surgery St. Louis : Mosby, 1984,
— id: 3540, year: 1984, vol: , page: 390, stat: Chapter,

The spectrum of calvarial bone grafting: introduction of the vascularized calvarial bone flap
McCarthy JG; Zide BM
1984 Jul;74(1):10-18, Plastic & reconstructive surgery
Two techniques of calvarial bone grafting (split-thickness and single-table) are reviewed. A new vascularized bone flap based on the temporal vasculature is presented. The indications and relative advantages of each are discussed. The calvarial bone flap is emphasized and strongly recommended. Since the flap is vascularized and contains membranous bone, it is particularly suited for bone grafting in clinically unfavorable recipient sites, such as scarred or irradiated beds or the hypoplastic zygomatic-maxillary complex in the Treacher Collins syndrome
— id: 18187, year: 1984, vol: 74, page: 10, stat: Journal Article,

Subfascial arterialized sole of the foot flap
McCarthy, J G
1984 Apr;73(4):691-691, Plastic & reconstructive surgery
— id: 99064, year: 1984, vol: 73, page: 691, stat: Journal Article,

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

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,

Congenital infiltrating lipomatosis of the face: clinicopathologic evaluation and treatment
Slavin SA; Baker DC; McCarthy JG; Mufarrij A
1983 Aug;72(2):158-164, Plastic & reconstructive surgery
Congenital lipomatosis of the face is characterized by collections of nonencapsulated, mature lipocytes which infiltrate local tissues and tend to recur after surgery. These lesions represent a distinct clinicopathologic entity that has not been previously reported in this location in children. Three children with congenital lipomatosis of the face were treated at the Institute of Reconstructive Plastic Surgery over a 2- to 14-year follow-up period. In each instance, pathologic evaluation by light and electron microscopy revealed similar lesions sharing the following morphologic criteria: (1) nonencapsulated tumors containing mature fat cells, (2) infiltration of adjacent muscle and soft tissue, (3) absence of malignant characteristics, (4) absence of lipoblasts, (5) presence of fibrous elements in conjunction with increased numbers of nerve bundles and vessels, and (6) hypertrophy of subjacent bone. All three lesions recurred after numerous excisions, some of which were extensive. All were benign by histologic examination and remained so for as long as 14 years. Surgical treatment improved the aesthetic appearance of each child despite evidence of tumor persistence. Although these tumors are benign, we recommend an early aggressive surgical approach to control the infiltrative nature of their growth and to improve facial appearance
— id: 51108, year: 1983, vol: 72, page: 158, stat: Journal Article,

The medial canthus revisited--an anatomical basis for canthopexy
Zide BM; McCarthy JG
1983 Jul;11(1):1-9, Annals of plastic surgery
Cadaver anatomical studies have demonstrated a superior component to the medial canthal tendon. The anatomical basis for the angular and dystopic deformities following nasoethmoidal trauma or surgical dissection is discussed. Based on these studies a more refined technique for medial canthopexy is presented. The three cardinal tenets of medial canthopexy are also emphasized
— id: 18188, year: 1983, vol: 11, page: 1, 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,

Plastic surgery symposium in China
McCarthy, J G; Shaw, W W
1982 Jan;69(1):170-171, Plastic & reconstructive surgery
— id: 99068, year: 1982, vol: 69, page: 170, stat: Journal Article,

CONTRIBUTION TO CONVERSES FLAP FOR NASAL RECONSTRUCTION - DISCUSSION
Mccarthy, JG
1982 ;69(4):702-702, Plastic & reconstructive surgery
— id: 30452, year: 1982, vol: 69, page: 702, stat: Journal Article,

TEMPOROFACIOCERVICAL FLAP - REPLY
Mccarthy, JG
1982 ;70(5):642-642, Plastic & reconstructive surgery
— id: 30517, year: 1982, vol: 70, page: 642, stat: Journal Article,

Extramammary Paget's disease
Pitman, G H; McCarthy, J G; Perzin, K H; Herter, F P
1982 Feb;69(2):238-244, Plastic & reconstructive surgery
Extramammary Paget's disease is an in situ skin and mucosal carcinoma frequently associated with and probably arising in a subjacent or regionally proximate carcinoma. Microscopic spread of tumor cells almost always extends beyond clinically apparent disease. Surgical treatment requires carefully planned, systematic excision under precise histologic control. An ideal treatment method remains to be developed. Inadequate excision usually results in recurrences that can be successfully treated by reexcision. Associated invasive carcinomas occur frequently, and mortality is high in these patients
— id: 99067, year: 1982, vol: 69, page: 238, stat: Journal Article,

EFFECT OF LENGTH AND PRESERVATION TIME ON PATENCY OF SMALL VEIN GRAFTS
Razaboni, RM; Greco, MA; Harper, AD; Ballantyne, DL; Shaw, WW; Mccarthy, JG
1982 ;33(1):564-566, Surgical forum
— id: 30671, year: 1982, vol: 33, page: 564, 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,

Immediate reconstruction of full-thickness chest wall defects
Boyd AD; Shaw WW; McCarthy JG; Baker DC; Trehan NK; Acinapura AJ; Spencer FC
1981 Oct;32(4):337-346, Annals of thoracic surgery
Twenty-one patients had full-thickness chest wall defects reconstructed at the New York University Medical Center in the last ten years. Marlex mesh provided chest wall stability in 5 patients. In 9 patients with radiation ulcers Marlex mesh was not required; a severe fibrotic reaction had obliterated the pleural space and prevented paradoxical motion. Partial sternal resections did not require Marlex stabilization, while a total sternectomy resulted in marked ventilatory insufficiency in a patient who would have benefited from the use of a stabilizing material. Random pattern flaps were used initially; more recently, axial pattern, myocutaneous, and myocutaneous free flaps were employed. Necrosis developed in 4 (36%) of the 11 patients with random pattern flaps, but was not seen with the newer flap techniques. Myocutaneous free flaps provided uncomplicated coverage of and stability to three large, potentially contaminated defects. It seems that with the currently available flap techniques and the methods of chest wall stabilization, immediate repair of all full-thickness chest wall defects is possible
— id: 18164, year: 1981, vol: 32, page: 337, stat: Journal Article,

Interview of a patient of Professor Jacques Joseph
Converse, J M; McCarthy, J G
1981 Apr;67(4):555-559, Plastic & reconstructive surgery
— id: 99072, year: 1981, vol: 67, page: 555, stat: Journal Article,

Orbital hypertelorism
Converse, J M; McCarthy, J G
1981 ;15(3):265-276, Scandinavian journal of plastic & reconstructive surgery
— id: 99073, year: 1981, vol: 15, page: 265, stat: Journal Article,

The scalping forehead flap revisited
Converse, J M; McCarthy, J G
1981 Jul;8(3):413-434, Clinics in plastic surgery
— id: 99069, year: 1981, vol: 8, page: 413, stat: Journal Article,

NEONATAL CRANIOFACIAL SURGERY
EPSTEIN, F; MCCARTHY, J
1981 ;15(3):217-219, Scandinavian journal of plastic & reconstructive surgery & hand surgery
— id: 40418, year: 1981, vol: 15, page: 217, stat: Journal Article,

Microgenia: a logical surgical approach
McCarthy, J G
1981 Apr;8(2):269-278, Clinics in plastic surgery
— id: 99071, year: 1981, vol: 8, page: 269, stat: Journal Article,

A CLINICAL INVESTIGATION INTO THE ETIOLOGY OF FRONTONASAL DYSPLASIA
Reich, EW; Wishnick, MM; Mccarthy, JG; Cox, RP
1981 ;33(6):A88-A88, American journal of human genetics
— id: 30507, year: 1981, vol: 33, page: A88, stat: Journal Article,

A study of regeneration in parietal bone defects in rabbits
Reid, C A; McCarthy, J G; Kolber, A B
1981 May;67(5):591-596, Plastic & reconstructive surgery
A study was undertaken to study the regeneration potential of surgically created parietal bone defects in newborn and fully grown rabbits. The results indicated that regeneration is greater in the newborn rabbits, especially if the periosteum and dura are preserved
— id: 99070, year: 1981, vol: 67, page: 591, 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,

Early and late surgery in craniofacial dysostosis: a longitudinal cephalometric study
Coccaro, P J; McCarthy, J G; Epstein, F J; Wood-Smith, D; Converse, J M
1980 Apr;77(4):421-436, American journal of orthodontics
Longitudinal clinical and cephalometric case studies are presented for two groups of patients with craniofacial dysostosis. The first sample includes two infants who underwent an extensive stripping procedure that was extended inferiorly to involve not only the coronal, but also the sphenozygomatic suture. The second sample includes two adolescents with midfacial hypoplasia who underwent a fronto-orbital-maxillary advancement. The extensive cranial stripping procedure had a favourable impact upon growth and development of the craniofacial structures, and longitudinal studies suggest the importance of promoting the growth potential of the bones contiguous to the affected sutures. Craniofacial surgery performed on adolescents results in a dramatic translocation of the skeletal and soft-tissue structures of the face. In contrast to early surgical intervention in infants in whom growth of the effected areas essential to the development of face and cranium was crucial, late surgery appeared to have little, if any, impact upon the development of the craniofacial skeletal structures that had been operated on
— id: 99075, year: 1980, vol: 77, page: 421, stat: Journal Article,

Delayed cauda equina reconstruction in meningomyelocele: preliminary report
Epstein, F; Spielholz, N; Battista, A; McCarthy, J
1980 May;6(5):540-541, Neurosurgery
Infants afflicted with meningomyelocele are paralyzed as a result of the physiological disconnection of the neural plate from the spinal cord. Intact neural elements within the placode often maintain segmental reflex innervation of the paralyzed lower extremity muscles. It was hypothesized that bridging this central-peripheral gap with vaible intercostal nerves would restore limited voluntary movement to the paralyzed muscles. This procedure has been performed on four infants and seems promising
— id: 140423, year: 1980, vol: 6, page: 540, stat: Journal Article,

Delayed cauda equina reconstruction in meningomyelocele
Epstein, F; Spielholz, N; McCarthy, J; Battista, A; Ransohoff, J
1980 ;7(1):31-42, Child's brain
Infants afflicted with meningomyelocele are paralyzed as a result of physiologic disconnection of the neural plate from the spinal cord. Intact neural elements within the placode often maintain segmental reflex innervation of paralyzed lower extremity muscles. It was hypothesized that bridging this central peripheral gap with viable intercostal nerves would restore limited voluntary movement to paralyzed muscles. The surgical technique and initial results are the subject of this report
— id: 67667, year: 1980, vol: 7, page: 31, 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,

Craniofacial synostosis in association with vitamin D--resistant rickets
McCarthy, J G; Reid, C A
1980 Feb;4(2):149-153, Annals of plastic surgery
A patient with craniofacial synostosis and vitamin D--resistant rickets who underwent successful Le Fort II advancement is presented. The association of premature cranial synostosis with a variety of metabolic and hematological disorders is discussed
— id: 99076, year: 1980, vol: 4, page: 149, stat: Journal Article,

The current status of the major histocompatibility complex (HLA) in family studies of craniofacial developmental anomalies
Rapaport, F T; Converse, J M; McCarthy, J G; Bachvaroff, R J; Raisbeck, A P; Bach, F H
1980 ;46:491-498, Progress in clinical & biological research
— id: 99077, year: 1980, vol: 46, page: 491, stat: Journal Article,

DOMINANTLY INHERITED OROFACIAL DEFECTS IN SEVERAL FAMILY MEMBERS - A NEW SYNDROME
Reich, EW; Cox, RP; Becker, MH; Genieser, NB; Mccarthy, JG; Converse, JM
1980 ;17(4):358-358, Cleft palate journal
— id: 27957, year: 1980, vol: 17, page: 358, stat: Journal Article,

Coverage of heel and sole defects: a new subfascial arterialized flap
Reiffel, R S; McCarthy, J G
1980 Aug;66(2):250-260, Plastic & reconstructive surgery
Defects of the heel and sole represent difficult reconstructive problems in terms of tissue availability and postoperative morbidity. Although local flaps offer the optimal type of coverage, their application has been restricted to defects of limited size. A study of the plantar skin and fascia, as well as its neurovascular supply, was undertaken in cadavers. Mobility of local flaps is greatest with a narrow pedicle. Dissection deep to the plantar fascia allows the inclusion of the medial or lateral plantar nerve and artery with the flap, thereby allowing considerably mobility while preserving vascularity and sensibility. Several variations of the flap are presented with clinical examples
— id: 99074, year: 1980, vol: 66, page: 250, stat: Journal Article,

Symposium on diagnosis and treatment of craniofacial anomalies
Converse, John Marquis.; McCarthy, Joseph G.; Wood-Smith, Donald
St. Louis : Mosby, 1979,
— id: 164, year: 1979, vol: , page: , stat: ,

Prophylactic craniofacial surgery
Epstein, F; McCarthy, J G; Coccaro, P J
1979 ;5(3):204-215, Child's brain
One-stage radical reconstructive surgery for the common craniofacial deformities has become standard procedure in a few medical centers. With increasing experience and expertise, young children and adolescents, as well as a few adults have been greatly benefited. It has long been recognized that both the cranial and facial deformities of Couzon's disease and Apert's syndrome are progressive, having their inception either before birth or in the neonatal period, and evolving to the full blown syndrome during the first years of life. The authors believe that the progressive nature of these anomalies is secondary to a combination of permaturely fused sutures of the calvarium and cranial base (coronal, sphenozygomatic, frontoethmoidal and frontosphenoidal). In an effort to arrest and correct both the cranial and facial deformities as well as obviate the need for future radical surgery the authors have treated several children with Crouzon's disease and Apert's syndrome with suture craniectomy along the base of the skull. Following this procedure, deformity has regressed and ultimate cosmetic improvement has been dramatic. It is unlikely that radical craniofacial surgery will be necessary in this group of patients at any future time. On the basis of this experience, it is believed that the pendulum is now swinging and that in the future, stripping of the appropriate sutures along the base of the skull will limit deformity and make additional surgery unnecessary
— id: 99081, year: 1979, vol: 5, page: 204, stat: Journal Article,

New concepts in the surgical treatment of the craniofacial synostosis syndromes in the infant
McCarthy JG
1979 Apr;6(2):201-226, Clinics in plastic surgery
— id: 63204, year: 1979, vol: 6, page: 201, stat: Journal Article,

A study of gustatory and olfactory function in patients with craniofacial anomalies
McCarthy, J G
1979 Jul;64(1):52-58, Plastic & reconstructive surgery
Olfactory and gustatory function can be reiably studied in patients with craniofacial anomalies over the age of 7 years. In our unoperated patients with orbital hypertelorism or craniofacial dysostosis, preoperative evaluation of the olfactory and gustatory functions showed normal values. The same techniques were employed to study any changes in these modalities following reconstructive craniofacial surgery, and the results are presented
— id: 99080, year: 1979, vol: 64, page: 52, stat: Journal Article,

Velopharyngeal function following maxillary advancement
McCarthy, J G; Coccaro, P J; Schwartz, M D
1979 Aug;64(2):180-189, Plastic & reconstructive surgery
In a series of 40 patients who had maxillary advancements, none developed velopharyngeal incompetence. Unlike the cleft palate patient who is more at risk, there are distinct anatomical characteristics in craniofacial dysostosis which favor maintenance of the integrity of the velopharyngeal mechanism. Hyponasality was eliminated in 5 patients with Crouzon's disease. On cephalometric study, it was observed that after maxillary advancement the nasopharyngeal volume was expanded and the angle formed by the hard and soft palates was increased. On phonating cephalograms, the velopharyngeal contact became more physiological after maxillary advancement in the craniofacial dysostosis patient. The only postoperative articulatory changes after maxillary advancement were in the production of the /s/ sound, which is particularly sensitive to changes in dentoalveolar relationships
— id: 99079, year: 1979, vol: 64, page: 180, stat: Journal Article,

SYMPOSIUM ON HORIZONS IN PLASTIC-SURGERY - FOREWORD
Mccarthy, JG
1979 ;6(2):123-124, Clinics in plastic surgery
— id: 30104, year: 1979, vol: 6, page: 123, stat: Journal Article,

Symposium on horizons in plastics surgery
McCarthy, Joseph G
Philadelphia : Saunders, 1979,
— id: 179, year: 1979, vol: , page: , stat: ,

The major histocompatibility complex (HLA) as a genetic marker in human craniofacial anomalies
Rapaport, F T; Bach, F H; Bachvaroff, R J; McCarthy, J G; Raisbeck, A P; Egelandsdal, B; Converse, J M
1979 Nov;14(5):407-421, Tissue antigens
Study of the incidence and segregation of the serologically detectable A and B products of the HLA complex in 140 family units in which one or more offspring was afflicted with a developmental craniofacial anomaly has uncovered no evidence of an association between HLA-A or B antigens or haplotypes and the malformations under study. Further analysis of HLA-D products in the same family units by the mixed leukocyte culture (MLC) technique has, however, uncovered a relatively high incidence of non-reactivity between the cells of one (or both) parent(s) and cells of some offspring in 41 of the 140 families included in this study. The parent couples involved in this finding were unrelated and generally did not share any HLA-SD haplotypes. When this finding was studied further by Primed LD Typing techniques, the results in six families suggested that such MLC non-reactivity is a consequence of the sharing of LD alleles by each pair of parents in these families. The known polymorphism of the HLA-D locus (or loci) and the low incidence of comparable findings in the normal population suggest that LD allele sharing in this particular population may be related to the selection of certain particular HLA-D products in families afflicted with developmental craniofacial anomalies. This result may be relevant to the possible existence in man of an analogue of the murine T/t complex which may occur in linkage with the HLA complex, in the same manner as the linkage disequilibrium which is been documented between the t complex and H-2 in chromosome 17 of the mouse
— id: 99078, year: 1979, vol: 14, page: 407, stat: Journal Article,

Genetic histocompatibility (HLA) associations with congenital craniofacial anomalies amenable to reconstructive surgery
McCarthy JG; Rapaport FT; Bachvaroff RJ; Bach FH; Converse JM
1978 ;29:605-606, Surgical forum
— id: 11455, year: 1978, vol: 29, page: 605, stat: Journal Article,

Early skeletal release in the infant with craniofacial dysostosis
McCarthy, J G; Coccaro, P J; Epstein, F; Converse, J M
1978 Oct;62(4):610-611, Plastic & reconstructive surgery
— id: 99082, year: 1978, vol: 62, page: 610, stat: Journal Article,

Early skeletal release in the infant with craniofacial dysostosis: the role of the sphenozygomatic suture
McCarthy, J G; Coccaro, P J; Eptstein, F; Converse, J M
1978 Sep;62(3):335-346, Plastic & reconstructive surgery
We describe our experience with early skeletal release in 10 infants with craniofacial dysostosis. The cranial base is the key to the deformity, and we extend the release toward it as well as resecting strips from the calvarium. Three procedures are described. The early results are encouraging
— id: 99083, year: 1978, vol: 62, page: 335, stat: Journal Article,

Recognition in adult patients of malformations induced by folic-acid antagonists
Reich, E W; Cox, R P; Becker, M H; Genieser, N B; McCarthy, J G; Converse, J M
1978 ;14(6B):139-160, Birth defects original articles series
Three patients are reported, two of whom had mothers who revealed ingestion of abortifacient drugs during pregnancy. All patients resemble one another and those described earlier with malformations that were probably either aminopterin- or methotrexate-induced. It is likely that Patients I and II have abnormalities associated with the teratogenic action of these folic-acid antagonists. The etiology of Patient III's defects remains uncertain
— id: 99084, year: 1978, vol: 14, page: 139, stat: Journal Article,

Reconstructive plastic surgery : principles and procedures in correction, reconstruction, and transplantation
Converse, John Marquis.; McCarthy, Joseph G.; Littler, J. William
Philadelphia : W. B. Saunders, 1977,
— id: 186, year: 1977, vol: , page: , stat: ,

Congenital ophthalmoplegia in oculoauriculovertebral dysplasia-hemifacial microsomia (Goldenhar-Gorlin syndrome). A clinicopathologic study and review of the literature
Aleksic, S; Budzilovich, G; Choy, A; Reuben, R; Randt, C; Finegold, M; McCarthy, J; Converse, J; Feigin, I
1976 Jul;26(7):638-644, Neurology
Two patients with Goldenhar-Gorlin syndrome showed paralysis of one or more extraocular eye movements on neurologic examination. At autopsy, a third patient showed unilateral agenesis of trochlear and abducens nerves and corresponding brain stem nuclei. Congenital ophthalmoplegia is not infrequent in Goldenhar-Gorlin syndrome and may be due to hypoplasia or agenesis, or both, of extraocular muscles, extraocular nerves, and brain stem nuclei
— id: 106860, year: 1976, vol: 26, page: 638, stat: Journal Article,

Computerized axial tomography of craniofacial malformations. A preliminary report
Becker, M H; McCarthy, J G; Chase, N; Converse, J M; Genieser, N B
1976 Jan;130(1):17-20, American journal of diseases of children
Computerized axial tomography is a new radiologic technique that permits noninvasive study of the skull, brain, and cerebral ventricles. This technique has been applied to the study of craniofacial malformations prior to intracranial surgical correction. The assessment of the cerebral ventricles is valuable as a base line study as well as helpful in detecting unsuspected abnormalities in the brain prior to surgery
— id: 99086, year: 1976, vol: 130, page: 17, stat: Journal Article,

The concept of a craniofacial anomalies center
McCarthy, J G
1976 Oct;3(4):611-620, Clinics in plastic surgery
— id: 99085, year: 1976, vol: 3, page: 611, stat: Journal Article,

Congenital trigeminal neuropathy in oculoauriculovertebral dysplasia-hemifacial microsomia (Goldenhar-Gorlin syndrome)
Aleksic, S; Budzilovich, G; Reuben, R; Feigin, I; Finegold, M; McCarthy, J; Aston, S; Converse, J M
1975 Oct;38(10):1033-1035, Journal of neurology neurosurgery & psychiatry
A 2 1/2 year old child with clinical features of Goldenhar-Gorlin syndrome showed diminished pinprick sensation over the right half of the face. After surgery for the cleft lip, the child died. Neuropathological investigations showed agenesis of the right trigeminal nerve and hypoplasia of the right trigeminal brain-stem nuclei. Nosological aspects of the Goldenhar-Gorlin syndrome and previously reported cases of congenital trigeminal anaesthesia in this disorder are discussed. It is suggested that the hypoplasia of the trigeminal nerve is responsible for the diminished facial sensation seen in some patients with this craniofacial syndrome
— id: 117265, year: 1975, vol: 38, page: 1033, stat: Journal Article,

Unilateral arhinencephaly in goldenhar-gorlin syndrome
Aleksic, S; Budzilovich, G; Reuben, R; Laguna, J; Finegold, M; McCarthy, J; Converse, J M; Feigin, I
1975 Aug;17(4):498-504, Developmental medicine & child neurology
The post-mortem examination of the brain of a 2 1/2-year-old girl with clinical featutes of oculo-auriculo-vertebral dysplasia and hemifacial microsomia (Goldenhar-Gorlin syndrom) revealed a unilateral absence of the olfactory foramina of the lamina cribrosa of the ethmoid bone and ipsilateral absence of olfactory bulb and tract. Other cerebral abnormalities were also present. In this report, unilateral arhinencephaly in this disorder has been documented for the first time and an attempt has been made to correlate various nosological, clinical and pathological aspects of the case with previously reported instances of arhinencephaly. It is concluded that unilateral arhinencephaly occurs in a variety of cranial and facial abnormalities and is not specific for any particular syndrome
— id: 117233, year: 1975, vol: 17, page: 498, stat: Journal Article,

Orbital hypotelorism. Pathogenesis, associated facio-cerebral anomalies, surgical correction
Converse, J M; McCarthy, J G; Wood-Smith, D
1975 Oct;56(4):389-394, Plastic & reconstructive surgery
— id: 99087, year: 1975, vol: 56, page: 389, stat: Journal Article,

Report on a series of 50 craniofacial operations
Converse, J M; Wood-smith, D; McCarthy, J G
1975 Mar;55(3):283-293, Plastic & reconstructive surgery
We present a retrospective study of 50 patients who have undergone craniofacial surgery. The indications, types of osteotomies, complications, and other aspects are reported
— id: 99088, year: 1975, vol: 55, page: 283, stat: Journal Article,

A proposed classification for craniofacial malformations
Becker, M H; McCarthy, J G; Genieser, N B; Converse, J M
1974 ;10(7):171-175, Birth defects original articles series
— id: 99092, year: 1974, vol: 10, page: 171, stat: Journal Article,

Craniofacial surgery
Converse, J M; Wood-Smith, D; McCarthy, J G; Coccaro, P J
1974 Jul;1(3):499-557, Clinics in plastic surgery
— id: 99090, year: 1974, vol: 1, page: 499, stat: Journal Article,

Bilateral facial microsomia. Diagnosis, classification, treatment
Converse, J M; Wood-Smith, D; McCarthy, J G; Coccaro, P J; Becker, M H
1974 Oct;54(4):413-423, Plastic & reconstructive surgery
— id: 99089, year: 1974, vol: 54, page: 413, stat: Journal Article,

The role of groin dissection in the management of melanoma of the lower extremity
McCarthy, J G; Haagensen, C D; Herter, F P
1974 Feb;179(2):156-159, Annals of surgery
— id: 99091, year: 1974, vol: 179, page: 156, stat: Journal Article,

Infections in plastic surgery
Converse, J M; McCarthy, J G
1972 Dec;52(6):1459-1466, Surgical clinics of North America
— id: 99093, year: 1972, vol: 52, page: 1459, stat: Journal Article,

Retroperitoneal fibrosis and large bowel obstruction: case report and review of the literature
McCarthy, J G; Porter, M R; Veenema, R
1972 Aug;176(2):199-204, Annals of surgery
— id: 99094, year: 1972, vol: 176, page: 199, stat: Journal Article,

The role of the groin dissection in the management of patients with melanoma of the lower extremity
McCarthy, J G
1971 Sep-Oct;28(5):374-375, Review of surgery
— id: 99095, year: 1971, vol: 28, page: 374, stat: Journal Article,

A radioisotopic method for determining optimum non-surgical therapy for advanced cancer. II. Clinical experience
Herter, F P; Mulcare, R J; McCarthy, J G; Gump, F E; Ukai, M; Buckley, K; Wheeler, B
1968 Sep;168(3):365-373, Annals of surgery
— id: 99096, year: 1968, vol: 168, page: 365, stat: Journal Article,

A radioisotopic method for determining optimum non-surgical therapy for advanced cancer. I. Experimental data
White, R L; Herter, F P; Mulcare, R J; McCarthy, J G; Martin, J; Buckley, K
1968 Sep;168(3):357-364, Annals of surgery
— id: 99097, year: 1968, vol: 168, page: 357, stat: Journal Article,