Bradley A. Hubbard

Toward engineering functional organ modules by additive manufacturing.

Tissue engineering is emerging as a possible alternative to methods aimed at alleviating the growing demand for replacement tissues and organs. A major pillar of most tissue engineering approaches is the scaffold, a biocompatible network of synthetic or natural polymers, which serves as an extracellular matrix mimic for cells. When the scaffold is seeded with cells it is supposed to provide the appropriate biomechanical and biochemical conditions for cell proliferation and eventual tissue formation. Numerous approaches have been used to fabricate scaffolds with ever-growing complexity. Recently, novel approaches have been pursued that do not rely on artificial scaffolds. The most promising ones utilize matrices of decellularized organs or methods based on multicellular self-assembly, such as sheet-based and bioprinting-based technologies. We briefly overview some of the scaffold-free approaches and detail one that employs biological self-assembly and bioprinting. We describe the technology and its specific applications to engineer vascular and nerve grafts.

Unilateral Frontosphenoidal Craniosynostosis With Achondroplasia: A Case Report

Isolated, premature fusion of the frontosphenoidal suture is rare. This report describes an unusual combination of frontosphenoidal craniosynostosis and achondroplasia. Although craniosynostosis is known to occur in allelic conditions such as thanatophoric dysplasia, craniosynostosis in individuals with achondroplasia is exceedingly rare. Due to the distracting diagnosis of achondroplasia or inadequate knowledge of craniosynostosis, the abnormal head shape was initially treated by other physicians with helmet molding. Plastic surgery consultation was obtained at 2 years of age and surgical care was provided. An acceptable head shape was obtained, but the delay in appropriate evaluation was disconcerting. To our knowledge this is the first reported case of isolated frontosphenoidal craniosynostosis associated with achondroplasia.

Adenoid involvement in velopharyngeal closure in children with cleft palate

OBJECTIVE To assess the role of the adenoid pad in velopharyngeal (VP) closure. DESIGN A retrospective review of patients with cleft palate (CP) who underwent nasendoscopy and multiview videofluoroscopy during evaluation for VP insufficiency (VPI) from January 2006 to March 2008. PATIENTS Thirty-two consecutive patients were identified. None of the patients were lost to follow-up. Five patients were excluded: two for advanced age, two due to mental disabilities and one with a submucous cleft. INTERVENTION Video nasendoscopy and multiview videofluoroscopy were performed for evaluation of VPI. OUTCOME MEASURES Adenoid size based on nasendoscopy studies, and adenoid involvement in VP closure based on videofluoroscopy were recorded. RESULTS The average patient age was 6.6 years (range three to 13 years). Seventy-eight per cent of patients had small adenoid volumes (less than 50% obstruction of the choanae), and six patients (two unilateral cleft lip and palate patients, one bilateral cleft lip and palate patient, two isolated CP patients and one cleft of secondary palate patient) had large adenoid volumes (50% or greater obstruction of the choanae); the adenoid pads of these patients were almost always (five of six patients) involved in their VP closure patterns. Videofluoroscopy showed that 26% (95% CI 9% to 40%) of patients did not significantly use their adenoid pad in VP closure. Forty-three per cent of those not using their adenoids attempted contact with a Passavants ridge. CONCLUSIONS In general, the adenoid pad should be maintained in CP patients. However, not all CP patients in the present study used their adenoid pad in attempted VP closure. If adenoidectomy is medically indicated, a percentage of these patents might be considered to be at lower risk for the development of postadenoidectomy VPI.

Contractility of sphincter pharyngoplasty: Relevance to speech outcomes

BACKGROUND Sphincter pharyngoplasty has demonstrated time-tested results as a surgical treatment for velopharyngeal incompetence (VPI). However, controversy surrounding the contractility of the transposed muscles persists. Completely unaddressed in the literature is whether the dynamism of the sphincter affects speech outcomes. OBJECTIVE To determine whether active sphincter contraction following sphincter pharyngoplasty influences velopharyngeal closure, nasal emission and hypernasality. METHODS A prospective analysis of patients with VPI after cleft palate repair undergoing sphincter pharyngoplasty by a single surgeon was performed. Video nasendoscopy and videofluoroscopy were performed preoperatively and postoperatively at three and 12 months. Eighteen consecutive patients with cleft palate with or without cleft lip and VPI were reviewed. The average age of the patients at initial evaluation was 7.3 years, with a range of three to 19 years. Dynamicity of sphincter pharyngoplasty, velar closing ratio (VCR), and lateral wall movement (LWM) were assessed by nasendoscopy and videofluoroscopy. Nasal emission and hypernasality were assessed by perceptual speech examination. RESULTS FOR LONGITUDINAL COMPARISON, THREE GROUPS WERE CREATED: dynamic at three and 12 months (n=12); adynamic at three months and dynamic at 12 months (n=4); and adynamic at three and 12 months (n=2). Perceived hypernasality scores significantly improved at three months (P=0.0001) and showed continued improvement at 12 months (P=0.03), despite no change in VCR and LWM from three to 12 months. There were no significant differences among the three groups at any time point. DISCUSSION Sphincter pharyngoplasty effectively treats VPI in appropriately selected patients. Although the VCR and LWM remained stable between three months and one year, four of six adynamic sphincters became dynamic. Considering all patients, hypernasality showed continued improvement from three months to one year. CONCLUSIONS There were no differences between dynamic and adynamic sphincters in terms of speech outcomes or the mechanical properties of velopharyngeal closure.

Atlas of Craniomaxillofacial Osteosynthesis: Microplates, Miniplates, and Screws, 2nd ed

Now in its second edition, the Atlas of Craniomaxillofacial Osteosynthesis: Microplates, Miniplates, and Screws again delivers an in-depth how-to guide for the surgeon seeking detailed procedure descriptions. The atlas is not as all-encompassing as its name might suggest, focusing most of its attention on mandibular, maxillary, and orthognathic procedures. Surgical technique is certainly the author’s first priority, as the indications for procedures and other clinical considerations in the traumatology sections are brief if present at all. However, the technique descriptions are perfectly detailed and not at all diffuse. The illustrations, by Andreas Reinhardt, are superb and plentiful, never requiring the reader to use imagination for comprehension. Similar to their inaugural edition, the authors steadfastly adhere to minimalist fixation methods as popularized by Champy. The initial chapters deal almost exclusively with the experimental and clinical research to defend this fixation dogma. In brief, the authors promote monocortical miniplate or microplate osteosynthesis along the lines of thickest cortex on tension bearing or buttress segments (lines of osteosynthesis). Absolute rigid fixation with bicortical screws, multiple plates, or locking reconstruction plates is shunned in most circumstances as excessive and having potentially deleterious effects on osseous healing. It is disappointing that the methodology and potential benefits of rigid fixation, currently used by many maxillofacial surgeons, receive little discussion. After multiple brief chapters applying the principles of miniplate and microplate osteosynthesis for traumatology, the second half of the book completely changes direction. In these later chapters on orthognathic surgery and mandibular reconstruction, the focus on technique remains, but the clinical indications and preoperative management receive thoughtful attention. The midface and mandibular osteotomies and distraction chapters are perhaps the highlight of the book. The second edition offers the reader several new topics of discussion. Notably, chapters on the use of resorbable fixation, additional methods for fixation of the condylar neck and head, and maxillary distraction have been added. The primary contributors for each chapter are virtually unchanged, although the chapters are appropriately updated with the current literature. Practicing surgeons and trainees alike would benefit from this volume as a read-though text as well as reference material. This is true for both the craniomaxillofacial and oral surgery fields. Champy and colleagues should be applauded for their invaluable contributions to our field. As a presentation of their extensive work, the Atlas of Craniomaxillofacial Osteosynthesis is certainly worthy of our regard.

Book Review: Atlas of Craniomaxillofacial Osteosynthesis: Microplates, Miniplates, and Screws, 2nd ed.:

Now in its second edition, the Atlas of Craniomaxillofacial Osteosynthesis: Microplates, Miniplates, and Screws again delivers an in-depth how-to guide for the surgeon seeking detailed procedure descriptions. The atlas is not as all-encompassing as its name might suggest, focusing most of its attention on mandibular, maxillary, and orthognathic procedures. Surgical technique is certainly the author’s first priority, as the indications for procedures and other clinical considerations in the traumatology sections are brief if present at all. However, the technique descriptions are perfectly detailed and not at all diffuse. The illustrations, by Andreas Reinhardt, are superb and plentiful, never requiring the reader to use imagination for comprehension. Similar to their inaugural edition, the authors steadfastly adhere to minimalist fixation methods as popularized by Champy. The initial chapters deal almost exclusively with the experimental and clinical research to defend this fixation dogma. In brief, the authors promote monocortical miniplate or microplate osteosynthesis along the lines of thickest cortex on tension bearing or buttress segments (lines of osteosynthesis). Absolute rigid fixation with bicortical screws, multiple plates, or locking reconstruction plates is shunned in most circumstances as excessive and having potentially deleterious effects on osseous healing. It is disappointing that the methodology and potential benefits of rigid fixation, currently used by many maxillofacial surgeons, receive little discussion. After multiple brief chapters applying the principles of miniplate and microplate osteosynthesis for traumatology, the second half of the book completely changes direction. In these later chapters on orthognathic surgery and mandibular reconstruction, the focus on technique remains, but the clinical indications and preoperative management receive thoughtful attention. The midface and mandibular osteotomies and distraction chapters are perhaps the highlight of the book. The second edition offers the reader several new topics of discussion. Notably, chapters on the use of resorbable fixation, additional methods for fixation of the condylar neck and head, and maxillary distraction have been added. The primary contributors for each chapter are virtually unchanged, although the chapters are appropriately updated with the current literature. Practicing surgeons and trainees alike would benefit from this volume as a read-though text as well as reference material. This is true for both the craniomaxillofacial and oral surgery fields. Champy and colleagues should be applauded for their invaluable contributions to our field. As a presentation of their extensive work, the Atlas of Craniomaxillofacial Osteosynthesis is certainly worthy of our regard.

Atlas of Craniomaxillofacial Osteosynthesis: Microplates, Miniplates, and Screws, 2nd ed Atlas of Craniomaxillofacial Osteosynthesis: Microplates, Miniplates, and Screws, 2nd Ed. Haerle F. Champy M. Terry B. Stuttgart, Germany Thieme Medical Publishers ISBN: 9783131164926 . Pp. 240. 414 illustrations. Indexed. Hardcover . 2009 .

Now in its second edition, the Atlas of Craniomaxillofacial Osteosynthesis: Microplates, Miniplates, and Screws again delivers an in-depth how-to guide for the surgeon seeking detailed procedure descriptions. The atlas is not as all-encompassing as its name might suggest, focusing most of its attention on mandibular, maxillary, and orthognathic procedures. Surgical technique is certainly the author’s first priority, as the indications for procedures and other clinical considerations in the traumatology sections are brief if present at all. However, the technique descriptions are perfectly detailed and not at all diffuse. The illustrations, by Andreas Reinhardt, are superb and plentiful, never requiring the reader to use imagination for comprehension. Similar to their inaugural edition, the authors steadfastly adhere to minimalist fixation methods as popularized by Champy. The initial chapters deal almost exclusively with the experimental and clinical research to defend this fixation dogma. In brief, the authors promote monocortical miniplate or microplate osteosynthesis along the lines of thickest cortex on tension bearing or buttress segments (lines of osteosynthesis). Absolute rigid fixation with bicortical screws, multiple plates, or locking reconstruction plates is shunned in most circumstances as excessive and having potentially deleterious effects on osseous healing. It is disappointing that the methodology and potential benefits of rigid fixation, currently used by many maxillofacial surgeons, receive little discussion. After multiple brief chapters applying the principles of miniplate and microplate osteosynthesis for traumatology, the second half of the book completely changes direction. In these later chapters on orthognathic surgery and mandibular reconstruction, the focus on technique remains, but the clinical indications and preoperative management receive thoughtful attention. The midface and mandibular osteotomies and distraction chapters are perhaps the highlight of the book. The second edition offers the reader several new topics of discussion. Notably, chapters on the use of resorbable fixation, additional methods for fixation of the condylar neck and head, and maxillary distraction have been added. The primary contributors for each chapter are virtually unchanged, although the chapters are appropriately updated with the current literature. Practicing surgeons and trainees alike would benefit from this volume as a read-though text as well as reference material. This is true for both the craniomaxillofacial and oral surgery fields. Champy and colleagues should be applauded for their invaluable contributions to our field. As a presentation of their extensive work, the Atlas of Craniomaxillofacial Osteosynthesis is certainly worthy of our regard.