Advances in Research
The Craniofacial Center at Cincinnati Children's Hospital Medical Center conducts basic and clinical research which is evident through clinical advances.
Basic Research
Tissue engineering of Bone and Cartilage
A research team is on the cutting edge of finding a way to grow better bone and cartilage, two critical components of reconstructive surgery for craniofacial bony defects. Dr. Jesse Taylor is the plastic and reconstructive surgeon on the team, and Dr. Donna Jones is the plastic surgery researcher.
Critical defects of the craniomaxillofacial region, as well as long bones, often are treated with vascularized osteocutaneous free flaps. These are lengthy operations, may be associated with considerable donor site morbidity, and often have suboptimal results, both functionally and aesthetically. The prospect of tissue engineering vascularized bone and cartilage offers an attractive alternative. Using a combination of adult mesenchymal stem cells, growth factors, cadaver bone, and vascularized periosteum, we have engineered vascularized bone and cartilage flaps which can be used to aid in our reconstructions. This will allow us to offer better, more effective, less morbid procedures to our patients.
Read more about how Dr. Taylor used this breakthrough to grow cheek bones for a 14 year old boy.
Composite Tissue Allotransplantation, also known as Facial Transplants
Facial transplantation, once a dream, is quickly becoming a reality. Cincinnati Children's is on the forefront of research efforts to make this promising treatment modality more safe through the development of improved surgical techniques and immunologic tolerance. Over the past year, our novel flap for facial and scalp transplantation received a warm reception American Society of Reconstructive Microsurgery's annual meeting. Our unique strategies to induce immunological tolerance, the holy grail in facial transplantation, provide unique insights into how humans identify self versus foreign material. It is our hope that we can translate our laboratory research efforts into the clinical setting in the near future.
Clinical Research
Clinical study on Usefulness and Reliability of Wideband Reflectance
A large clinical study is underway which will evaluate the usefulness and reliability of Wideband Reflectance, a new technique which will help us determine the health of a child's middle ear. We are studying two groups of children between 3 months and 18 years of age: Group 1 is children with normal hearing but without any ear infections or other ear diseases, and Group 2 are children with active middle ear disease. This study will establish a baseline of normal middle ear function in children using wideband reflectance.
Positional Plagiocephaly
The epidemic of positional plagiocephaly, or “flat head”, has significantly increased since the American Academy of Pediatrics issued the "Back to Sleep" campaign to reduce the incidence of SIDS in the newborn population. An effective treatment is the use of a molding helmet. The research study will use 3-D imaging to compare cranial asymmetry and head growth before the initiation of helmet therapy and after completion of therapy.
Clinical Innovations
Minimally invasive craniofacial surgery
Drs. Christopher Gordon and Jesse Taylor are pioneers in the new field of minimally invasive craniofacial surgery. The promise of achieving the same, or better, results with less risk is what minimally invasive surgery can deliver. Drs. Gordon and Taylor have developed techniques to perform most craniofacial osteotomies, including those in which distraction osteogenesis is employed, through minimally invasive means.
Nasoalveolar molding (NAM) and Pre-surgical Orthopedics
Our pediatric dentists and plastic surgeons work together to determine if a newborn with a large cleft lip and nasal deformity will benefit from nasoalveolar molding. NAM is a combination of a palatal device that moves the baby’s gums into better dental alignment and a nasal mold that reshapes the nostrils. Our team provides an individualized evaluation of each infant so that the best combination of palatal device and/or nasal molds is done.
The palatal device that we do is also known as a pre-surgical orthopedic appliance. It is similar to an orthodontic appliance and is surgically pinned into the palate by the pediatric dentist. The baby wears the appliance 24 hours a day for about six weeks. Parents are instructed in turning the screw that allows active movement of the appliance. Babies are seen by the pediatric dentist once a week to check and adjust the appliance.
After six weeks, the palatal segments (gums) along with the cleft lip are in better alignment for surgical closure. The device is removed at the time of the cleft lip repair.
The nasal molds are customized to the degree of severity of the nasal deformity. We offer several approaches for improving the nasal shape.
Dr. Murray Dock, pediatric dentist, Division of Pediatric Dentistry, speaks about cleft palate alignment and nasoalveolar molding (NAM).
