Publications by authors named "Bernard J Costello"

47 Publications

The Association Between Age at Palatoplasty and Speech and Language Outcomes in Children With Cleft Palate: An Observational Chart Review Study.

Cleft Palate Craniofac J 2020 02 24;57(2):148-160. Epub 2019 Oct 24.

Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, PA, USA.

Objective: To determine whether timing of palatoplasty (early, standard, or late) is associated with speech and language outcomes in children with cleft palate.

Design: Retrospective case series.

Setting: Tertiary care children's hospital.

Participants: Records from 733 children born between 2005 and 2015 and treated at the Cleft Craniofacial Clinic of a tertiary children's hospital were retrospectively reviewed. Exclusion criteria were cleft repair at an outside hospital, intact secondary palate, absence of postpalatoplasty speech evaluation, syndromes, staged palatoplasty, and introduction to clinic after 12 months of age. Data from 232 children with cleft palate ± cleft lip were analyzed.

Interventions: Palatoplasty.

Main Outcome Measures: Speech/language delays and disorders at 20 months and 5 years of age based on formal hospital or community-based testing or screening evaluation in the Cleft Craniofacial Clinic; additional speech surgery.

Results: Median age at palatoplasty was 12.6 months (range: 8.8-21.9 months). Age at palatoplasty was classified as early (<11 months, n = 28), standard (11-13 months, n = 158), or late (>13 months, n = 46). Late palatoplasty was associated with increased odds of speech/language delays and speech therapy at 20 months, and language delays at 5 years, compared with standard or early palatoplasty ( < .05 for all comparisons). However, speech sound production disorders, velopharyngeal incompetence, tube replacement, and hearing loss were not significantly associated with age at palatoplasty.

Conclusions: Late palatoplasty may be associated with short- and long-term delays in speech/language development. Future studies with standardized surgical technique/timing and outcome measures are required to more definitively describe the impact of age at palatoplasty on speech/language development.
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http://dx.doi.org/10.1177/1055665619882566DOI Listing
February 2020

Chronic Recurrent Multifocal Osteomyelitis of the Mandible: A Diagnostic Challenge.

Plast Reconstr Surg 2018 07;142(1):186-192

From the Department of Plastic Surgery, School of Dental Medicine, and the Division of Pediatric Rheumatology, University of Pittsburgh, Children's Hospital of Pittsburgh of UPMC.

Chronic recurrent multifocal osteomyelitis is a rare autoinflammatory bone disorder of children and adolescents characterized by monofocal or multifocal inflammatory bone lesions that are culture-negative on biopsy, associated with periods of exacerbation and resolution that can last over several months to years. Although it is predominantly a disease of long bones and the spine, craniofacial involvement is not uncommon, affecting the mandible in up to one-fifth of cases. Similarities with other causes of osteitis in clinical presentation and imaging, and the lack of specific symptoms or laboratory tests, make chronic recurrent multifocal osteomyelitis mainly a diagnosis of exclusion. An accurate diagnosis is required for appropriate treatment to induce remission. This article highlights the challenges faced by plastic and oral surgeons in diagnosing mandibular chronic recurrent multifocal osteomyelitis, and describes two pediatric patients affected with the disease. Both cases were initially confused with other entities, leading to unnecessary initial treatments and a delayed diagnosis. A review aimed at surgeons summarizes the major aspects of this condition so that it is considered as a differential diagnosis in young patients presenting with a facial bony mass.

Clinical Question/level Of Evidence: Therapeutic, V.
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http://dx.doi.org/10.1097/PRS.0000000000004494DOI Listing
July 2018

Cleft and Craniofacial Surgery.

J Oral Maxillofac Surg 2017 08;75(8S):e126-e150

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http://dx.doi.org/10.1016/j.joms.2017.04.031DOI Listing
August 2017

Soft Tissue Regeneration Incorporating 3-Dimensional Biomimetic Scaffolds.

Oral Maxillofac Surg Clin North Am 2017 Feb;29(1):9-18

Cranofacial Cleft Surgery, Department of Oral and Maxillofacial Surgery, University of Pittsburgh School of Dental Medicine, 214 Eye and Ear Institute, 203 Lothrop Street, Pittsburgh, PA 15213, USA. Electronic address:

Soft tissue replacement and repair is crucial to the ever-developing field of reconstructive surgery as trauma, pathology, and congenital deficits cannot be adequately restored if soft tissue regeneration is deficient. Predominant approaches were sometimes limited to harvesting autografts, but through regenerative medicine and tissue engineering, the hope of fabricating custom constructs is now a feasible and fast-approaching reality. The breadth of this field includes tissues ranging from skin, mucosa, muscle, and fat and hopes to not only provide construct to replace a tissue but also to replace its function.
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http://dx.doi.org/10.1016/j.coms.2016.08.003DOI Listing
February 2017

Rescue of Premature Coronal Suture Fusion with TGF-β2 Neutralizing Antibody in Rabbits with Delayed-Onset Synostosis.

Cleft Palate Craniofac J 2018 07 26;55(6):844-855. Epub 2018 Feb 26.

Objectives: An overexpression of Tgf-β2 leads to calvarial hyperostosis and suture fusion in individuals with craniosynostosis. Inhibition of Tgf-β2 may help rescue fusing sutures and restore normal growth. The present study was designed to test this hypothesis.

Design: Twenty-eight New Zealand White rabbits with delayed-onset coronal synostosis had radiopaque markers placed on either side of the coronal sutures at 10 days of age. The rabbits were randomly assigned to: (1) sham control rabbits (n = 10), (2) rabbits with control IgG (100 μg/suture) delivered in a collagen vehicle (n = 9), and (3) rabbits with Tgf-β2 neutralizing antibody (100 μg/suture) delivered in a collagen vehicle (n = 9). Longitudinal growth data were collected at 10, 25, 42, and 84 days of age. Sutures were harvested at 84 days of age for histomorphometry.

Results: Radiographic analysis showed significantly greater ( P < .05) coronal suture marker separation, craniofacial length, cranial vault length, height, shape indices, cranial base length, and more lordotic cranial base angles in rabbits treated with anti-Tgf-β2 antibody than in controls at 42 and 84 days of age. Histologically, rabbits treated with anti-Tgf-β2 antibody at 84 days of age had patent and significantly ( P < .05) wider coronal sutures and greater sutural area compared to controls.

Conclusions: These data support our hypothesis that antagonism of Tgf-β2 may rescue fusing coronal sutures and facilitate craniofacial growth in this rabbit model. These findings also suggest that cytokine therapy may have clinical significance in infants with progressive postgestational craniosynostosis.
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http://dx.doi.org/10.1597/16-065DOI Listing
July 2018

Regenerative Technologies for Craniomaxillofacial Surgery.

J Oral Maxillofac Surg 2015 Dec;73(12 Suppl):S116-25

Director, Center for Craniofacial Regeneration; Associate Professor, Department of Oral Biology; Associate Dean for Research, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA.

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http://dx.doi.org/10.1016/j.joms.2015.04.036DOI Listing
December 2015

Is Computed Tomography an Adequate Imaging Modality for the Evaluation of Juvenile Ossifying Fibroma? A Comparison of 2 Imaging Modalities (Computed Tomography and Magnetic Resonance Imaging).

J Oral Maxillofac Surg 2015 Jul 28;73(7):1304-13. Epub 2015 Jan 28.

Professor of Radiology, Otolaryngology, and Biomedical Informatics, Division of Neuroradiology, Department of Radiology, University of Pittsburgh, Pittsburgh, PA.

Purpose: Given the problems of overuse of medical technology and the current burden of health care cost in the United States, it is important to establish clear imaging guidelines to diagnose conditions such as juvenile ossifying fibroma (JOF). This study compared the efficacy of computed tomography (CT) and magnetic resonance imaging (MRI) in the evaluation of JOF and thus could aid establishing such guidelines.

Materials And Methods: Radiologic criteria were established by 2 radiologists to compare the efficacy of CT and MRI in the evaluation of JOF. The following parameters were compared: presence of a well-defined corticated border, presence of a well-delineated internal calcified component, fluid-to-fluid levels, and anatomic extent of the lesion. Six patients diagnosed with JOF of the craniofacial bones from 2002 to 2013 had preoperative CT and MRI studies available for review.

Results: After review of CT and MRI images, fluid-to-fluid levels and anatomic extent of the lesions were comparable on CT and MRI. However, the corticated borders and the internal calcified component were better defined on CT images, which also enabled for distinction between the 2 subtypes of JOF. No MRI characteristics were identified that allowed for this distinction.

Conclusion: Based on these findings, CT is an adequate and preferable imaging modality in the evaluation of JOF.
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http://dx.doi.org/10.1016/j.joms.2015.01.013DOI Listing
July 2015

In vivo study of magnesium plate and screw degradation and bone fracture healing.

Acta Biomater 2015 May 21;18:262-9. Epub 2015 Feb 21.

The Center for Craniofacial Regeneration, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Department of Oral Biology, University of Pittsburgh, Pittsburgh, PA, USA; The McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address:

Each year, millions of Americans suffer bone fractures, often requiring internal fixation. Current devices, like plates and screws, are made with permanent metals or resorbable polymers. Permanent metals provide strength and biocompatibility, but cause long-term complications and may require removal. Resorbable polymers reduce long-term complications, but are unsuitable for many load-bearing applications. To mitigate complications, degradable magnesium (Mg) alloys are being developed for craniofacial and orthopedic applications. Their combination of strength and degradation make them ideal for bone fixation. Previously, we conducted a pilot study comparing Mg and titanium devices with a rabbit ulna fracture model. We observed Mg device degradation, with uninhibited healing. Interestingly, we observed bone formation around degrading Mg, but not titanium, devices. These results highlighted the potential for these fixation devices. To better assess their efficacy, we conducted a more thorough study assessing 99.9% Mg devices in a similar rabbit ulna fracture model. Device degradation, fracture healing, and bone formation were evaluated using microcomputed tomography, histology and biomechanical tests. We observed device degradation throughout, and calculated a corrosion rate of 0.40±0.04mm/year after 8 weeks. In addition, we observed fracture healing by 8 weeks, and maturation after 16 weeks. In accordance with our pilot study, we observed bone formation surrounding Mg devices, with complete overgrowth by 16 weeks. Bend tests revealed no difference in flexural load of healed ulnae with Mg devices compared to intact ulnae. These data suggest that Mg devices provide stabilization to facilitate healing, while degrading and stimulating new bone formation.
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http://dx.doi.org/10.1016/j.actbio.2015.02.010DOI Listing
May 2015

Fracture healing using degradable magnesium fixation plates and screws.

J Oral Maxillofac Surg 2015 Feb 28;73(2):295-305. Epub 2014 Sep 28.

Professor, Center for Craniofacial Regeneration, Department of Bioengineering, Department of Oral Biology, and McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA. Electronic address:

Purpose: Internal bone fixation devices made with permanent metals are associated with numerous long-term complications and may require removal. We hypothesized that fixation devices made with degradable magnesium alloys could provide an ideal combination of strength and degradation, facilitating fracture fixation and healing while eliminating the need for implant removal surgery.

Materials And Methods: Fixation plates and screws were machined from 99.9% pure magnesium and compared with titanium devices in a rabbit ulnar fracture model. Magnesium device degradation and the effect on fracture healing and bone formation were assessed after 4 weeks. Fracture healing with magnesium device fixation was compared with that of titanium devices using qualitative histologic analysis and quantitative histomorphometry.

Results: Micro-computed tomography showed device degradation after 4 weeks in vivo. In addition, 2-dimensional micro-computed tomography slices and histologic staining showed that magnesium degradation did not inhibit fracture healing or bone formation. Histomorphology showed no difference in bone-bridging fractures fixed with magnesium and titanium devices. Interestingly, abundant new bone was formed around magnesium devices, suggesting a connection between magnesium degradation and bone formation.

Conclusion: Our results show potential for magnesium fixation devices in a loaded fracture environment. Furthermore, these results suggest that magnesium fixation devices may enhance fracture healing by encouraging localized new bone formation.
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http://dx.doi.org/10.1016/j.joms.2014.09.007DOI Listing
February 2015

Management of cleft lip and palate and cleft orthognathic considerations.

Oral Maxillofac Surg Clin North Am 2014 Nov 23;26(4):565-72. Epub 2014 Oct 23.

Craniofacial Disorders Program, Department of Pediatric Craniomaxillofacial Surgery, Arnold Palmer Hospital for Children, 83 West Columbia Street, MP 197, Orlando, FL 32806, USA. Electronic address:

Cleft lip and palate are among the most common congenital anomalies in humans. The treatment of this group of patients is best conducted by a multidisciplinary team approach. This article discusses the accepted treatment algorithm and timeline, as well as special considerations for this patient group when performing orthognathic surgery. Patients with cleft lip and palate often present with significantly more technical and challenging procedures, so clinicians should familiarize themselves with these special considerations before attempting to care for these individuals.
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http://dx.doi.org/10.1016/j.coms.2014.08.007DOI Listing
November 2014

A method for direct fabrication of a lingual splint for management of pediatric mandibular fractures.

Plast Reconstr Surg Glob Open 2013 Oct 7;1(7):e51. Epub 2013 Nov 7.

University of Cincinnati Medical Center, Cincinnati, Ohio; and University of Pittsburgh, Pittsburgh, Pa.

Summary: Pediatric mandibular fractures have successfully been managed in various ways. The use of a lingual splint is one such option. The typical indirect method for acrylic lingual splint fabrication involves obtaining dental impressions. Dental models are produced from those impressions so that model surgery may be performed. The splint is then made on those models using resin powder and liquid monomer in a wet laboratory and transferred to the patient. Obvious limitations to this technique exist for both patient and operator. We present a technique for direct, intraoperative, fabrication of a splint using commercially available light-cured material that avoids some of the shortcomings of the indirect method. Recommendations are made based on available material safety information.
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http://dx.doi.org/10.1097/GOX.0b013e3182aa876eDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4174053PMC
October 2013

Regeneration of periosteum by human bone marrow stromal cell sheets.

J Oral Maxillofac Surg 2014 Jun 11;72(6):1078-83. Epub 2014 Feb 11.

Professor, Center for Craniofacial Regeneration, Departments of Bioengineering and Oral Biology, University of Pittsburgh and McGowan Institute for Regenerative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA. Electronic address:

Purpose: The presence of a functional periosteum accelerates healing in bone defects by providing a source of progenitor cells that aid in repair. We hypothesized that bone marrow stromal cell (BMSC) sheets could be used to engineer functional periosteal tissues.

Materials And Methods: BMSCs were cultured to hyperconfluence and produced sufficient extracellular matrix to form robust tissue sheets. The sheets were wrapped around calcium phosphate pellets and implanted subcutaneously in mice for 8 weeks. Histologic comparisons were made between calcium phosphate samples with and without BMSC sheet wraps. Bone and periosteum formation were analyzed through tissue morphology and tissue-specific protein expression.

Results: Calcium phosphate pellets wrapped in BMSC sheets regenerated a bone-like tissue, but pellets lacking the cell sheet wrap did not. The bone-like tissue seen on the calcium phosphate scaffolds wrapped with the BMSC sheets was enclosed within a periosteum-like tissue characterized morphologically and through expression of periostin.

Conclusions: These data indicate that cell sheet technology has potential for regenerating a functional periosteum-like tissue that could aid in future orthopedic therapy.
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http://dx.doi.org/10.1016/j.joms.2014.02.005DOI Listing
June 2014

The utility of hybrid promotion and tenure tracks for dental school faculty.

J Dent Educ 2013 Jun;77(6):706-15

Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA.

The promotion and tenure process for faculty members varies, by design, for different disciplines, departments, and academic institutions. For many faculty members in U.S. dental schools, the process may thus appear nebulous and be difficult to navigate. In this article, we review the history, forces of change, and some of the mechanisms utilized for promotion and tenure of faculty in the health sciences, particularly for clinician-educators. Some institutions have successfully created hybrid tracks for clinician-educators in order to develop and recognize these faculty members' scholarly activity in addition to their clinical teaching. Hybrid tracks empower faculty members to successfully perform scholarly activities that realistically reflect institutional missions. The authors of this article conclude with a number of practical suggestions to enhance development and retention of faculty using the hybrid promotion and tenure mechanism. These include demonstrating the congruence of institutional mission, faculty activities, and promotion and tenure guidelines; developing scholarly activities for clinician-educators that can be measured in the promotion and tenure process; rewarding scholarly achievement for clinician-educators utilizing the promotion and tenure mechanism; and developing an evaluation system that accounts for changes in mission and faculty activities.
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June 2013

Growth and development considerations for craniomaxillofacial surgery.

Oral Maxillofac Surg Clin North Am 2012 Aug;24(3):377-96

Division of Craniofacial and Cleft Surgery, University of Pittsburgh School of Dental Medicine, 3501 Terrace Street, Pittsburgh, PA 15261, USA.

The purpose of craniomaxillofacial surgery is to improve function, occlusion, craniofacial balance, and aesthetics. Accurate diagnosis, assessment, and careful treatment planning are essential in achieving a successful outcome, and an understanding of the pattern of facial growth is integral in this process. Patients with craniofacial congenital dysmorphologies, posttraumatic asymmetries, or disturbances of facial balance from radiation may have functional and/or aesthetic issues that require treatment. Understanding the complexities of growth in the skull and face is a key component to appropriate treatment planning for these disorders. This article reviews growth and development in the craniofacial skeleton.
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http://dx.doi.org/10.1016/j.coms.2012.05.007DOI Listing
August 2012

Craniosynostosis: diagnosis and surgical management.

Atlas Oral Maxillofac Surg Clin North Am 2010 Sep;18(2):77-91

Arnold Palmer Hospital for Children, 83 West Columbia Street, Orlando, FL 32806, USA.

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http://dx.doi.org/10.1016/j.cxom.2010.08.002DOI Listing
September 2010

The coronal scalp flap: surgical technique.

Atlas Oral Maxillofac Surg Clin North Am 2010 Sep;18(2):69-75

Arnold Palmer Hospital for Children, 83 West Columbia Street, Orlando, FL 32806, USA.

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http://dx.doi.org/10.1016/j.cxom.2010.08.005DOI Listing
September 2010

Revisiting the recurrence risk of nonsyndromic cleft lip with or without cleft palate.

Am J Med Genet A 2010 Nov;152A(11):2697-702

Center for Craniofacial and Dental Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Sub-epithelial defects (i.e., discontinuities) of the superior orbicularis oris (OO) muscle appear to be a part of the phenotypic spectrum of cleft lip with or without cleft palate (CL ± P). Analysis of the OO phenotype as a clinical tool is hypothesized to improve familial recurrence risk estimates of CL ± P. Study subjects (n = 3,912) were drawn from 835 families. Occurrences of CL ± P were compared in families with and without members with an OO defect. Empiric recurrence risks were calculated for CL ± P and OO defects among first-degree relatives (FDRs). Risks were compared to published data and/or to other outcomes of this study using chi-square or Fisher's exact tests. In our cohort, the occurrence of CL ± P was significantly increased in families with OO defects versus those without (P < 0.01, OR = 1.74). The total FDR recurrence of isolated OO defects in this cohort is 16.4%; the sibling recurrence is 17.2%. The chance for one or more FDRs of a CL ± P proband to have an OO defect is 11.4%; or 14.7% for a sibling. Conversely, the chance for any FDR of an individual with an OO defect to have CL ± P is 7.3%; or for a sibling, 3.3%; similar to published recurrence risk estimates of nonsyndromic (NS) CL ± P. This study supports sub-epithelial OO muscle defects as being part of the CL ± P spectrum and suggests a modification to recurrence risk estimates of CL ± P by utilizing OO defect information.
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http://dx.doi.org/10.1002/ajmg.a.33695DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2965308PMC
November 2010

A unique presentation of a squamous cell carcinoma in a pregnant patient.

Quintessence Int 2010 Jul-Aug;41(7):581-3

Department of Oral and Maxillofacial Surgery, University of Pittsburgh, Pennsylvania, USA.

The literature reports an increasing occurrence of carcinoma in the young adult nonsmoking and nondrinking population. With it, this trend brings the potential for new comorbidities. This report discusses one such case in which a 30-year-old woman, 28 weeks pregnant, was diagnosed with a hybrid verrucous carcinoma/squamous cell carcinoma. Several years preceding the presentation of the hybrid lesion, the patient had an odontogenic cyst associated with the same region. The original lesion was reported to have mucosal change overlying it. Newly available immunohistochemical stains were used to review the lesion to assess the potential for aggressiveness and proliferative changes. All the biomarkers were unremarkable, suggesting that the progression of the initial lesion could not have been predicted with the current immunohistochemical stains. This report discusses the diagnosis and treatment of this unusual scenario involving progression of a benign lesion to a malignant hybrid.
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October 2010

Molecular diagnostics for head and neck pathology.

Oral Maxillofac Surg Clin North Am 2010 Feb;22(1):183-94

Department of Oral and Maxillofacial Surgery, University of Pittsburgh School of Dental Medicine, 3501 Terrace Street, Pittsburgh, PA 15261, USA.

Molecular diagnostic techniques are quickly finding a role in the detection and diagnosis of tumors, and in predicting their behavior. They may also prove useful in developing new therapeutic approaches to head and neck cancer. The surgeon working in the craniomaxillofacial region should have an understanding of these technologies, their availability in various settings, and how they affect various aspects of treatment, particularly in the detection and treatment of malignancies. This article offers an overview of recent advances in molecular diagnostic techniques, with their implications for diagnosis and management of head and neck tumors.
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http://dx.doi.org/10.1016/j.coms.2009.10.006DOI Listing
February 2010

Temporary skeletal anchorage devices for orthodontics.

Oral Maxillofac Surg Clin North Am 2010 Feb;22(1):91-105

Department of Oral and Maxillofacial Surgery, University of Pittsburgh School of Dental Medicine, 3471 5th Avenue, Suite 1112, Pittsburgh, PA 15213, USA.

This article discusses the recent advances and basic concepts of skeletal anchorage devices of various types and reviews the current literature on their use. Temporary skeletal anchorage devices allow orthodontic movements that were previously thought to be difficult if not impossible. Much like the concepts introduced during the beginnings of orthognathic dentofacial teams, treatment that uses skeletal anchorage requires interdisciplinary collaboration and planning with regular interaction, continuing education, and a regular review of the latest relevant literature.
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http://dx.doi.org/10.1016/j.coms.2009.10.011DOI Listing
February 2010

Cleft lip and palate surgery: an update of clinical outcomes for primary repair.

Oral Maxillofac Surg Clin North Am 2010 Feb;22(1):43-58

Division of Craniofacial and Cleft Surgery, Department of Oral and Maxillofacial Surgery, University of Pittsburgh School of Dental Medicine, 3471 Fifth Avenue, Suite 1112, Pittsburgh, PA 15213, USA.

The comprehensive management of cleft lip and palate has received significant attention in the surgical literature over the last half century. It is the most common congenital facial malformation and has a significant developmental, physical, and psychological impact on those with the deformity and their families. In the United States, current estimates place the prevalence of cleft lip and palate or isolated cleft lip at approximately 1 in 600. There is significant phenotypic variation in the specific presentation of facial clefts. Understanding outcome data is important when making clinical decisions for patients with clefts. This article provides an update on current primary cleft lip and palate outcome data.
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http://dx.doi.org/10.1016/j.coms.2009.11.003DOI Listing
February 2010

Regenerative medicine for craniomaxillofacial surgery.

Oral Maxillofac Surg Clin North Am 2010 Feb;22(1):33-42

Division of Craniofacial and Cleft Surgery, Department of Oral and Maxillofacial Surgery, University of Pittsburgh School of Dental Medicine, 3471 Fifth Avenue, Suite 1112, Pittsburgh, PA 15213, USA.

Regenerative medicine has recently seen much activity in basic and translational research. These advances are now making their way into surgical practice. A convergence of technologies has afforded opportunities previously not available with conventional surgical reconstructive techniques. Patients requiring complex reconstructive surgery in the craniomaxillofacial region typically benefit from local or regional flaps, nonvascularized grafts, microvascular tissue transfer, or substitute alloplastic materials to restore function and form. In these clinical situations, grafting procedures or alloplastic substitute materials provide best-case replacements for resected, injured, or congenitally missing tissues. However, ideal reconstructive goals, such as a complete return to original form and function, are frequently not completely achieved. Regenerative techniques now in clinical use and at the translational research stage hold promise for custom-tailored constructs with the potential to regenerate tissue in the host without significant donor site morbidity. These techniques may provide better structure, aesthetics, and function than the best currently available options. This article presents the latest concepts in craniomaxillofacial regenerative medicine and reviews the multipronged approach to restoring architecture using novel "smart" multifunctional scaffolds, cellular technologies, growth factors, and other novel regenerative medical strategies.
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http://dx.doi.org/10.1016/j.coms.2009.10.009DOI Listing
February 2010

Prenatal diagnosis and treatment of craniomaxillofacial anomalies.

Oral Maxillofac Surg Clin North Am 2010 Feb;22(1):5-15

Craniofacial and Cleft Surgery, Department of Oral and Maxillofacial Surgery, University of Pittsburgh School of Dental Medicine, 3471 Fifth Avenue, Suite 1112, Pittsburgh, PA 15213, USA.

Many advances in health care are built on the evolution of technology. An entirely new patient has emerged in fetal medicine, with these advances in prenatal imaging allowing one to see and diagnose disease not previously appreciated. Clinicians can better plan for the delivery of the neonate, with identified anomalies being optimally managed and the impact on the neonate's health minimized. The oral and maxillofacial surgeon offers expertise in the management of craniomaxillofacial anomalies, including congenital tumors, facial clefts, craniosynostosis, micrognathia, and other congenital abnormalities. The techniques for perinatal care of the patient with craniofacial abnormalities continue to evolve as the technology improves. The authors describe their experience and some of the more common abnormalities with their management considerations that may be encountered by the oral and maxillofacial surgeon on the fetal diagnosis and treatment team.
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http://dx.doi.org/10.1016/j.coms.2009.10.003DOI Listing
February 2010

Clinical innovation and technology in craniomaxillofacial surgery. Preface.

Oral Maxillofac Surg Clin North Am 2010 Feb;22(1):xiii-iv

Department of Oral and Maxillofacial Surgery, University of Pittsburgh School of Dental Medicine, Salk Hall, 3501 Terrace Street, Pittsburgh, PA 15261, USA.

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http://dx.doi.org/10.1016/j.coms.2009.11.004DOI Listing
February 2010

Retrieval of a displaced third molar using navigation and active image guidance.

J Oral Maxillofac Surg 2010 Feb 15;68(2):480-5. Epub 2010 Jan 15.

Department of Oral and Maxillofacial Surgery, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, USA.

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http://dx.doi.org/10.1016/j.joms.2009.06.032DOI Listing
February 2010

Unilateral cleft lip and nasal repair: the rotation-advancement flap technique.

Atlas Oral Maxillofac Surg Clin North Am 2009 Sep;17(2):103-16

Department of Oral and Maxillofacial Surgery, University of Pittsburgh School of Dental Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.

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http://dx.doi.org/10.1016/j.cxom.2009.07.001DOI Listing
September 2009

Fetal diagnosis and treatment of craniomaxillofacial anomalies.

J Oral Maxillofac Surg 2008 Oct;66(10):1985-95

Department of Oral and Maxillofacial Surgery, University of Pittsburgh School of Dental Medicine, and Children's Hospital of Pittsburgh, Pittsburgh, PA 15213, USA.

So many advances in health care are built on the evolution of technology. In the case of fetal medicine, technology has availed an entirely new patient. Advances in prenatal imaging allow us to see and diagnose disease not previously appreciated. Armed with this information, clinicians can better plan for the delivery of the neonate such that any identified anomalies are optimally managed, and the impact on the neonate's health minimized. The oral and maxillofacial surgeon can be a key member in this team by offering expertise in the management of craniomaxillofacial anomalies including congenital tumors, facial clefts, craniosynostosis, micrognathia, and other congenital abnormalities. The techniques for perinatal care of the patient with craniofacial abnormalities continue to evolve as the technology improves. The review of the cases presented at the University of Pittsburgh Fetal Diagnosis and Treatment Team during the past 6 years has shown many opportunities for craniomaxillofacial prenatal evaluation. We describe our recent experience and some of the more common abnormalities with their management considerations that may be encountered by the oral and maxillofacial surgeon on the fetal diagnosis and treatment team.
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http://dx.doi.org/10.1016/j.joms.2008.01.042DOI Listing
October 2008

Oral and maxillofacial surgery at the University of Pittsburgh.

J Oral Maxillofac Surg 2008 Oct;66(10):1981-4

University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, USA.

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http://dx.doi.org/10.1016/j.joms.2007.10.009DOI Listing
October 2008

Mandibular distraction osteogenesis in children.

Oral Maxillofac Surg Clin North Am 2005 Nov;17(4):475-84

Division of Pediatric Craniofacial Surgery, Department of Oral/Maxillofacial Surgery, Southwest Florida Oral and Facial Surgery, Children's Hospital of Southwest Florida, 5285 Summerlin Road, Suite 101, Fort Myers, FL 33919, USA.

Distraction osteogenesis is currently considered a useful treatment option for the correction of specific facial skeletal deformities. Although it is apparent that distraction may have significant potential and broader application in the management of maxillofacial problems, very few comprehensive scientific data exist, making it difficult to describe its exact role in the reconstructive oral and maxillofacial surgeon's armamentarium. This article reviews the biological basis for distraction osteogenesis, potential applications, and current surgical approaches for mandibular distraction in children.
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http://dx.doi.org/10.1016/j.coms.2005.09.002DOI Listing
November 2005