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Contributors
Andrew Beech Department of Oral and Maxillofacial Surgery, University of
Michigan, Ann Arbor, MI, USA
Department of Oral and Maxillofacial Surgery, Thomas Jefferson University,
Philadelphia, PA, USA
Poolak Bhatt Division of Craniofacial and Surgical Care, ASoD, University of
North Carolina at Chapel Hill, Chapel Hill, NC, USA
Residency Program in Oral and Maxillofacial Surgery, University of North Carolina
Hospitals, Chapel Hill, NC, USA
Jo-Lawrence Martinez Bigcas Department of Otolaryngology Head and Neck
Surgery, Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas,
Las Vegas, NV, USA
Daniel Boczar, MD Department of Surgery, University of Washington, Seattle,
WA, USA
Hilliard T. Brydges Hansjörg Wyss Department of Plastic Surgery, New York
University Langone Health, New York, NY, USA
BrianH.Cameron Department of Otorhinolaryngology-Head and Neck Surgery,
University of Texas Health Science Center in Houston, McGovern Medical School,
Houston, TX, USA
Steve Cannady Division Chief for Head and Neck Surgery, Department of
Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA, USA
SrinivasaR.Chandra Oral and Maxillofacial Surgery, Oregon Health Sciences
School of Dentistry, Portland, OR, USA
BoChen, MD Department of Diagnostic and Interventional Imaging, UTHealth
McGovern Medical School, Houston, TX, USA
AllenCheng Head and Neck Surgical Associates, Oral, Head and Neck Cancer
Center Program, Legacy Cancer Institute, Portland, OR, USA
Paulo G. Coelho, MD, DDS, PhD, MBA Department of Biochemistry and
Molecular Biology, University of Miami Miller School of Medicine, Miami, FL, USA
Division of Plastic Surgery, Department of Surgery, University of Miami Miller
School of Medicine, Miami, FL, USA
Ricardo Rodriguez Colon Hansjörg Wyss Department of Plastic Surgery, New
York University Langone Health, New York, NY, USA
Caitlin M. Coviello Department of Otolaryngology—Head and Neck Surgery,
Baylor College of Medicine, Houston, TX, USA
Bruce Cronstein, MD Department of Medicine, NYU Grossman School of
Medicine, New York, NY, USA

Contributors
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NagiDemian Oral and Maxillofacial Surgery, University of Texas Health Science
Center at Huston, Houston, TX, USA
Neeraja Dharmaraj Bernard and Gloria Pepper Katz Department of Oral and
Maxillofacial Surgery, The University of Texas Health Science Center at Houston,
School of Dentistry, Houston, TX, USA
Tobias Ettl Department of Oral and Maxillofacial Surgery, University Medical
Centre Regensburg, Regensburg, Germany
Elda Fisher Division of Craniofacial and Surgical Care, ASoD, University of
North Carolina at Chapel Hill, Chapel Hill, NC, USA
Residency Program in Oral and Maxillofacial Surgery, University of North Carolina
Hospitals, Chapel Hill, NC, USA
Roberto L. Flores, MD Hansjörg Wyss Department of Plastic Surgery, NYU
Grossman School of Medicine, New York, NY, USA
AbigailFrazier Division of Craniofacial and Surgical Care, ASoD, University of
North Carolina at Chapel Hill, Chapel Hill, NC, USA
Residency Program in Oral and Maxillofacial Surgery, University of North Carolina
Hospitals, Chapel Hill, NC, USA
Joseph Geiger Oral and Maxillofacial Surgery, DeWitt Daughtry Family
Department of Surgery, Miller School of Medicine/Jackson Health System,
University of Miami, Miami, FL, USA
YohaannAliGhosh School of Medicine and Dentistry, Grifth University, Gold
Coast, Australia
Integrated Prosthetics and Reconstruction, Department of Head and Neck Surgery,
Chris O’Brien Lifehouse, Sydney, NSW, Australia
Matthew R. Greives Division of Plastic Surgery, Department of Surgery,
McGovern Medical School at the University of Texas Health Science Center,
Houston, TX, USA
ShawnGroth Division of Thoracic Surgery, Michael E.DeBakey Department of
Surgery, Baylor College of Medicine, Houston, TX, USA
Jeffrey T.Gu Department of Otolaryngology-Head and Neck Surgery, Oregon
Health and Science University, Portland, OR, USA
DanielHammer Department of Oral and Maxillofacial Surgery, Naval Medical
Center San Diego, San Diego, CA, USA
Issa Hanna Department of Oral and Maxillofacial Surgery, UTHealth Houston,
Houston, TX, USA
Jeffrey Hartgerink Chemistry and Bioengineering, Rice University,
Houston, TX, USA
Undergraduate Studies, Rice University, Houston, TX, USA

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Contributors
StevenHengen Department of Oral and Maxillofacial Surgery, UTHealth Houston,
Houston, TX, USA
Tang Ho Division of Facial Plastic and Reconstructive Surgery, Department of
Otorhinolaryngology Head and Neck Surgery, University of Texas Health Science
Center in Houston, Houston, TX, USA
Department of Otorhinolaryngology-Head and Neck Surgery, University of Texas
Health Science Center in Houston, McGovern Medical School, Houston, TX, USA
Andrew T. Huang Department of Otolaryngology—Head and Neck Surgery,
Baylor College of Medicine, Houston, TX, USA
Mohammad S. Jafferji Division of Thoracic Surgery, Michael E. DeBakey
Department of Surgery, Baylor College of Medicine, Houston, TX, USA
Jonathon Jundt Bernard and Gloria Pepper Katz Department of Oral and
Maxillofacial Surgery, School of Dentistry, The University of Texas Health Science
Center at Houston, Houston, TX, USA
Philipp Jürgens Department of Cranio-Maxillofacial Surgery, Leading Medical
Center (LMC) Munich, Munich, Germany
Arshad Kaleem Division of Oral and Maxillofacial Surgery, DeWitt Daughtry
Family Department of Surgery, Section of Head and Neck Surgical Oncology and
Microvascular Reconstructive Surgery, Miller School of Medicine/Jackson Health
System, University of Miami, Miami, FL, USA
Head and Neck Oncology/Microvascular Reconstructive Surgery, High Desert Oral
and Facial Surgery, El Paso, TX, USA
Ryan Keyho Division of Plastic Surgery, Department of Surgery, McGovern
Medical School at the University of Texas Health Science Center, Houston, TX, USA
RoderickY.Kim Department of Oral and Maxillofacial Surgery, John Peter Smith
Hospital, Fort Worth, TX, USA
NatalieA.Krane Division Facial Plastic and Reconstructive Surgery, Department
of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University,
Portland, OR, USA
CheukSunEdwinLai Rice University, Houston, TX, USA
KevinC.Lee Department of Oral and Maxillofacial Surgery, University at Buffalo,
New York, NY, USA
AlexisM.Linnebur Carle Foundation Hospital, Urbana, IL, USA
Stanley Yung-Chuan Liu Division of Sleep Surgery, Department of
Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine,
Stanford, CA, USA

Contributors
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xvii
Garren Michael Iida Low Department of Otolaryngology Head and Neck
Surgery, Drexel University College of Medicine, Pittsburgh, PA, USA
Department of Otolaryngology Head and Neck Surgery, Allegheny Health Network,
Pittsburgh, PA, USA
Myriam Loyo Department of Otolaryngology-Head and Neck Surgery, Oregon
Health and Science University, Portland, OR, USA
Victoria A. Manon Bernard and Gloria P. Katz Department of Oral and
Maxillofacial Surgery, University of Texas Health Science Center at Houston,
Houston, TX, USA
MichaelR.Markiewicz Department of Oral and Maxillofacial Surgery, University
at Buffalo, Buffalo, NY, USA
JeffreyS.Marschall Department of Oral and Maxillofacial Surgery, University of
Iowa Hospital and Clinics, Iowa City, IA, USA
Robert E. Marx Department of Oral and Maxillofacial Surgery, University of
Miami School of Medicine, Florida, USA
JamesC.Melville, DDS Bernard and Gloria Pepper Katz Department of Oral and
Maxillofacial Surgery, School of Dentistry, The University of Texas Health Science
Center at Houston, Houston, TX, USA
Department of Oral and Maxillofacial Surgery, The University of Texas Health
Science Center at Houston, Houston, TX, USA
Justine Moe Department of Oral and Maxillofacial Surgery, University of
Michigan, Ann Arbor, MI, USA
Department of Oral and Maxillofacial Surgery, Thomas Jefferson University,
Philadelphia, PA, USA
Marta Morawska Department of Cranio-Maxillofacial Surgery, Advanced
Osteotomy Tools (AOT) AG, Basel, Switzerland
Anthony B. Morlandt, MD, DDS, FACS Oral and Maxillofacial Surgery,
University of Alabama at Birmingham, Birmingham, Alabama, USA
Vasudev Vivekanand Nayak, MSci, PhD Department of Biochemistry and
Molecular Biology, University of Miami Miller School of Medicine, Miami, FL, USA
AnnieNguyen Department of Orthodontics, Montreal Children’s Hospital, McGill
University Health Centre, Quebec, Canada
PhuongD.Nguyen Division of Plastic Surgery, Department of Surgery, McGovern
Medical School at the University of Texas Health Science Center, Houston, TX, USA
Children’s Memorial Hermann Hospital, Houston, TX, USA
Justin Odette Dental Department, USS Theodore Roosevelt (CVN 71), San
Diego, CA, USA

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Contributors
AshishPatel Oral, Head and Neck Surgery, Head and Neck Surgical Associates,
Portland, OR, USA
NeelPatel Division of Oral and Maxillofacial Surgery, DeWitt Daughtry Family
Department of Surgery, Head and Neck Surgical Oncology and Microvascular
Reconstructive Surgery, Miller School of Medicine/Jackson Health System,
University of Miami, Miami, FL, USA
Zachary S. Peacock Oral and Maxillofacial Surgery, Massachusetts General
Hospital (MGH), Boston, MA, USA
Daniel Petrisor Head and Neck Oncologic and Microvascular Reconstructive
Surgery, Department of Oral and Maxillofacial Surgery, Oregon Health and Science
University, Portland, OR, USA
MatthewJ.Recker Department of Neurosurgery, Jacobs School of Medicine and
Biomedical Sciences, Buffalo, NY, USA
RenéeM.Reynolds Department of Neurosurgery, Jacobs School of Medicine and
Biomedical Sciences, Buffalo, NY, USA
EduardoD.Rodriguez Hansjörg Wyss Department of Plastic Surgery, New York
University Langone Health, New York, NY, USA
Dominik Rudecki Department of Oral and Maxillofacial Surgery, UTHealth
Houston, Houston, TX, USA
ChristopherM.Runyan, MD, PhD Department of Plastic Surgery, Wake Forest
University School of Medicine, Winston-Salem, NC, USA
Kunal R. Shetty Otorhinolaryngology—Head and Neck Surgery, University of
Texas Health Sciences Center at Houston, Houston, TX, USA
Jonathan Shum Maxillofacial Oncology and Microvascular Reconstructive
Surgery, Houston, TX, USA
Department of Oral and Maxillofacial Surgery, The University of Texas Health
Science Center at Houston, Houston, TX, USA
The University of Texas Health Science Center at Houston, Houston, TX, USA
Raymond P. Shupak Division of Oral and Maxillofacial Surgery, Geisinger
Medical Center, Danville, PA, USA
Department of Oral Medicine and Maxillofacial Surgery, Geisinger Commonwealth
School of Medicine, Geisinger Health System, Danville, PA, USA
ParulSinha Division of Facial Plastic and Reconstructive Surgery, Department of
Otorhinolaryngology Head and Neck Surgery, University of Texas Health Science
Center in Houston, Houston, TX, USA
Allison Slijepcevic Department of Otolaryngology-Head and Neck Surgery,
Atrium Wake Forest Baptist, Wake Forest, NC, USA

Contributors
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xix
EmilioSupsupin Jr, MD Division of Neuroradiology, Department of Radiology,
University of Florida College of Medicine - Jacksonville,Jacksonville, FL, USA
Department of Diagnostic and Interventional Imaging, UTHealth McGovern
Medical School, Houston, TX, USA
MariAlina Timoshchuk Department of Oral and Maxillofacial Surgery, School
of Dentistry, Louisiana Health Sciences Center, New Orleans, LA, USA
AndreaTorroni, MD, PhD Hansjörg Wyss Department of Plastic Surgery, NYU
Grossman School of Medicine, New York, NY, USA
HuyQ.Tran Bernard and Gloria P. Katz Department of Oral and Maxillofacial
Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA
Ramzey Tursun Division of Oral and Maxillofacial Surgery, DeWitt Daughtry
Family Department of Surgery, Head and Neck Surgical Oncology and Microvascular
Reconstructive Surgery Fellowship, Miller School of Medicine/Jackson Health
System, University of Miami, Miami, FL, USA
Clinical Surgery, University of Miami, Miami, FL, USA
Oral, Head & Neck Oncologic, University of Miami, Miami, FL, USA
Division of Oral Maxillofacial Surgery, DeWitt Daughtry Family Department of
Surgery, Leonard M. Miller School of Medicine, University of Miami,
Miami, FL, USA
Microvascular Reconstructive Surgery, University of Miami, Miami, FL, USA
Security Forces Hospital, Riyad, Saudi Arabia
Chi T. Viet Oral and Maxillofacial Surgery, Loma Linda University, Loma
Linda, CA, USA
Oral and Maxillofacial Surgery, Loma Linda University, Loma Linda, CA, USA
JasonWahidi Division of Oral and Maxillofacial Surgery, Department of Surgery,
UT Southwestern/Parkland Memorial Hospital, Dallas, TX, USA
RayY.Wang Department of Otolaryngology—Head and Neck Surgery, Baylor
College of Medicine, Houston, TX, USA
Mark K. Wax Department of Otolaryngology-Head and Neck Surgery, Oregon
Health and Science University, Portland, OR, USA
FayetteC.Williams Department of Oral and Maxillofacial Surgery, John Peter
Smith Hospital, Fort Worth, TX, USA
Lukasz Witek, MSci, PhD Biomaterials Division, NYU College of Dentistry,
New York, NY, USA
Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine,
New York, NY, USA
Department of Biomedical Engineering, NYU Tandon School of Engineering,
Brooklyn, NY, USA

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Contributors
Mark E. Wong Bernard & Gloria Pepper Katz Department of Oral and
Maxillofacial Surgery, University of Texas School of Dentistry Houston,
Houston, TX, USA
SarahAnneWong Oral and Craniofacial Sciences Graduate Program, School of
Dentistry, San Francisco, CA, USA
Simon Young Bernard and Gloria Pepper Katz Department of Oral and
Maxillofacial Surgery, School of Dentistry, The University of Texas Health Science
Center at Houston, Houston, TX, USA
Department of Oral and Maxillofacial Surgery, The University of Texas Health
Science Center at Houston, Houston, TX, USA
WaleedZaid Department of Oral and Maxillofacial Surgery, School of Dentistry,
Louisiana Health Sciences Center, New Orleans, LA, USA
Site Director Baton Rouge LSUHSC Oral and Maxillofacial Surgery Department,
Our Lady of Lake Regional Medical Center, Baton Rouge, LA, USA
John R. Zuniga Division of Oral and Maxillofacial Surgery, Department of
Surgery and Neurology, UT Southwestern/Parkland Memorial Hospital,
Dallas, TX, USA

Chapter 1
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Innovations inCraniofacial Surgery
MatthewJ.Recker, KevinC.Lee, RenéeM.Reynolds, AnnieNguyen,
andMichaelR.Markiewicz
Introduction
The history of craniofacial surgery speaks to the rapid evolution of the eld. The
origins of modern craniofacial surgery date back to the 1960s with the work of Paul
Tessier [1, 2]. The concept of autogenous bone grafting and his techniques for transcranial and subcranial osteotomies were revolutionary at the time. In the 1980s, the
advent of rigid xation allowed surgeons to perform more extensive and aggressive
osteotomies with greater condence in the stability of their work. In the 1990s,
Joseph McCarthy introduced the concept of mandibular distraction allowing for
movements of the signicantly underdeveloped mandible and soft tissues [3]. Many
proponents of distraction soon applied the same concept to other parts of the skull
and face. Over the last 15years, computer-aided surgery has gained popularity and
wide acceptance within the surgical community. Each innovation and breakthrough
in craniofacial surgery builds on the principles that came before. The works of
M. J. Recker · R. M. Reynolds
Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences,
Buffalo, NY, USA
e-mail: mrecker@ubns.com; rreynolds@ubns.com
K. C. Lee · M. R. Markiewicz (*)
Department of Oral and Maxillofacial Surgery, University at Buffalo, New York, NY, USA
e-mail: kcl2136@cumc.columbia.edu; mrm25@buffalo.edu
A. Nguyen
Department of Orthodontics, Montreal Children’s Hospital, McGill University Health Centre,
Quebec, Canada
e-mail: annie.nguyen@muhc.mcgill.ca
© The Author(s), under exclusive license to Springer Nature
Switzerland AG 2023
J. C. Melville et al. (eds.), Advancements and Innovations in OMFS, ENT, and
Facial Plastic Surgery, https://doi.org/10.1007/978-3-031-32099-6_1
1

2
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Tessier and others before and after him have not been rendered obsolete in the modern era. Rather, today’s technology optimizes the results and carries forward the
vision of those original pioneers.
M. J. Recker et al.
Craniosynostosis
Introduction
Craniosynostosis is dened as the premature closure of cranial sutures and can
result in abnormal skull development and morphology with sequelae. For centuries,
anatomists have recognized a range of skull-shape abnormalities and postulated an
association with abnormal cranial sutures [4, 5]. In Virchow’s seminal work published in 1851, he dened skull growth patterns related to the fusion of specic
cranial sutures and explained that these patterns were due to restriction of skull
growth perpendicular to the fused suture [6] (Fig.1.1). Subsequent work expanded
upon Virchow’s Law to form our contemporary knowledge of craniosynostosis. We
now understand that early sutural fusion initiates compensatory growth in adjacent
sutures and within the skull base [7]. In addition to optimizing the cosmetic outcome, the surgical treatment of craniosynostosis is intended to facilitate normal
cranial volume expansion and reduce the risk of increased intracranial pressure and
subsequent neurodevelopmental delay.
Fig. 1.1 Sagittal synostosis showing arrested growth perpendicular to the fused suture (blue
arrows) with compensatory overgrowth parallel to the suture (green arrow)

1 Innovations inCraniofacial Surgery
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3
Epidemiology andEtiology
The incidence of craniosynostosis is estimated to be between 1:2000 and 1:2500
with a male predominance reported between 2:1 and 3:1 [8]. Craniosynostosis
can be categorized in several different ways including single versus multisuture, syndromic versus non-syndromic, and by the specic suture affected.
Single suture craniosynostosis is more common with the sagittal suture being
the most often affected suture. This accounts for over half of cases. This is followed by unilateral coronal (20–25%), metopic (10%), and lambdoid (2%) craniosynostosis. Non- syndromic cases are typically sporadic events, with no
identiable etiology; however, various risk factors have been implicated such as
advanced paternal age and maternal history of smoking [9]. Syndromic cases
are related to specic genetic abnormalities and associated syndromes, such as
Apert Syndrome (FGFR-2), Crouzon Syndrome (FGFR-2, FGFR-3), Pfeiffer
Syndrome (FGFR-1, FGFR-2), Muenke Syndrome (FGFR-3), among others.
Syndromic craniosynostosis is more likely to present with multi-suture involvement [8].
Traditional Repair
The treatment of craniosynostosis has undergone a series of trends over decades
of evolution. In the late 1800s to mid-1900s, strip craniectomy was used to
release the fused suture, but this technique was marred by surgical morbidity
and variable cosmetic outcomes due to refusion at craniectomy sites [10, 11].
The evolution of current strategies in management is credited to Tessier after
developing cranial vault remodeling in the 1970s, which is the foundation for
open techniques used today [12]. Modern open cranial vault expansion encompasses a number of procedures, which are carried out via a coronal incision
where portions of the cranium are either removed, remodeled, and replaced
with fixation, or remodeled without bony removal. Variations of open cranial
vault expansion are tailored to the specific sutures involved and the deformity
of the patient. Included in this group are fronto- orbital advancement and posterior vault expansion. These techniques can be carried out with or without the
use of distraction osteogenesis. These procedures require consideration of
patient age as considerable blood loss can be expected, and operative time and
optimal bone thickness to withstand surgical remodeling are pertinent factors.
Additionally, the rate of revision surgery is potentially higher in extremely
younger patients.
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