Faculty Bibliography

The identification of ancient worked materials is one of the fundamental goals of lithic use wear analysis and one of the most important parts of understanding how stone tools were used in the past. Given the documented overlaps in wear patterns generated by different materials, it is imperative to understand how individual materials' mechanical properties might influence wear formation. Because isolating physical parameters and measuring their change is necessary for such an endeavor, controlled (rather than replicative) experiments combined with objective measurements of surface topography are necessary to better grasp how surface modifications formed on stone tools. Therefore, we used a tribometer to wear natural flint surfaces against five materials (bone, antler, beech wood, spruce wood, and ivory) under the same force, and speed, over one, three, and five hours. The study aimed to test if there is a correlation between surface modifications and the hardness of the worked material. We measured each raw material's hardness using a nano-indentation test, and we compared the surface texture of the flint bits using a 3D optical profilometer. The interfacial detritus powder was analyzed with a scanning electron microscope to look for abraded flint particles. We demonstrate that, contrary to expectation, softer materials, such as wood, create a smoother surface than hard ones, such as ivory.

Background/Purpose: Pediatric mandibular fractures remain a therapeutic challenge due to the presence of tooth buds, the need to preserve the growth centers of the jaw, and the high risk to ankylosis in patients with trauma to the condyles. More specifically, condylar fracture with lateral dislocation out of the temporomandibular joint (TMJ) can pose significant challenges due to the difficulty with application of maxillomandibular fixation (MMF) as well as rigid plate fixation. Furthermore, open reduction of the condyle poses long term risk to dysfunction. Herein, we present a novel transfacial pinning surgical technique for the management of pediatric bilateral condylar fractures with lateral dislocation and concomitant symphyseal fracture in a patient less than 5 years of age. Methods/Description: A healthy 3-year-old male patient, who sustained a complex facial fracture in a golf cart accident in which he was unrestrained. Physical exam was remarkable for panfacial edema with no soft tissue injuries and limited oral excursion. Craniofacial computed tomography (CT) revealed a tripartite mandibular fracture, including bilateral condylar fractures with lateral dislocation of the left condyle and a symphyseal fracture. There were no other facial fractures and the patient's cervical spine was cleared both clinically and radiographically. The deciduous teeth precluded the use of traditional MMF and the presence of tooth buds within the entirely of the mandibular body and symphysis made the use of rigid fixation not feasible. The operative plan entailed a staged lower jaw reconstruction with: closed reduction of the laterally dislocated condyle; transfacial pinning with a 2.8 mm threaded Steinman pin between the mandibular angles to secure the medial location mandibular ramus and angle; application of MMF using circummandibular wiring and intermaxillary fixation screws. Two weeks later, MMF was released and the patient started a soft diet and oral excursion exercises with the transfacial pin in place. Two months after the first surgery, the transfacial pin was removed.
Result(s): The patient tolerated all procedures well. Immediate postoperative CT taken after placement of the transfacial pin (first surgery) revealed appropriate reduction of the laterally displaced condyle. At the time of transfacial pin removal (8 weeks after the initial repair), the patient demonstrated full and pain free oral excursion and stable class I occlusion. Follow-up CT analysis after removal of the transfacial pin demonstrates a stable reduction of the dislocated condyle and bony union of all three fractures.
Conclusion(s): Transfacial pinning technique can be a safe and effective technique for treatment of pediatric mandible fractures with lateral dislocation of the condyle

Movement disorder emergencies of the aerodigestive tract are dramatic and often life threatening. With appropriate timely evaluation and intervention, most patients can be effectively managed and major morbidity avoided. This chapter provides a comprehensive review of both the causes and appropriate treatment of breathing disturbances secondary to primary disorders and iatrogenic causes, as well as swallowing emergencies. Additionally, basic physiology, anatomy, and various methods for assessment of the upper aerodigestive tract are reviewed. Specific disorders that are addressed include the following: spasmodic dysphonia, adductor laryngeal breathing dystonia, Shy-Drager abductor weakness, drug-induced tardive dystonia, oromandibulolingual dystonia, multiple system atrophy, multiple sclerosis, amyotrophic lateral sclerosis, Parkinson's disease, Huntington's disease, and palatal myoclonus.
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Background/Purpose: Primary cheiloplasty for infants born with cleft lip and palate has long been preceded and facilitated by oral appliances intended to aid in feeding, narrow the cleft width, or mold the surrounding cartilages. Presurgical infant orthopedic (PSIO) therapy has evolved in both its popularity and focus of treatment since its advent. Nasoalveolar molding (NAM), nasal elevators, the Latham appliance, lip taping, and passive plates are the modern treatment options offered by cleft teams, and each varies in their associated protocols and treatment philosophies. The purpose of this study is to examine trends in the currently available modalities of PSIO care and PSNS for the management of patients with cleft lip and palate. Methods/Description: Methods: An electronic survey comprised of eight questions was distributed to the one hundred and sixty-seven cleft team coordinators listed by the American Cleft Palate Association. The survey reported on team setting, provider availability, PSIO treatment offerings, relative contraindications, and use of postsurgical nasal stenting. Descriptive statistics and analyses were performed using MS Excel (Microsoft, Redmond, WA) and SPSS (IBM, Chicago, IL).
Result(s): One hundred and two survey responses were received from the total one hundred, and sixty-seven sent, resulting in a response rate of 61%. The majority of settings were children's specialty hospitals (66%) or university hospitals (27%). PSIO was offered by 86% of cleft teams, and the majority of those (68%) provided NAM. Nasal elevators and lip taping are offered at 44% and 53% of centers, respectively. Latham and passive plates are both offered at 5.5% of centers. Teams with a dental specialist as the PSIO provider offered NAM significantly more than centers with surgeons as the provider of PSIO. Most centers (45%) had an orthodontist providing treatment. Patients are considered contraindicated for treatment at many centers for reasons such as mild cleft severity (46%), medically-compromised (42%), advanced age at first visit (29%), far commute (35%), and/or financial reasons (16%). The majority of centers use postsurgical nasal stenting (86%), and almost all insert the device immediately in the operating room (88%).
Conclusion(s): NAM is the most popular PSIO technique in North American cleft centers followed by the nasal elevator, suggesting that the nasal molding component of PSIO of critical influence on current treatment practices. With 86% of centers providing PSIO, access to care is improving with an increasing variety of treatment modalities. Postsurgical nasal stenting is also gaining popularity. The use of various PSIO techniques is ubiquitous, but the emphasis on nasal molding may continue to be the driving force for treatment in the future

Glass ceramics' fractures in zirconia fixed dental prosthesis (FDP) remains a clinical challenge since it has higher fracture rates than the gold standard, metal ceramic FDP. Nanoindentation has been shown a reliable tool to determine residual stress of ceramic systems, which can ultimately correlate to failure-proneness.

Background/Purpose: Traditional palatoplasty techniques rely on repositioning of soft palate muscle and mucosa to restore velopharyngeal closure. In the case of the wide cleft palate (10 mm or greater), we hypothesize that soft palate nasal mucosa closure can result in vertical shortening of the palate. Furthermore, horizontal release of the reconstructed soft palate nasal mucosa from the hard palate will result in significant lengthening of the soft palate, identifying a potential loss of domain of palatal length in patients with a wide cleft palate. This study characterizes this potential loss of vertical length of the nasal soft palate mucosa in patients with a wide cleft. Methods/Description: A retrospective review of all patients who underwent a primary cleft palate repair with a buccal flap prior to 18 months of age by a single plastic surgeon over a 2-year period. Inclusion criteria was defined as patients with cleft palate at least 10 mm in length at the area of the posterior nasal spine. All patients who met inclusion criteria underwent primary cleft palate repair with horizontal transection of the nasal mucosa during palatoplasty. This transection was performed after nasal mucosa repair, but prior to muscular reconstruction. The resulting mucosal defect was measured and reconstructed with a buccal flap. Patient demographics, intra-operative palatal measurements, and post-operative outcomes were analyzed.
Result(s): Twenty-two patients met inclusion criteria. Mean age at surgery was 10.68+/-1.04 months, mean gestational age at birth was 38.14+/-1.75 weeks, and mean weight at surgery was 8.75+/-1.22 kg. Three (13.6%) had a history of Pierre Robin sequence and 5 (22.7%) had an associated syndrome. Notably, 13 (59.1%) had a history of nasoalveolar molding, and 15 (68.2%) had previously had a cleft lip repair. No patients had a Veau I cleft, 7 (31.8%) had a Veau II, 12 (54.5%) had a Veau III, and 3 (13.6%) had a Veau IV cleft. Regarding palate repair techniques employed, 12 (54.5%) had a Bardach, 7 (31.8%) had a Von Langenbeck, 3 (13.6%) had an Oxford, and all had a concomitant radical intravelar veloplasty. All 22 (100%) patients had a right buccal flap during primary palatoplasty. The mean cleft width or horizontal separation of the palate at the posterior nasal spine was 10.6+/-2.82 mm, and the mean lengthening of the palate was measured as 10.5+/-2.23 mm. For complications, there were 2 (9.1%) fistulas, 1 (4.5%) wound dehiscence, 1 (4.5%) 30-day readmission (for RSV bronchiolitis), and no bleeding complications.
Conclusion(s): Patients with a wide cleft palate have a potential loss of vertical length of approximately 1 cm. Considering that patients with a wide palatal cleft are predisposed to developing VPI, these data provide supportive evidence that acute palatal lengthening during palatoplasty should be considered for this patient population. The buccal flap can mitigate the loss of domain in palatal length, and potentially improve palatal excursion

In New York City, the population of Chinese Americans has grown faster than that of any other minority racial/ethnic group, and now this community constitutes almost half of all Chinese Americans living in the northeastern United States. Nonetheless, scant research attention has been given to Chinese American ethnic enclaves and little is known about the health status of their residents. This study aims to help address this gap in the literature by: (1) improving our understanding of the spatial settlement of Chinese Americans living in New York City from 2000 to 2016; and (2) assessing associations between a New York City resident's likelihood of living in a Chinese American enclave and their access to health care and perceived health status, two measures of community health. In support of this aim, this study establishes a robust criterion for defining ethnic enclaves at the Census tract level in New York City as the communities of interest in this paper. An ethnic enclave is defined as an area at the Census tract level with high dissimilarity and a spatial cluster of Chinese Americans. The spatial findings were that Chinese Americans in New York City were least segregated from other Asian American residents, somewhat segregated from White residents, and most segregated from Black residents. Also, the population density of Chinese Americans increased since 2000, as reflected by their declining exposure index with other Asian Americans. Results from logistic regression indicated that the probability of living in a Chinese American enclave was negatively associated with positive self-perception of general health and positively associated with delays in receiving health care. For Chinese American residents of New York City, living in an ethnic enclave was also associated with both lower socioeconomic status and poorer community health.

Background/Purpose: Craniofacial microsomia (CFM) is the second most common congenital facial anomaly, yet its genetic etiology remains unknown. Methods/Description: We perform whole-exome or genome sequencing of 146 kindreds with sporadic (n=138) or familial (n=8) CFM.
Result(s): We identify a highly significant burden of loss of function variants in SF3B2 (P=3.8 x 10-10), a component of the U2 small nuclear ribonucleoprotein complex, in probands. We describe twenty individuals from seven kindreds harboring de novo or transmitted haploinsufficient variants in SF3B2. Probands display mandibular hypoplasia, microtia, facial and preauricular tags, epibulbar dermoids, lateral oral clefts in addition to skeletal and cardiac abnormalities. Targeted morpholino knockdown of SF3B2 in Xenopus results in disruption of cranial neural crest precursor formation and subsequent craniofacial cartilage defects, supporting a link between spliceosome mutations and impaired neural crest development in congenital craniofacial disease.
Conclusion(s): The results establish haploinsufficient variants in SF3B2 as the most prevalent genetic cause of CFM, explaining ~3% of sporadic and ~25% of familial cases