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Biologics in Craniofacial Reconstruction: Morphogens and Stem Cells

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The Embryologic Basis of Craniofacial Structure

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Abstract

Bioengineering of bone represents a rapidly evolving frontier of craniofacial reconstruction. The combination of powerful morphogens, scaffolds, templates, and mesenchymal cells capable of assuming an osteogenic fate can produce a biomaterial which can induce its own blood supply and thereby escape the constraints of vascularized bone flaps. This chapter describes selected aspects of this field from a perspective derived from early work with recombinant human bone morphogenetic protein-2 and connecting forward to autologous adipose-derived mesenchymal cells. This discussion is designed to serve as a springboard for further innovation by readers with an interest in stem cell biology and tissue engineering. The learning objective is to unleash your own imagination.

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Authors and Affiliations

  1. Wake Forest Institute of Regenerative Medicine, Wake Forest University, Winston-Salem, NC, USA

    Michael H. Carstens

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  1. Michael H. Carstens
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Editors and Affiliations

  1. Plastic and Reconstructive Surgery, Saint Louis University Plastic and Reconstructive Surgery, Falls Church, VA, USA

    Michael H. Carstens

Commentary: S. M. Balaji

Commentary: S. M. Balaji

This book is the culmination of a few decades’ long experience as well as the lifelong accumulated knowledge of the author—Prof. Michael Carstens. It is an enthusiastic celebration of many innovations, modifications, and discoveries that the author has done in the field of facial cleft rehabilitation, reconstruction, and regenerative medicine. He relies on and uses tools that are either of natural origin or biomimetics of human proteins in function and most importantly biological relevance. This deep understanding of biological mechanisms is presented in the earlier part of the book where the process of embryo formation and face development is meticulously described. Michael and I have worked together in complex craniofacial cases in India and several parts of the world. During these times, I have closely observed the way he would translate basic knowledge into innovative surgical results. His unique and deep understanding of the complex anatomy, physiology, and molecular biology would thrill me. I always looked forward to operating with him. In this process, we mutually learnt a lot while our patients stood benefitted.

This textbook—Craniofacial Structure: Developmental Anatomy, Evolutionary Design, and Clinical Applications—is seminal and is also a fitting unique tribute to the many forerunners in the field. The abundance of colorful illustrations—clinical as well as infographics—adds unique value to this compilation of experiences. Michael Carstens’ ability to interweave clinical situations with basic molecular biology in a very appealing way is a standing testimony to his focus and mastery of the subject. Although the emphasis of this book is predominantly clinical, the overall effect is that such a treatment approach will revolutionize the way healthcare delivery is done. The ultimate benefactor of this newly emerging scientific field will be society. After all, the destiny of science and well-being of society are highly linked. Every chapter abounds with the enthusiasm of the author and his collaborators. The book is the result of an intellectual fascination with human facial development, which has motivated to understand exactly how this process works. The work is unique in its profundity and breadth. It represents a passionate search for underlying mechanisms as the fundamental requirement for the treatment of facial clefts. The results of this quest are told as a tightly knit story in an intriguing and visually appealing way. I sincerely believe that this book will become a cornerstone of craniofacial education. This will also take craniofacial cleft reconstruction beyond the science of mere observation. Such a developmental approach based on neuroembryology represents a new method of inquiry leading toward a better understanding of the complexity of human facial development.

Donning several hats—clinician, surgeon, academician, researcher, entrepreneur, and scientist—Prof. Carstens has condensed his skills, experience, and knowledge into a single textbook, with a noble intention to pass on this hard-earned knowledge to the next generation of surgeons. The approach is a unique and forward-thinking approach; in point of fact, it represents a challenge, a throwing-down of the gauntlet as it is the obvious intention of the author to motivate the reader to think, probe, and act. He has been quite successful in this noble goal. The book succeeds in captivating the readers and takes them through various stages of face formation right from the embryo. Later, it branches into the neuromeric theory and the neurovascular embryology behind how various clefts are formed. In my opinion, this knowledge is directly relevant for the diagnosis and treatment of a wide variety of craniofacial anomalies. This book serves as a reminder that medical-surgical science will continue to accomplish unimaginable feats so long as people like Prof. Michael Carstens continue to look beneath the surface and challenge the dogma of the status quo, in the search for better results in the well-being of patients.

As a colleague and friend, I wish Prof. Michael Carstens all success and all readers a fruitful reading and learning process.

S.M. Balaji

Balaji Dental and Craniofacial Hospital, Teynampet, Chennai, India

A Note from Dr. Carstens

S.M. Balaji

From the vantage point of the Balaji Dental and Craniofacial Hospital in Chennai (formerly Madras), Tamil Nadu, India, Prof. Dr. S.M. Balaji cuts an imposing figure with an impossibly long list of accomplishments. As his full name is also impossibly long, I shall refer to him as Bala, and he is a true force of nature. A relentless perfectionist, academician, optimist, and general overachiever, his energy (seemingly boundless) is somehow contained within a sizeable and powerful frame. However, behind the booming voice and irrepressible smile is a restless and innovative mind, rather unencumbered by dogma and quick to seek clinical implementation for concepts he considers of value. Given this constellation of attributes, it is not surprising that Bala has been the driving force behind the introduction of rhBMP-2 to reconstructive surgery for the Indian subcontinent and Southeast Asia. We started out doing cleft cases together, but he quickly found a way innovate with bone grafts with an eye toward regenerative applications in the future. In the operating theatre, I found him to be a master technician and a never-ending source of new ideas. Away from the hospital, Bala and his wife, Sachin, were the most gracious of hosts. But our cooperation did not stop there, for Bala is a tireless organizer and connector—his conferences in the Seychelles and Maldives gathered together like minds with the results that were eye-opening. Bala showed me the promise of a much larger world. I am convinced that innovation in medicine for the twenty-first century will come about as clinicians and scientists from India harness the incredible power of their clinical experience and produce studies that will change the direction of our thinking and techniques. As this story unfolds, I am sure that Dr. S.M. Balaji will be in the forefront; I hope to follow along to see its denouement.

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Carstens, M.H. (2023). Biologics in Craniofacial Reconstruction: Morphogens and Stem Cells. In: Carstens, M.H. (eds) The Embryologic Basis of Craniofacial Structure. Springer, Cham. https://doi.org/10.1007/978-3-031-15636-6_20

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  • DOI: https://doi.org/10.1007/978-3-031-15636-6_20

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