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Dr. Kaban receives 2011 Norton M. Ross Award

Dr. Kaban receives 2011 Norton M. Ross Award
Dr. Kaban

Boston—Dr. Leonard B. Kaban says there are three stages in life: youth, middle age and the award-winning stage.

If that’s true, he may be settled in the latter-most phase. The past recipient of the Harvard School of Dental Medicine Distinguished Alumni Award, American Association of Oral and Maxillofacial Surgeons Research Recognition Award, published author of 300 peer-reviewed articles and internationally renowned lecturer will have to make room in his trophy case for one more honor. He’s the 2011 recipient of the Norton M. Ross Award for Excellence in Clinical Research.

Dr. Kaban received the award Oct. 12 during Annual Session.

The ADA presents the award in memory of Dr. Ross, a dentist and pharmacologist who contributed significantly to oral medicine and dental clinical research. Dr. Kaban, who is also an M.D., receives a plaque and a $5,000 award made possible by sponsorship from Johnson & Johnson Healthcare Products, Division of McNeil-PPC Inc.

The Ross Award is a special honor for him because it’s shared by only one other oral and maxillofacial surgeon, Dr. Daniel M. Laskin, winner of the Norton M. Ross Award in 1993. Dr. Laskin is one of Dr. Kaban’s role models as an academic surgeon and an icon in the field.

“I’m very proud to follow in Dr. Laskin’s footsteps in this award,” said Dr. Kaban.

He has built his career at Harvard School of Dental Medicine, Harvard Medical School and Massachusetts General Hospital and is recognized for his pioneering research in pediatric oral surgery—most notably the treatment of craniofacial deformities and jaw tumors in children. As chief of Oral and Maxillofacial Surgery at Mass General and the Walter C. Guralnick professor and head of the Department of Oral and Maxillofacial Surgery at Harvard, his work has led to “clinical investigations that have advanced the diagnosis and treatment of major oral and craniofacial diseases,” wrote Dr. R. Bruce Donoff, dean of the Harvard School of Dental Medicine.

Having the opportunity to work under the tutelage of Joseph Murray, M.D., and Dr. Walter Guralnick early in his career, Dr. Kaban was in a position to make major contributions to research that was a departure from the way surgeons traditionally looked at pediatric craniofacial surgery.

“The dogma at the time was that you don’t operate on children because you make the deformity worse,” said Dr. Kaban. “You wait until they finish growing then treat the end-stage deformity. Dr. Murray and Dr. Leonard Swanson (another of his mentors) felt that if you could intervene early and improve the so-called ‘functional matrix,’ you might get a better end result with a smaller operation and it would benefit the child psychologically.” 

That was especially true in the case of hemifacial microsomia, a condition where the lower half of one side of the face fails to grow normally. It’s the second most common facial birth defect after cleft lip and palate.

Emerging research on hemifacial microsomia coincided with the development of a new craniofacial center, the Plastic and Oral and Maxillofacial Surgery Division at the Brigham and Women’s Hospital and Children’s Hospital of Boston. Dr. Murray recruited Dr. Kaban for the center.

These were the halcyon days that set him on a career path dedicated to research and scholarly activities, and he’s never regretted it. “It was a magical time for me. I think we (Drs. Kaban, Murray and John Mulliken) published over 70 papers together.”

Among the most important was “Three-Dimensional Approach to Analysis and Treatment of Hemifacial Microsomia,” published in 1981 in Cleft Palate Journal.
“We devised a protocol to lengthen the lower jaw while the patient was still growing,” explained Dr. Kaban. “This created a space or open bite on the affected side. Then, Dr. Swanson would orthodontically manipulate the teeth on the upper jaw to erupt, thereby stimulating vertical growth of the maxilla. When the upper and lower teeth finally matched up, the skeletal and dental asymmetry was corrected.

“We showed in multiple studies and publications that in fact you could do an elongation of the lower jaw and get the face to grow and end up with a better result. The early treatment protocol improved growth and prevented secondary deformities.

“Until the early 1990s, we were the only ones treating hemifacial microsomia in growing children,” he said. “Many craniofacial centers are treating growing children now.” 

They do so using distraction osteogenesis, another area in which Dr. Kaban and his colleagues have developed novel methods. “Distraction is a technique of making a cut across the bone and stretching it with a device. Bone forms in the gap so you don’t need bone grafts,” he said.

With Dr. Maria Troulis of Harvard, Dr. Kaban now has a grant from the National Institutes of Health to complete the development of a totally buried miniature automated distraction device. “Within our group here, we have a series of publications on the biology of the distraction wound, distraction device design and imaging methods for 3-D reconstruction that facilitate distraction procedures.”

Said Dr. Donoff of this work: “One has only to see a youngster treated with distraction, who no longer is dependent upon tracheotomy for breathing, to appreciate this advance.”

Dr. Kaban’s career took a brief detour to the University of California at San Francisco in 1985 where he became professor and chairman of OMS, before he returned to Mass General in 1994 to head the department at Harvard and become chief of the MGH Service. At MGH and Harvard, he “added new dimensions to our specialty,” said Dr. Donoff. These included methods for treating high-flow arterio-venous malformations, minimally invasive techniques for condylar fractures and antiangiogenic therapy of recurrent giant cell tumors with interferon alfa-2A.

The latter stands as a singular achievement for Dr. Kaban and his colleagues.

The treatment of tumors took on new meaning after Judah Folkman, M.D., discovered angiogenesis, which hypothesized that in order for tumors to grow, they have to stimulate blood vessels to form.

“I had thought for years that giant cell tumors of the jaws were vascular-proliferative tumors that stimulate blood vessel formation,” said Dr. Kaban.

He brought a 6-year-old patient with a recurrent giant cell tumor of the jaw to Dr. Folkman as a candidate for antiangiogenic therapy. The patient had already had a massive resection and there were no options beyond high dose radiation and chemotherapy with potentially serious morbidity.

“Instead, we treated her with antiangiogenic therapy, and it cured the tumor. This was the first instance of a solid tumor being treated with interferon.” His research, “Antiangiogenic Therapy of a Recurrent Giant Cell Tumor,” was published in 1999 in the journal Pediatrics.

A native New Yorker and a good student with a keen interest in science, Dr. Kaban pursued his undergraduate degree at the Queens College of the City University of New York, earned a regent’s scholarship and became a biology major. One day, the premed advisor introduced him to Dr. Howard Oaks, then dean of admissions of the Harvard School of Dental Medicine, a meeting which Dr. Kaban remembers fondly. “He had on a Harris Tweed jacket, a bow tie and a haircut like John F. Kennedy, who was one of my heroes. He said to me, ‘You should come to Harvard.’ ”

Dr. Kaban knew dentistry and surgery were a good fit because he loved to work with his hands. Once he decided to become an oral surgeon, he became fascinated with pediatric surgery. “I liked the concept that you’re dealing with anatomy and surgical technology but then there’s this fourth dimension, which is time and growth.”

Dr. Donoff said Dr. Kaban’s work “is testimony to his dedication to discovery in the interest of improved patient care.” For Dr. Kaban, that meant pursuing a rigorous research agenda.

“When you’re young and starting out in an academic career, you worry about whether you’ll have enough patients, whether your clinical practice will grow enough. Dr. Murray told me, ‘Don’t worry about building your practice; that will come. The most important thing to do is to develop a research program. Research will fulfill your career.’ ”

It’s advice that he regularly dispenses to new generations of students, residents and junior faculty, too. He fostered innovative programs like a fellowship in OMS for dental students interested in careers in the specialty and an internal research funding program for faculty and residents.

“We mentor a lot of students in our department but my main interest is mentoring junior faculty and getting them promoted,” he said. At Harvard, junior faculty start out as instructors. Many of those whom Dr. Kaban has mentored have gone on to be assistant professors, associate professors and some are now becoming professors.

Dr. Kaban has received many accolades, but he’s most proud of the fact that he was one of the first oral surgeons to take an interest in pediatrics. His research now forms the basis of teaching pediatric oral surgery.

Dr. Donoff, the Harvard dean, said Dr. Kaban’s exceptional career “is not over yet.”

“Dr. Kaban is a surgeon’s surgeon, a scholar’s scholar and an inspiration to all who are fortunate to come under his influence,” he wrote in a nomination letter. “He sees his mission to foster the next generation of clinical scholars as critical to the profession.”

“On behalf of the ADA, I congratulate Dr. Kaban for this well-deserved honor,” said ADA Immediate Past President Ray Gist. “His research has changed the way patients with craniofacial conditions are treated, and has improved health outcomes for countless patients and their families.”

“It is our pleasure to recognize Dr. Kaban with the Norton Ross Award,” added Lori Kumar, Ph.D., vice president of Global Consumer Health Care Research and Development, Johnson & Johnson Consumer & Personal Products Worldwide, sponsors of the Ross Award. “Dr. Kaban’s clinical research has advanced pediatric oral surgery, inspired generations of oral surgeons and has improved the lives of children and their families. It is fitting to honor Norton Ross and his legacy of elevating clinical research and advancing oral health by celebrating Dr. Kaban and his impressive contributions and leadership in clinical research.”