Dr. Don Enlow is THE state of the art in the field of growth and development of the human face. He is truly a legend and the source of all knowledge on the subject. To say that his career has been distinguished is a gross understatement.
Enlow’s distinguished career started after World War II, when he left the service and started college–all over again–as a pre-med major. He took biology and has stated in his own words “It hit me like a freight train. It opened my eyes to a fantastic, whole new world. I found that everything in biology is purely fascinating, exciting, and absolutely compelling. Changing my major to pure biology, I took every course in the catalog. Soon, I found one particular professor who was, in every way, the dynamic kind of scholarly professor I wished to be. I signed up for all the courses he presented . . . comparative anatomy, embryology, histology, vertebrate paleontology . . . Oh brother, was I ever hooked! He was a paleontologist and had done his Harvard doctorate under Al Romer, the modern father of paleontology.”1
After receiving his master’s degree, Dr. Enlow began teaching and doing extensive fossil field prospecting all over West Texas. He became a paleontologist. Couple this fact with a minor in geologic sedimentary petrology and fast forward to one expedition. “During one particular fossil expedition, I was looking over some bone fragments I had just found, and a small piece of a neural spine of edaphosaurus, an early mammal-like reptile, really caught my interest. I thought I could make out some structure in its broken end. I asked my professor if ground sections of fossil bone have ever been made. ‘I don’t think so’ was the response with a negative shake, and ‘why don’t you try it?’ Well, back at the lab I did just that. And what I saw just absolutely FLOORED me. I tell you I was just ASTOUNDED. I remember that my hands were shaking as I stared at that first section for long minutes, almost disbelieving. Most of the key histology was there. I was transfixed in silence, pondering the compact and cancellous areas, the lacunae, the lamellae, and the vascular canals. Great heavens, can you believe, there were even elaborate canaliculi flowering out from each lacuna, perfectly and beautifully intact. I could not help but think that what I was seeing was just impossible. After all, I was looking at bone tissue over 200 million years old, TWO HUNDRED MILLION YEARS OLD. Yet I had to believe my eyes. I was seeing something that no one had ever seen. Yes, profoundly exciting. I think it must have been something like an explorer’s feeling when discovering something like a new continent. Big!”1
Don Enlow decided to seriously work at an academic career. First, he had to enter an appropriate university and complete the doctorate degree. He did so and received his Ph.D. in anatomy from Texas A & M University in 1955. He then proceeded to serve with the Anatomy Department of the University of Michigan School of Medicine for 15 years and was Director of the Physical Growth Program at the Center for Human Growth and Development at the University of Michigan. He moved from Michigan to be the Chairman of Anatomy at West Virginia University School of Medicine. He then made another move to Cleveland, Ohio, where he was the Thomas Hill Distinguished Professor and Chairman of Orthodontics at Case Western Reserve University from 1977 to 1989. While at Case Western, he also served as acting Dean of the School of Dentistry for three years. Currently, Dr. Enlow is Professor Emeritus in the Department of Orthodontics at Case Western Reserve University. He lives in Milton, Wisconsin and visits Case Western several times a year to lecture to students in the School of Dental Medicine. Over his distinguished career, he has been elected as a Fellow in the Royal Society of Medicine, has written several books, has over 140 journal publications and chapters in textbooks, and has been invited to lecture extensively throughout the United States and numerous countries around the world. He received an Award of Special Merit from the American Association of Orthodontists and the Award of Recognition for contributions to orthodontic education from The American Board of Orthodontics.
Now fast forward backwards. How did this unique, magnetic individual achieve all of these things? He achieved them because of his sense of EXCITEMENT, and the fact that he could transfer this wonder and excitement to the students who studied his specialty, facial growth and development. Essentially, the study of facial growth–and the understanding of the subject– can be divided into pre-Enlow and post-Enlow.
Prior to Don Enlow, facial growth was essentially a nonbiologic package. It was taught that the face and the components of the face grew downward and forward. This concept created some problems. First, it was insisted that the mandibular condyles might control virtually everything about mandibular growth. Additionally, sutures were presumed to be important, proactive growth regulating centers. However, when sutures are surgically removed in an experiment, everything develops naturally as though nothing happened. In essence, prior to Don Enlow and his proactive thinking and research, growth was looked upon as simple periosteal deposition and endosteal resorption. These simplistic teachings about facial growth, some of which were either incorrect or misleading, were incorporated into standard orthodontic principles and thought.
During his years at Michigan, Dr. Enlow, already skeptical of the past ways of looking at growth, decided that there had to be a reason about why bone growth behaves as it does during the formation of seemingly endless histogenic variations among all of the bones in all the different vertebrate groups, and finally, in the human face and neurocranium. He decided that there had to be some kind of rule book underlying the reasons that determine the patterns of bone growth everywhere. Nothing could be random. He states in The Path:1
“So, my goal was to find out what the basic rules are and why. But the rules determining bone tissue microstructure, for so many years the baffling puzzle, have now at last been worked out and I think are fairly well understood. They closely parallel geologic systems of sedimentation, and to biologists, are known by our old, long used term of remodeling, but greatly expanded beyond the old, simplistic understanding. The developmental principle involved is quite simple. When this principle hit me, I can’t recall. It was not like a clap of thunder, but whenever and however, the title I’ve given to it is simple and descriptive . . . just as simple as how the principle itself is so straightforward. The key developmental process is Area Relocation. It is the fundamental reason all bones must remodel as they grow. It fully explains the seemingly endless diversity seen in the microscopic structure of bone.”
Because of Don Enlow, growth processes are now understood. The development of the face and the neurocranium can now be accurately traced through many detailed analyses. Much like geologic formations, it can be recorded. Don Enlow has taught the health science professions the language of bone growth and the manner in which craniofacial growth processes can be determined. He has given medicine and dentistry an understanding of how bone becomes displaced throughout all the groupings of separate bones, and the overall development of the entire facial and neurocranial composite can now be completely worked out. This is a life’s work. It has been happening in Don Enlow’s mind for 50 years. It is truly one of the most monumental–and immortal–contributions to our understanding of how the human face grows and develops.
James L. Vaden, D.D.S., M.S.
Professor and Chair
Department of Orthodontics
University of Tennessee
Health Science Center
Mark Hans, D.D.S., M.S.D.
Professor and Chair
Department of Orthodontics
Case Western Reserve University
References
1. Enlow D: The path. In: Enlow D, Hans M: Essentials of facial growth. 2nd ed. Ann Arbor, MI: Needham Press; 2008:IX-XIV.
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