New approach for early repair of cleft palate

Stem cells obtained from umbilical cord blood could be a promising new approach for repair of cleft lip and palate in infants, reports a new study published in The Journal of Craniofacial Surgery. Stem cells were found safe and effective in decreasing the inflammatory process and develop better scars than the regular series in cleft lip and palate surgery.

Umbilical cord blood is a rich source of various types of stem cells, which have the potential to develop into many different types of specialized cells, including bone and cartilage.

"Performed as part of reconstructive surgery when the infant is a few months old, the stem cell procedure provides good results in growing new bone to close the upper jaw cleft - and may avoid the need for later bone graft surgery," said Alejandro Garcia Botero, MD, of Hospital De San Jose, Bogota, Colombia.

Dr. Botero and his associates reported their experience with the stem cell procedure in an infant with cleft lip and palate, diagnosed by ultrasound before birth. The baby girl had an alveolar cleft, involving an area of bone where teeth are located.

This study had the purpose to demonstrate the advantages of stem cell into tissue healing at patients with lip and palate cleft. The surgical protocol was used in all lip and palate cleft patients studied, part of them had stem cells injection and part had only the conventional treatment done, considered as a control group.

Immediately after delivery, a sample of the infant's umbilical cord blood was collected to isolate stem cells, which were processed and frozen to preserve them for later use.

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"Since the age is that of the newborn, [umbilical cord stem cells] have a greater potential to regenerate the organism," Dr. Botero and coauthors write. For the first few months, the infant underwent a nonsurgical "nasoalveolar shaping" procedure to align the soft tissues of the upper jaw.

Nine patients with cleft lip and palate were operated and had stem cells from umbilical cord blood and placenta blood injected into the bone and soft tissue during the primary procedure (rhinocheiloplasty).

At age five months, stem cells were placed in a pocket of soft tissue bridging the gap in the upper jaw. A small piece of absorbable biomaterial (Gelfoam) was used a scaffold to guide the growth of new bone across the cleft palate. This procedure was performed at the same time as surgery to correct the cleft lip (cheiloplasty).

Follow-up confirmed the formation of new bone to close the cleft palate, providing good position and support for the normal eruption of the teeth. Imaging scans when the patient was five years old showed a good thickness of the upper jaw bone in the area where the cleft had been.

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The stem cells activity into soft tissue and bone were evaluated. Preliminary results have shown no adverse results and improvement at the inflammatory response. A treatment protocol with stem cells was developed. It had a long time follow-up of 10 years.

A major potential advantage of the stem cell procedure is avoiding the need for later bone grafting surgery - currently the standard technique for closing the cleft.

The researchers emphasize the need for further studies evaluating their stem cell technique in a large number of patients - including steps to confirm that bone formation results from the stem cells, and not from the initial "boneless bone graft" surgery.

Lip and palate clefts are congenital craniofacial malformations that compromise the lip individually, hard or soft palate or even the 3 structures together.