Houston, Texas, USA : A technique using umbilical cord blood stem cells could be a promising new approach for repair of cleft palate in infants researchers report. 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, according to the case report by Alejandro Garcia Botero, MD, of Hospital De San José, Bogota, Colombia, and colleagues.
Cleft lip and palate is a congenital malformation that requires a multidisciplinary treatment that evolves pediatrician, obstetrics, fetal medicine, genetics, plastic surgery, orthodontics, speech therapist, nursery, and psychology. Actually, the authors believe that it could be possible to ad protocols to use stem cells.
The intrauterine diagnosis leads to preborn parental orientation and better parental collaboration to accept a precocious multidisciplinary treatment. After birth the authors’ protocol is: orthodontic devices, phonoaudiology, and surgical procedures.
The authors’ cleft lip and palate reconstructive surgery protocol demands several steps and begins at 4 to 6-month old with rhinocheiloplasty and soft palate closure at the same moment. The treatment sequence involves the hard palate surgery (8–18 months after the first surgical step), alveoloplasty (after 10 years old), and secondary rhinoplasty (after 14 years old).
New ideas to use stem cells and blood from the umbilical cord and also blood from placenta are discussed to improve final surgical results. Maternal stem cells are easy to collect, there are no damage to the patient and mother, it is autologous and it could be very useful in the authors’ protocol.
Nine patients with clef 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).
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.
Stem Cells Could Be New Option for Closure of Alveolar Cleft Dr. Botero and colleagues report 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 was approved by the Facial Defects Study and Research Center Ethics Committee and all parents received a Consenting Form and an explanatory class of the conventional surgical treatment protocol. Two weeks later they returned with the authorization of their children accession in this study. It was clear all the time about the possibility to decline the participation at this study.
From 2007 to 2016, 9 newborn patients with cleft lip only or associated with palate cleft were diagnosed by prenatal ultrasonography and had their umbilical cord and placenta blood collected at birth, the least 3 of them had also the umbilical cord collected. This group of patients was designed Stem Cell Group (SCG).
Other group of 9 patients with similar clinical presentation of cleft lip and palate was chosen to be compared with the Stem Cell Group and was submitted to the same surgical procedures without the use of stem cells. This other group was designed Control Group (CG). Each patient of the Control Group was evaluated after birth, for this reason it was impossible to collect stem cell at birth.
The surgical procedures were done by the same plastic surgeon and the techniques used were the same to both groups.
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. 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.
“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.
At age five months, the stem cells were thawed for use as part of “boneless bone grafting” surgery (gingivoperiostioplasty). The 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 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 formation of new bone to close the cleft palate, providing good position and support for normal eruption of the teeth. Imaging scans when the patient was five years old showed good thickness of the upper jaw bone in the area where the cleft had been.
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. This procedure uses bone taken from elsewhere in the child’s body, typically the hip. Bone grafting has potential complications and subjects the child to one or more additional surgeries.
The study is the first to use stem cells as part of primary surgery to repair cleft palate in an infant. Dr. Botero and colleagues note that their patient will need further monitoring to ensure adequate bone thickness in the upper jaw. 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.
“Our conclusion of this preliminary report is that stem cells in cleft lip and palate surgery decrease the inflammatory process and develop better scars than the regular series. The stem cells used in association with the regular surgical treatment do not cause any damage to the patient.
Besides the clinical conclusion, we developed a clinical protocol to safety use of stem cells, in a high amount of stem cells, with future possibilities to get better results in future clinical series.” the research team said.
The paper titled “Importance of Stem Cell Transplantation in Cleft Lip and Palate Surgical Treatment Protocol” in The Journal of Craniofacial Surgery is published in the Lippincott portfolio by Wolters Kluwer.