The first human connection is established at birth when the infants breastfeed. Mother’s milk is also the first quantified nutrition that builds up child immunity and promotes growth. But one in every 1000 is devoid of this connect living with the birth defect of a cleft lip and palate.
Inability to breast feed is directly related to decrease milk production and health related problems of an infant. The child suffers from increased hunger, irritation, unsuccessful bonding, dissatisfaction and weakness. While child loses essential nutrient in the first year of life it also loses the formation of important gut bacteria for promoting digestion and immunity through Ig A in mother’s milk.
Due to naso-oral connection, respiration is severely affected with increased regurgitation of fluids from mouth to nose, labored breathing and harboring of harmful oral bacteria in the nasal passage and vice versa.
Speech is affected as lip and palate together are involved in phonetics and articulation of words so “Peter Patter may not have a Peanut Butter!!”
Most of these clefts are diagnoses before birth by ultrasound. But cleft of soft palate that are missed during birth can be detected by the pediatrician or pediatric dentist in the first year of life.
The formation of palate is a play of synchrony with expansion of jaw, lowering of tongue position with the balance of adhesion, proliferation and differentiation regulated by cell signaling molecules. A disturbance in any of these steps result in defect of lip, hard and soft palate.
The cleft palate surgery is primarily performed in 6-8 months of life after initial cleft lip. Primary closure holds the foundation for subsequent growth of jaws and failure during this part has a deleterious effect on the profile and growth of face. Failure may be attributed to decrease bone density, increased chance of wound dehiscence and incisional line opening.
Early closure has an advantage of better speech development but also a disadvantage over restricted mid face growth. The self-repairing protocol will be therefore beneficial if the maxillary growth is not restricted and promote regeneration through osteogenesis, angiogenesis and prime play of neural crest cells involved in oro -pharyngeal complex. NCC signals the palatal muscle circuit to fall in the right inserts and regulate functional movements. Tissue engineering guide regeneration through mesenchymal stem cells (MSC) by differentiation into bone cells and bone morphogenic proteins (BMP’s) will regenerate bone in the defect.
The best available sources at present are umbilical blood, maternal stem cells, blood from placenta, and deciduous exfoliating teeth. The stem cells collected through these sources have proangiogenic, adipogenic, myogenic, neurogenic and odontogenic potential. Stem cells are isolated through the blood which is preserved then later thawed as part of boneless bone grafting by the fifth month. A biomaterial like gel foam is used as scaffold to guides osteoinduction and osteoconduction. This procedure may be done at the same time as cleft lip repair and provide an advantage to avoid later bone grafting surgery (7-10 years), reduce operative time, decrease intraoperative blood loss and decreases additional complication associated with bone harvesting iliac crest.
Image scanning will be able to confirm the increase in bone density at a long term follow up of 5 and 10 years.
The potential of harvesting a stem cells has a better prognosis over harvesting an iliac crest and holds a promising future if we could precisely control the differentiation following regeneration.
GAMEFACE 