New method to fix cleft palate shows promise in Mayo Clinic lab study

January 22, 2005

ROCHESTER, Minn. -- Results from a Mayo Clinic laboratory study in animals suggest that using distraction osteogenesis, a procedure that uses the mechanical force of an appliance to lengthen soft tissue and bone, may be a feasible and effective method to repair cleft palate in the future. Cleft palate is a common birth defect in which a child is born with a gap in the roof of the mouth. This condition occurs in one out of 700 to 1,000 births in the United States.

"Right now, nobody tries to close cleft palate with distraction osteogenesis," says Eric Moore, M.D., Mayo Clinic otorhinolaryngologist and one of the study's investigators. "It's used in other areas of the body and other craniofacial problems, but not in cleft palate. Before taking it to the clinic to use in people, we wanted to try it in an animal model. This study tells us that it is possible to close cleft palate with distraction osteogenesis."

The Mayo Clinic researchers conducted this study in animals in order to find a method of repairing a child's cleft palate that would be even better than the current standard surgery. The distraction osteogenesis method is designed to gradually lengthen the bone of the palate through tension. An appliance made of a central body piece, four plates and screws is surgically inserted with the patient under anesthesia. After a rest period of 10 days, a key in the appliance is turned slightly each day for four weeks to slowly lengthen the bone and soft tissue. Finally, the device is surgically removed.

"This method of repairing a cleft palate is potentially superior to standard surgery because it brings in bone and soft tissue to cover the opening," says Bob Tibesar, M.D., chief resident in Mayo Clinic Department of Otorhinolaryngology and a study investigator. "This has positive implications for the shape of the palate and for speech later."

Currently, standard treatment for cleft palate repair involves surgery in which the mucosal flaps of the roof of the mouth are sewn together over the cleft. The actual missing bone is not repaired. Some of the potential downsides of this repair method, according to Dr. Moore, can include leaving exposed areas of hard palate bone, producing scars that sometimes interfere with the child's later midfacial growth. This growth impairment can lead not only to a poor cosmetic appearance, but also can lead to poor contact between lower and upper teeth when the child's mouth is closed. The lack of actual bony repair of the cleft, in addition to the tension placed on the mucosal flaps on the roof of the mouth during traditional cleft palate repair surgery, also increases risk of the wound splitting open or the creation of an abnormal passage between the mouth and nose. The current repair method also may shorten and scar the soft palate, which can impair speech.

The study of this method of cleft palate repair was conducted on 10 adult hounds, due to similarities to the human mouth. Two hounds served as study controls and had a surgically created cleft palate, but no subsequent repair. In the other eight hounds, the distraction osteogenesis device was used to close the cleft palate. In seven of the eight hounds that were treated, the researchers observed some degree of bony closure of the cleft; in five of them the cleft was closed completely with no side effects.

The Mayo Clinic researchers are currently working on perfecting the technique through study of the hounds with incomplete closure. The researchers also felt that the distraction osteogenesis device used in this study was too bulky, so they are now testing another more agile apparatus, says Dr. Moore.

"We continue to work on improving this procedure in the laboratory," says Dr. Tibesar. "We are not ready to perform this yet on human patients, but we are hopeful that day will come soon."

Uldis Bite, M.D., Mayo Clinic plastic surgeon, co-director of Mayo's Cleft Palate/Craniofacial Clinic and co-investigator in this research project, echoes this sentiment. "While this study shows great promise, it cannot currently be applied to the treatment of children with clefts of the lip and palate. We are still honing this technique in the laboratory. Meanwhile, it is important to know that in most children, the standard techniques of cleft lip and palate repair and careful multidisciplinary follow-up through our Cleft Palate/Craniofacial Clinic give excellent results."
-end-
This research was funded through a grant from the Plastic Surgery Educational Foundation and the Smile Train.

Mayo Clinic

Related Cleft Palate Articles from Brightsurf:

For children with cleft lip and palate, no major psychological impact of repeated surgeries
Children born with cleft lip and cleft palate (CLP) commonly undergo multiple surgical procedures between infancy and adolescence.

Children born with a cleft lip unlikely to be genetically inclined to do poorly at school
New research has found that children born with a cleft lip, either with or without a cleft palate, are not likely to be genetically predisposed to do less well at school than their peers.

Skin and non-adhesive cells found to play pivotal role in the formation of fin
Human fingers are sculpted from a primitive pad-like structure during embryonic development.

Speech impairment in five-year-old international adoptees with cleft palate
In a group of internationally adopted children with cleft lip and/or palate, speech at age five is impaired compared to a corresponding group of children born in Sweden, a study shows.

Variation in the shape of speech organs influences language evolution
Why do speech sounds vary across languages? Does the shape of our speech organs play a role?

The mystery behind cleft palate and lips: Study shines a light on genetic factors
Researchers found more than 100 new genes that could lead to the development of cleft lip and palates.

Salamanders chew with their palate
'According to the textbooks, amphibians swallow their prey whole, but we have been able to refute this,' says Dr.

New technique uses umbilical cord stem cells for early repair of cleft palate
A technique using umbilical cord blood stem cells could be a promising new approach for repair of cleft palate in infants, reports a paper in The Journal of Craniofacial Surgery, published in the Lippincott portfolio by Wolters Kluwer.

Novel genome-wide association study risk loci for nonsyndromic orofacial clefts
At the 96th General Session of the International Association for Dental Research (IADR), held in conjunction with the IADR Pan European Regional (PER) Congress, Azeez Butali, University of Iowa, Iowa City, USA, gave an oral presentation titled 'Novel Genome-wide Association Study Risk Loci for Nonsyndromic Orofacial Clefts.'

In the gaping mouth of ancient crocodiles
A new study by a team of international experts, led by University of Witwatersrand PhD candidate Kathleen Dollman and Professor Jonah Choiniere published today in the American Museum Novitates, endeavoured to further explore the mouth of one of the earliest occurring and least understood groups of crocodilians, the shartegosuchids.

Read More: Cleft Palate News and Cleft Palate Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.