What are orofacial clefts?
Orofacial clefts, including cleft palate and cleft lip, are congenital disabilities. The lip and the roof of the mouth, called the palate, form between the fourth and ninth weeks of pregnancy, as body tissue grows from the sides toward the center of the head, joining together to form the face and the roof of the mouth. However, sometimes this tissue does not join completely, resulting in a cleft, or opening, in the upper lip or the palate.
How common are orofacial clefts?
Every year, over 7000 babies are born with a cleft palate or cleft lip in the United States, making this birth defect one of the most common in the country. Usually, these defects are detected during pregnancy by ultrasound, or just after birth, but in some cases, some types of cleft palate may be diagnosed later in life. Cleft lip and cleft palate can cause problems with feeding and speaking, as well as recurrent ear infections, hearing issues or dental problems.
Although the exact causes of orofacial clefts are unknown, several risk factors can increase the likelihood of having a baby with one of these defects. These risk factors include smoking during pregnancy, maternal diabetes before the pregnancy and the use of certain medications for epilepsy during the first three months of pregnancy.
Can they be fixed?
Treatment of orofacial clefts requires surgery, in which bone or skin grafts are inserted to join both sides of the cleft and close it. Surgery is recommended within the first 12 months of life for cleft lip, and up to the first 18th months of age for cleft palate. Surgical repair can improve the appearance of the child’s face as well as functionality related to feeding and speech. However, these surgeries often need to be complemented by additional surgical procedures as the child grows to fill the gaps that may form during growth.
A new approach may make it possible to forego the need for further surgery, while improving surgical results. In a study published in the Journal of Craniofacial Surgery, researchers from Brazil used umbilical cord blood stem cells during reconstructive surgery of nine patients with cleft palate, with or without cleft lip. The stem cells were injected directly into the bone and the soft tissue during the surgical procedure. These cells would then transform into bone or skin cells and fill the gap in the palate or the lip. For cleft palate, a small portion of absorbable biomaterial was used to bridge the gap, in order to guide the growing bone cells across the palate.
Follow-up confirmed the formation of new bone, which successfully closed the cleft palate. Five years later, the bone structure of the child’s upper jaw was normal. As a result, there was not a need for further bone grafting surgery, which can have complications and would have required the extraction of bone from another part of the child’s body. These results show, once again, the enormous potential of umbilical cord blood stem cells for regenerating tissue, and the vast number of uses that these stem cells can have in modern medicine.
Parker SE, Mai CT, Canfield MA et al; for the National Birth Defects Prevention Network. Updated national birth prevalence estimates for selected birth defects in the United States, 2004-2006. Birth Defects Research (Part A). Clinical and Molecular Teratology, 2010;88:1008-16.
Marcelo Paulo Vaccari Mazzetti, Nivaldo Alonso et al. Importance of Stem Cell Transplantation in Cleft Lip and Palate Surgical Treatment Protocol. Journal of Craniofacial Surgery, 2018;29(6):1445–1451.