Long-term facial growth after endoscopic and open in-utero repair of a cleft lip model in the fetal lamb

Abstract

Abstract. Fetal anomalies are now routinely detected by ultrasound allowing for intervention in utero, as a result of this fetal deformities have been treated successfully. The purpose of this study was to examine the long-term (6 months) facial growth after in utero repair of a cleft lip model in the fetal lamb. At 100 days gestation, the uterus was exposed through laparotomy, surgiports were placed in the uterus and a 3--4 mm wedge of upper lip extending into the base of the nose was excised under endoscopic visualization. Repair of the defect was performed endoscopically with staples or in an open fashion with sutures. The treatment groups were: 1) control: fetus observed with endoscope; 2) lip defect created; 3) neonatal repair: lip defect created, lip repair at 5 days old; 4) fetal staple repair: lip defect created and repaired, and; 5) fetal suture repair: lip defect created and repaired. Three-dimensional CT scans of the skulls were obtained at one week and six months of age. Direct measurements of the dry skulls were obtained at six months along with lip histology. The fetal "cleft" model in the lamb demonstrated long-term mid-facial growth inhibition. There was no difference in facial growth between endoscopic staples versus open hysterotomy suture repair. The fetal lamb model does not afford reliable neonatal repair after creation of a cleft defect endoscopically. Intrauterine repair of a cleft lip model appears to improve facial growth as measured at six months of age, both by 3-D CT scan and dry skull measurements.

Three-Dimensional Cephalometric Evaluation of Maxillary Growth following in utero Repair of Cleft Lip and Alveolar-Like Defects in the Mid-Gestational Sheep Model

“…The authors found no signifi cant differences between the treatment groups and concluded that in utero cleft palate repair, with or without scarring, resulted in normal maxillary growth in the 1-month-old lamb. In addition, Smith et al [29] evaluated the long-term facial growth after in utero repair of CL defects in sheep fetuses using both endoscopic as well as an open hysterotomy technique and found that the in utero repair of CL-like defects appeared to improve facial growth of the lambs. The evaluation was performed by means of measurements on 3D-CT scans 1 week after birth, and by means of both direct measurements on dry skulls and on 3D-CT scans after 6 months of age.…”

“…For this purpose, both the rabbit [18,36,37], as well as the sheep model [27,[29][30][31][32]38], have been used, while many of the above investigations are dealing with repair of CL or CLP defects [18,23,27,29,31,32] .…”

“…In order to evaluate the differences between the left and right (operated/cleft vs. nonoperated/ noncleft side) skull sides in each group as well as the asymmetry between experimental and control groups, 16 landmarks were defi ned and used ( fi g. 1 , 2 , table 1 ), and 24 linear measurements were performed on the reconstructed skulls (12 on the operated/cleft side and 12 on the nonoperated/noncleft side) ( table 2 ). The landmarks used in this study were derived or modifi ed from a selection of papers dealing with cephalometric measurements on sheep [24,27,[29][30][31][32] or on rabbit skulls [18,33] after in utero CLP surgery.…”

Histologic effects of amniotic fluid in the early phases of bone healing: an experimental study on rabbits

“…Various research studies have been performed on various tissues of fetal animals [5,8,13,14,17,31,[34][35][36][37][38]41]. Although fetal animals have been subject to a considerable number of experimental studies, the human fetus has been operated on only over the last 20 years and until now, only lethal diseases have been considered ethically appropriate for fetal surgical manipulation [1,9,15,16,21,24].…”

“…Although fetal animals have been subject to a considerable number of experimental studies, the human fetus has been operated on only over the last 20 years and until now, only lethal diseases have been considered ethically appropriate for fetal surgical manipulation [1,9,15,16,21,24]. It is likely that at some point, elective surgery on the human fetus will be performed to harness its scarless wound healing and its high regenerative capacity [6,9,16,41].…”