IN-UTERO CLEFT-PALATE REPAIR IN THE OVINE MODEL

Cleft lip and palate defects assume many for forms from mild to severe , but all may be associated with abnormal craniofacial development. Ev en the most expert and sophisticated methods of surgical repair are fo llowed by scar contraction and fibrosis, which result in skeletal defe cts, dental abnormalities, cosmetic disfigurement, and speech impairme nt. Recent clinical and experimental observations that fetal cutaneous wounds heal without scarring are of great potential interest in the m anagement of cleft lip and palate. The objective of this study was to investigate the effect of prenatal repair of iatrogenically produced c left palate on scar formation in the fetal lamb model. Ten ewes were o perated on ranging in gestation from 70 to 133 days. Fifteen lambs wer e studied (nine cleft palates produced and repaired in utero; one clef t produced in utero and not repaired, four normal, unoperated palates; and one cleft palate produced and repaired 1 week postnatally). The l ambs were delivered normally at 145 to 147 days gestation and maintain ed with the ewe until 1 month of age. The lambs were euthanized, and t he surgical area of the palates studied grossly and histologically. An imals operated at 112 days or later in gestation exhibited scars both clinically and histologically. The animals that had cleft palate produ ced and repaired at 70 days gestation did not have a visible palatal s car at 1 month of age. Histologically, there was evidence of minimal s carring without disruption of normal architecture. Studies are underwa y to determine the impact of reduced scarring on craniofacial growth a fter palatal repair during mid gestation in the ovine model.