By Susan Richards
A cleft lip is one of the most common facial birth defects, affecting more than 4,000 babies born in the U.S. each year, according to the Centers for Disease Control and Prevention. It may be accompanied by a cleft palate, or the palate can be cleft with the lip intact. The deformity occurs in the womb during the first trimester when the connective tissue forming the face and mouth doesn’t fully fuse, leaving a split. A cleft lip can usually be detected on a prenatal ultrasound, while the cleft palate often isn’t diagnosed until birth.
Surgery to repair the clefts is typically performed before the child reaches 12 months – between three and six months of age. Genetics and possible environmental factors such as prenatal medications or smoking and alcohol use may play a part, but the healthiest of pregnancies with no family history can result in a cleft.
Because of the malformation in the nose and mouth area, children born with a cleft lip or palate may experience difficulties with any one or a combination of the following:
• Nursing or bottle feeding
• Speech development
• Ear infections or hearing loss
• Visible scarring
Most of these issues are addressed with an ear, nose and throat specialist, speech therapist, or an astute dental professional. Unfortunately, the scar from a cleft lip repair can be quite noticeable, causing life-long discomfort and impacting the child’s self-esteem. Until recently, the best efforts at scar reduction were medical silicone gels and over-the-counter remedies.
Hope for New Smiles
Exciting news in the world of scar research has brought new hope for those with pronounced cleft lip scars – and more. This spring, scientists at Stanford University announced a breakthrough in blocking the molecular signals that cause scars to form, and they’ve done it with a medication that’s been on the market for two decades.
When skin is damaged, either through cuts, burns or surgical incisions, our bodies release platelets and immune cells to aid in the repair. The cells that close the outer edges of the wound are called fibroblasts, and they quickly form layers of collagen fibers. The resulting scar tissue is thicker than our normal skin, but not as flexible. It’s also lacking hair follicles or oil and sweat glands making the skin more sensitive and the scar more evident.
Dr. Michael Longaker of Stanford has long been interested in the science of scar reduction, and his team’s research paid off when they injected verteporfin at the edge of wounds created on mice. The drug ostensively coaxes the wound to repair more slowly and thoroughly than mice bodies would naturally allow.
The treated skin not only re-formed smoothly without scarring, but the fur grew back as well.
Verteporfin has been used for twenty years intravenously in combination with laser light therapy to treat age-related macular degeneration. This isn’t the first time we’ve heard of research leading to alternative breakthroughs for existing science. The technology that was behind the current successful COVID-19 vaccines is based on mRNA – or messenger ribonucleic acid, and scientists are seeing promising applications in cancer medicines.
The Stanford team has moved forward by using the medication on pigs, which have skin more akin to humans, and the results have been similarly dramatic. Patents have been filed to use verteporfin specifically for reducing scar formation. More work still needs to be done to see if all the skin structures are retained, but the scientific and medical community is enthusiastic. In addition to surgical use, Dr. Longaker hopes to see physicians using the treatment when stitching up lacerations in the office, and potentially for healing old scars and burns with minor surgery and the injections of verteporfin.
While the drug is technically already on the market, Dr. Longaker is seeking approval from the Food and Drug Administration to begin clinical trials on babies with cleft lips and palates by the end of this year.
For the dental industry, that impact on young smiles would be incalculable.
Author: Susan Richards is a staff writer at DOCS Education. With over 20 years of experience in local journalism and business marketing, Susan’s career includes award-winning feature writing, as well as creating content with context for a wide variety of industries.