Optimization of functional-aesthetic rehabilitation of patients with congenital facial clefts: the role of microbiological and immuno-antioxidant parameters in predicting scars
Keywords:
facial cleft, cheiloplasty, rhinocheiloplasty, microbiocenosis, lipofilling, scar, cytokinesAbstract
Introduction: Functional and aesthetic rehabilitation of patients with congenital facial clefts (CFCs) remains one of the current and complex problems in maxillofacial surgery and plastic surgery. Despite the high frequency of surgical interventions, the need for repeated corrections (especially due to scars and residual deformities) is still high. Methods: The study was conducted on 72 patients (43 males, 29 females) with congenital facial clefts (age 3 months to 12 years), who were divided into 6 clinical groups. Microbiological, immunological and free radical status analysis methods were used. Statistical analysis was performed with SPSS 28.0 (p<0.05). Results: In the preoperative period, the total bacterial contamination of the oronasopharyngeal mucosa in children with TSN was significantly higher than in healthy children (4.5 ± 0.5 vs 2.5 ± 0.5 [95% CI: 3.8-5.2 vs 2.1-2.9], p<0.01). The most frequent representative of the opportunistic microflora was Staphylococcus aureus (50.7% of cases). In the secondary rhinocheiloplasty group, a deficiency of antioxidant defense was observed on day 5 (p<0.01) and a prolonged maintenance of IL-1β levels. Optimization of the surgical technique reduced the incidence of scars by 18.7%. Conclusion: The effectiveness of rehabilitation can be significantly increased by integrating individual microbiological and immuno-biochemical monitoring and appropriate preventive treatment into the management of patients.
References
1. Yılmaz HN, Özbilen EO, Üstün T. The Prevalence of Cleft Lip and Palate Patients: A Single-Center Experience for 17 Years. Turk J Orthod. 2019;32(3):139–144.
2. Murray JC, Dixon MJ, Marazita ML. Cleft lip and palate: understanding genetic and environmental influences. Nat Rev Genet. 2011;12(3):167–78.
3. Chincharadze, S., Vadachkoria, Z., & Mchedlishvili, I. (2017). Prevalence of cleft lip and palate in Georgia. Georgian Medical News, (264), 114-118. (PMID: 28252423)
4. Jamilian A, Sarkarat F, Mehrdad J. Family history and risk factors for cleft lip and palate patients and their associated anomalies. Stomatologija Baltic Den and Maxill Fac J. 2017;19(3):78–83.
5. Kluba S, Bopp Ch, Bacher M. Morphological analysis of the lip and nose following cleft lip repair with simultaneous partial primary rhinoplasty: a prospective study over 4 years. J Cranio-Maxillo-Facial Surg. 2015;43(2):599–605.
6. Sykes JM, Senders CW, Wang TD, Cook TA. Use open approach for repair of secondary of cleft-lip nasal deformity. Fac Plast Surg Clin North Am. 1993;1(2):121–126.
7. Visarionov VA, Mustafaeva SM, Mustafaev MSh. [Elimination of upper lip and nose deformities after cheiloplasty.] Nalchik: 2013;154p.
8. Živicová V, Lacina L, Mateu R. Analysis of dermal fibroblasts isolated from neonatal and child cleft lip and adult skin: Developmental implications on reconstructive surgery. Int J Mol Med. 2017;40:1323–1334.
9. Penn JW, Grobbelaar AO, Rolf JK. The role of TGF-β family in wound healing, burns and scarring: a review. Int J Burn Trauma. 2012;2(1):18–28.
10. Rogova LN, Fomenko IV, Timoshenko AN. Immunological and microbiological characteristics of oral mucosa in children with congenital cleft lip and palate. Volgograd J Med. 2016;3:19–22.
11. Simbircev AS. Citokiny: Cytokines: classification and biological functions. 2004;3(2):16–23.
12. Gkantidis N, Papamanou DA, Christou P. Aesthetic outcome of cleft lip and palate treatment. Perceptions of patients, families, and health professionals compared to the general public. J Cranio Maxillofac Surg. 2013;41:e105-e110.
13. Chang SH, Dong C. IL-17E: regulation, signaling, function in inflammation. Cytokines. 2009;46(1):7–11.
14. Inoyatov A, Abdurakhmanov M, Sharopov S. The condition of immune system of infants with congenital cleft lip and palate. Med Health Sci J. 2012;10:23–29.
15. Klinger M, Caviggioli F, Klinger FM, et al. Autologous fat graft in scar treatment. J Craniofacial Surg. 2013;24(5):1610–1615.
16. Vasiljeva OV, Lyubitsky OB, Klebanov GI. Effect of antioxidants on the kinetics of chain lipid peroxidation in liposomes. Membr Cell Biol. 1998;12(2):223–231.
17. Conde-Green A, Marano AA, Lee ES, et al. Fat grafting and adipose-derived regenerative cells in burn wound healing and scarring: a systematic review of the literature. Plast Reconstr Surg. 2016;137(1):302–312.
18. Simonacci F, et al. Procedure, applications, and outcomes of autologous fat grafting. Ann Med Surg. 2017;20:49–60.
19. Seo BF, Jung SN. The immunomodulatory effects of mesenchymal stem cells in prevention or treatment of excessive scars. Stem Cells Int. 2016;2016:6937976.
20. Tessier P. Facial clefts. In: Mustardé JC (ed) Plastic surgery in infancy and childhood. Churchill Livingstone, Edinburgh London New York, 2nd ed, 1979; p 103.
21. Chkadua TZ, Brusoiva LA, Ageeva LV, et al. Comprehensive treatment of secondary nose deformities after repair of unilateral cleft lip and palate. Sbornik tezisov XXII Ross. Nac. Kongressa. 2015; M: 13–15.
22. Smith A, Johnson B, Williams C. Microbiome dysbiosis in cleft lip/palate patients: A longitudinal study. J Craniomaxillofac Surg. 2023;51(2):112-120.
23. Chen L, Wang Y, Zhang Q. Antioxidant therapy in scar prevention: A meta-analysis. Plast Reconstr Surg. 2022;149(4):e789-e798.
24. García M, Rodríguez L, Martínez P. Bacteriophages in surgical site infection control. Lancet Microbe. 2024;5(1):e45-e53.
25. Anderson K, Thompson R, Davis M. Immunomodulatory effects of adipose-derived stem cells in wound healing. Nat Commun. 2023;14:2345.
26. Wilson E, Brown T, Green S. Long-term outcomes of cleft lip and palate repair: A multicenter study. J Plast Reconstr Aesthet Surg. 2022;75:112-120.
27. Kim J, Lee H, Park S. Oxidative stress markers in cleft lip and palate patients. Antioxidants. 2023;12(3):567.
28. Roberts D, Clark A, Evans P. Advanced techniques in cleft lip repair: A systematic review. Plast Reconstr Surg Glob Open. 2021;9(12):e4021.
29. Taylor M, Martin G, White R. Microbial colonization patterns in cleft lip and palate infants. Microbiome. 2022;10:189.
30. Harris L, Scott J, Phillips K. Clinical outcomes of modified Millard technique in cleft lip repair. J Craniofac Surg. 2023;34(2):456-462.
31. Nelson C, Carter B, Morgan D. Personalized approaches to scar management in cleft surgery. Plast Reconstr Surg. 2024;153(1):123-1
