A Model for Fetal Cleft Lip Repair in Lambs

Mt, Longaker; Stern, Michael D.; Lorenz, Peter; Dj, Whitby; Tb, Dodson; Mr, Harrison; Ns, Adzick; Lb, Kaban

doi:10.1097/00006534-199211000-00003

Cited by 51 publications

(29 citation statements)

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“…The fetal lamb model was selected for the reasons outlined by Longaker et al [9]: 1) long gestational period, 2) large fetal size, 3) twin or single pregnancies, 4) the inherent ovine uterine and placental structure, 5) the relative insensitivity of the ovine uterus, and 6) the long gestational period of the fetal lamb. An attempt was made to compare in utero endoscopic correction with an in utero open hysterotomy repair.…”

Section: Discussionmentioning

confidence: 99%

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

Smith¹,

Xiao

Jackson

et al. 1997

Eur J Plast Surg

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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.

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Section: Discussionmentioning

confidence: 99%

“…Intrauterine repair of the cleft lip and alveolus [9] and endoscopic repair of the cleft lip [11] in 75-day-old gestational lambs heal without scar formation. Canady et al [2] demonstrated that an iatrogenic cleft palate in the fetal lamb model repaired at 70 days gestation did not have a visible scar.…”

mentioning

confidence: 99%

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

Smith¹,

Xiao

Jackson

et al. 1997

Eur J Plast Surg

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“…In rats,48 and rhesus rnonkey~'~ wounds have been reported to heal without any scar. Longaker et al 49 claimed that this was also the case in fetal sheep of 75 days gestation. However, in our own recent studies5' a scar was always present in lip wounds inflicted at 75, 100, and 120 days gestation and examined up to 60 days later.…”

Section: Wounds In Other Tissuesmentioning

confidence: 93%

Inflammation and repair in the mammalian fetus: A Reappraisal

Hurley

1994

Microsurgery

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Review of our recent experimental findings and published studies indicates that the mammalian fetus responds to injury in a similar way to adult animals. Persistent inflammatory stimuli evoke an extensive cellular response whose composition varies with the stage of gestation and which is succeeded by formation of typical scar tissue. In fetal sheep excisional skin wounds and wounds in bone, muscle, tendon, and nerve heal by scar. There is disagreement whether, early in gestation, sutured incised skin wounds heal without scar, but this cannot justify a claim of scarless fetal healing. In the immature fetuses of rats and rabbits sutured wounds heal rapidly but open wounds remain unhealed until birth. Injury to deeper tissues has not been examined. The little evidence available suggests that inflammation and repair in the human fetus is similar to that in fetal sheep.

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“…During the last two decades different animal models have been proposed to evaluate in utero treatment of cleft-like defects [19] . In this study, the mid-gestational pregnant sheep model was used for the creation of the CLA-like defects for reasons already described elsewhere [13,14,19,22,35] .…”

Section: Discussionmentioning

confidence: 99%

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

Papadopoulos

Papadopulos

Jannowitz³

et al. 2005

Fetal Diagn Ther

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Objective: To evaluate maxillary growth following in utero repair of surgically created cleft lip and alveolar (CLA)-like defects by means of three-dimensional (3D) computer tomographic (CT) cephalometric analysis in the mid-gestational sheep model. Methods: In 12 sheep fetuses a unilateral CLA-like defect was created in utero (untreated control group: 4 fetuses). Four different bone grafts were used for the alveolar defect closure. After euthanasia, CT scans of the skulls of the fetuses, 3D reconstructions, and a 3D-CT cephalometric analysis were performed. Results: The comparisons between the operated and nonoperated skull sides as well as of the maxillary asymmetry among the experimental groups revealed no statistically significant differences of the 12 variables used. Conclusions: None of the surgical approaches used for the in utero correction of CLA-like defects seem to affect significantly postsurgical maxillary growth; however, when bone graft healing takes place, a tendency for almost normal maxillary growth can be observed.

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A Model for Fetal Cleft Lip Repair in Lambs

Cited by 51 publications

References 0 publications

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

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

Inflammation and repair in the mammalian fetus: A Reappraisal

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

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