Stem cells 2013 July-6

 

Mesenchymal stem cells – a promising perspective in the orofacial cleft surgery.

Bratisl Med J. 2013;114(2):50-2.

Stanko P, Mracna J, Stebel A, Usakova V, Smrekova M, Vojtassak J.

Department of Stomatology and Maxillofacial Surgery, Comenius University, Bratislava, Slovakia. pstanko@ousa.sk

Abstract

Autologous bone grafts provide the golden standard for closure of oronasal fistulas in the cleft palate. Augmentation may be performed also by homografts and various xenogenic or alloplastic materials to prevent morbidity at the donor site but they may cause many problems (transmission of infections, immune response etc.). All the mentioned approaches also often reveal recurrences of the fistulas and prolong suffering of the cleft patients. Combination of mesenchymal stem cells (MSCs) and so called “platelet gel” seems to be a perspective method in this way. The platelet gel contains hydroxyapatite particles mixed with platelet rich plasma coagulated under effect of the calcium ions. The MSCs from the pelvic bone marrow aspirate are cultivated on a scaffold (collagen membrane) for 3-4 weeks before placement into the cleft defect. The method provides promising results in the alveolar clefts. Authors document a successful case of the secondary surgery in 25-year-old man with the unilateral complete cleft (Fig. 5, Ref. 10).

PMID: 23331197

Peter Stanko-2

Press release:

Mesenchymal stem cells help in the secondary alveolar cleft surgery

Research published in the Bratislava Medical Journal supports the idea that adult mesenchymal stem cells can improve the final results in closure of oronasal fistulas in alveolar clefts.

Team from the Faculty of Medicine, Comenius University in Bratislava (Slovakia) uses a concept of closure of the alveolar cleft (Fig. 1) by combination of osteoconductive (hydroxyapatite granules, HA), osteoinductive (platelet rich plasma, PRP) and osteogenic (mesenchymal stem cells, MSCs) components.

Surgery includes closure of the nasal layer after incision (Fig. 2) and filling of the cannal with „platelet gel“ (HA + PRP). Then a collagen membrane is applied which serves as a scaffold for the MSCs in number of 6 – 20 millions depending on their growth acticity (Fig. 3) and closure of the oral mucoperiost follows (Fig. 4). To achieve amount of the MSCs as high as possible additional application of MSCs in suspension (content 3 – 12 millions of MSCs in 1.5 ml of suspension) is performed – immediatelly after the operation and then on the 7th and the 14th day postOP. The injection is administred slowly without pressure through the vestibular mucosa (Fig. 5). Inicial bone formation appears on the x-ray or CT after 3 months (Fig. 6).

The researchers evaluate now their results in a group of 14 cleft patients (Ref.). They believe that the method with the MSCs will move the perspective of bone substitute materials from simple space holders to bone of the highest biological quality.

 

Reference:

Stanko P, Mracna J, Stebel A, Vojtassak J.: Letter to the editor BMJ – Contribution to long-term functional results in cleft patients. Bratisl Lek Listy. 2013; 114(3), 177.

 

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