title: Injection and adhesion palatoplasty: a preliminary study in a canine model.
abstract: BACKGROUND
  Raising mucoperiosteal flaps in traditional palatoplasty impairs mid-facial growth. Hyaluronic acid-based hydrogels have been successfully tested for minimally invasive craniofacial bone generation in vivo as carriers of bone morphogenetic protein-2 (BMP-2). We aimed to develop a novel flapless technique for cleft palate repair by injecting a BMP-2 containing hydrogel.
  
  
  METHODS
  Dog pups with congenital cleft palate were either non-treated (n=4) or treated with two-flap palatoplasty (n=6) or with the proposed injection/adhesion technique (n=5). The experimental approach was to inject a hyaluronic acid-based hydrogel containing hydroxyapatite and BMP-2 subperiosteally at the cleft palate margins of pups aged six weeks. At week ten, a thin strip of the medial edge mucosa was removed and the margins were closed directly. Occlusal photographs and computed tomography (CT) scans were obtained up to week 20.
  
  
  RESULTS
  Four weeks after the gel injection the cleft palate margins had reached the midline and engineered bone had enlarged the palatal bones. Removal of the medial edge mucosa and suturing allowed complete closure of the cleft. Compared to traditional palatoplasty, the injection/adhesion technique was easier, and the post-surgical recovery was faster. CT on week 20 revealed some overlapping or "bending" of palatal shelves in the two-flap repair group, which was not observed in the experimental nor control groups.
  
  
  CONCLUSIONS
  A minimally invasive technique for cleft palate repair upon injectable scaffolds in a dog model of congenital cleft palate is feasible. Results suggest better growth of palatal bones. This represents an attractive clinical alternative to traditional palatoplasty for cleft palate patients.
authors.affiliation: Departamento de Anatomía y Embriología Humana I, Facultad de Medicina, Facultad de Odontología, Universidad Complutense de Madrid, Madrid, Spain. cmartinez@med.ucm.es
authors.forename: Concepción
authors.initials: C
authors.lastname: Martínez-Álvarez
authors.forename: Beatriz
authors.initials: B
authors.lastname: González-Meli
authors.forename: Beatriz
authors.initials: B
authors.lastname: Berenguer-Froehner
authors.forename: Irene
authors.initials: I
authors.lastname: Paradas-Lara
authors.forename: Yamila
authors.initials: Y
authors.lastname: López-Gordillo
authors.forename: Cruz
authors.initials: C
authors.lastname: Rodríguez-Bobada
authors.forename: Pablo
authors.initials: P
authors.lastname: González
authors.forename: Manuel
authors.initials: M
authors.lastname: Chamorro
authors.forename: Pablo
authors.initials: P
authors.lastname: Arias
authors.forename: Jöns
authors.initials: J
authors.lastname: Hilborn
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Casado-Gómez
authors.forename: Elena
authors.initials: E
authors.lastname: Martínez-Sanz
mesh_terms: D000818:Animals; D055396:Bone Morphogenetic Protein 2 / Q000008:administration & dosage / Q000627:therapeutic use*; D002972:Cleft Palate / Q000000981:diagnostic imaging / Q000601:surgery*; D004285:Dogs; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D020100:Hydrogels; D007267:Injections; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D023421:Models, Animal; D010159:Palate / Q000000981:diagnostic imaging / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D054457:Tissue Scaffolds; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D055396:Bone Morphogenetic Protein 2; D020100:Hydrogels; D006820:Hyaluronic Acid
keywords: Cleft palate; Dog; Minimally invasive treatment; Surgical research