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Importance of Stem Cell Transplantation in Cleft Lip and Palate Surgical Treatment Protocol

Mazzetti, Marcelo Paulo Vaccari, MD, MSc*; Alonso, Nivaldo, MD, PhD; Brock, Ryane Schmidt, MD, MSc; Ayoub, Alexandre, MD§; Massumoto, Sally Mizukami, MSc||; Eça, Lilian Piñero, PhD

doi: 10.1097/SCS.0000000000004766
Original Articles

Cleft lip and palate is a congenital malformation that requires a multidisciplinary treatment that evolves pediatrician, obstetrics, fetal medicine, genetics, plastic surgery, orthodontics, speech therapist, nursery, and psychology. Actually, the authors believe that it could be possible to ad protocols to use stem cells.

The intrauterine diagnosis leads to preborn parental orientation and better parental collaboration to accept a precocious multidisciplinary treatment. After birth the authors’ protocol is: orthodontic devices, phonoaudiology, and surgical procedures.

The authors’ cleft lip and palate reconstructive surgery protocol demands several steps and begins at 4 to 6-month old with rhinocheiloplasty and soft palate closure at the same moment. The treatment sequence involves the hard palate surgery (8–18 months after the first surgical step), alveoloplasty (after 10 years old), and secondary rhinoplasty (after 14 years old).

New ideas to use stem cells and blood from the umbilical cord and also blood from placenta are discussed to improve final surgical results. Maternal stem cells are easy to collect, there are no damage to the patient and mother, it is autologous and it could be very useful in the authors’ protocol.

Nine patients with clef lip and palate were operated and had stem cells from umbilical cord blood and placenta blood injected into the bone and soft tissue during the primary procedure (rhinocheiloplasty).

The stem cells activity into soft tissue and bone were evaluated. Preliminary results have shown no adverse results and improvement at the inflammatory response. A treatment protocol with stem cells was developed. It had a long time follow-up of 10 years.

*Brazilian Plastic Surgery Society, Brazilian Cleft Lip and Palate Society, Plastic Surgery Division at Darcy Vargas Children Hospital

Brazilian Plastic Surgery Society, Brazilian Craniofacial Surgery Society, Plastic Surgery at São Paulo University

Brazilian Plastic Surgery Society, Plastic Surgery Division at Darcy Vargas Children Hospital

§Brazilian Cryogenic Center (BCC)

||Umbilical Cord Blood Laboratory of Brazilian Cryogenic Center (BCC)

Facial Defects Studies and Research Center, São Paulo, Brazil.

Address correspondence and reprint requests to Marcelo Paulo Vaccari Mazzetti, MD MSc, 475, Ceci Avenue, São Paulo, SP 04065-000, Brazil; E-mail:

Received 10 January, 2018

Accepted 10 May, 2018

The authors report no conflicts of interest.

© 2018 by Mutaz B. Habal, MD.