"Use of Autologous Umbilical Cord Stem Cell Transplantation in the Reconstruction of Alveolar Cleft "

A lot has progressed in the care of Cleft lip and palate with development of multidisciplinary team approach. Despite these achievements there are still a lot of challenges in the treatment of alveolar cleft. Alveolar cleft being the less conspicuous component of the cleft abnormality attracted less interest in its correction; its treatment history dates in the not-so-distant past were as cleft lip history repair dates as far as 390 Before Christ and palate repair in 1764. The first attempt to treat alveolar cleft with bone graft was in 1901 then again in 1908 but it was not until 1914 that Dracher was the first to perform a successful bone graft of the alveolar defect using tibial bone that gave birth to the primary alveolar bone graft. This approach was later found to be destructive to the developing face and was abandoned. Then in 1972 Secondary bone grafting of maxilla and residual alveolar clefts at the stage of transitional dentition this become popular in some centers.

In 1967 Swedish Plastic Surgeon Tord Skoog introduced yet a new concept called boneless alveolar graft or primary periosteoplasty (PPP) which he performed during the time of lip repair at 3 months in this repair periosteal flaps were raised clearing soft tissue between the alveolar defect and the flaps were closed to form a tunnel at the time of lip repair. This was because it was believed that with time bone would form in the tunnel and so bone graft will not be needed. Follow up in many studies indicated bone developed in the tunnel in about 60 to 72% of the cases. His follow up study up to the age of 18years indicated that despite a delay in facial growth at early age by 18 years all are at the same level.

This study is set out to address the challenge of bone regeneration in alveolar cleft and improve on the surgical outcome by the use of stem cell therapy in African population. All the documented studies are conducted only in non-African populations which have slightly different phenotype and use to pre-surgical orthodontic treatment.

Stem-cells are un-differentiated progenitor cells capable of self-renewal and differentiation into any specialized cells. Umbilical cord stem cells in gingivoperiosteoplasty has shown good bone regeneration in alveolar cleft and minimizing the donor mobility. But there is a need for us to establish its possibility and effectiveness in out setting. This will be the first stem cell trial in cleft treatment protocol in our region . With the establishment of a stem cell center at Makerere and recently funded to improve its capacity, we believe we can contribute to the improvement of cleft care in Uganda.

Problem statement The current accepted gold standard protocol for alveolar defect is controversial on timing, outcome, and associated morbidity. Therefore, the second common protocol of Gingivoperiosteoplasty (GPP) carried out during primary lip repair at 3 to 6 months would provide a better alternative by providing early repair with a smaller number of surgeries and also obviate the need for secondary bone graft with further use of stem cell transplant. The use of umbilical stem cell transplantation in gingivoperiosteoplasty procedure has only been done in 10 cases and the results indicate good bone regeneration in the alveolar bone defect. Despite the demonstration of success in the previous stem cell therapy there is need to do a clinical trial in African population to prove the role and use of stem cells in alveolar bone regeneration in our setting.