Use of autologous platelet-rich plasma in complete cleft palate repair

Platelet Rich Products in Cleft Palate Repair

ObjectiveCleft palate (CP) is a common congenital malformation with numerous popular and effective techniques described for operative repair. Despite this, the fistula rate following primary as well as secondary palate repairs remains high with reports ranging between 15% and 55% fistula rate. We conducted a systematic meta-analysis review to evaluate the effect of platelet rich products (PRPs) on rate of fistula formation given its well documented association with accelerated wound healing.DesignMeta-analysis systematic review.SettingArticles identified through MEDLINE, Embase, Pubmed, Google Scholar, Web of Science, Scopus, Cochrane, References, related articles.Patients, ParticipantsPatients in randomized controlled trials undergoing primary or secondary CP repair.InterventionsPRP vs no PRP.Main Outcome MeasureRate of fistula formation.ResultsFive articles with a total of 164 patients were identified and included in our final meta-analysis. There were 82 patients in each experimental and control groups. A total 22 patients experienced a fistula. Fistula rates in PRP and non-PRP groups were 4.9% (n = 4) and 22.0% (n = 18). The difference of fistula rates between PRP and non-PRP groups was statistically significant (pooled risk ratio: 0.32 (0.12-0.82, p = .02) on our overall pooled meta-analysis.ConclusionIn our meta-analysis review, PRP was found to significantly reduce fistula rates after primary or secondary palatoplasty in CP repair. PRP may represent an effective intra-operative adjunct to conventional surgical management and repair of CP to reduce the risk of fistula formation. Further investigation is required to explore the impact of the use of PRP on other post-operative parameters for CP.

The Use of Platelet Concentrates in the Reconstruction of the Alveolar Cleft Defect: A Systematic Review and Meta-Analysis

ObjectiveEvaluate quantitative and qualitative outputs when comparing the incidence of platelet concentrates (PCs) combined with autogenous bone grafts to an autograft control group for the reconstruction of alveolar cleft defects.DesignSystematic review and meta-analysis.Patients/ParticipantsRandomized and nonrandomized controlled clinical trials where PCs were used in the reconstruction of alveolar cleft defects.InterventionsUse of PCs in combination with autogenous bone graft in the experimental group and autogenous bone graft alone in the control group.Main Outcome Measure(s)Average bone formation and bone density were evaluated, mean differences were calculated and pooled by a meta-analysis technique. Additionally, clinical outcomes such as wound dehiscence, closure of the oronasal fistula, pain, swelling, discharges, infections, and bleeding were considered in the qualitative synthesis.ResultsAfter an evaluation of forty-nine articles, nineteen were considered for the review. The qualitative assessment of bone density, bone formation, and clinical outcomes showed no differences between groups in most of the included studies. The meta-analysis showed no statistical differences between PCs groups when compared to the control group in bone density at three months (mean difference 45.67 HU, P = .23) and six months (mean difference 48.57 HU, P = .64). Neither were statistical differences in the percentage of regenerated bone volume at six months (mean difference 6.39%, P = .15) and the volume of newly formed bone at 12 months (mean difference 0.37 mm3, P = .99).ConclusionsThere were no significant differences in terms of bone formation, bone density, and clinical outputs between groups.

Evaluation of the use of an advanced platelet-rich fibrin (A-PRF+) membrane in children undergoing primary palatoplasty-- a prospective randomized clinical pilot-study

The aim of this study was to evaluate whether an A-PRF + membrane can lower the fistula rate in patients undergoing primary palatoplasty. A total of 20 children were included: 10 were randomized and included in the platelet-rich fibrin (PRF) group, and 10 were assigned to the control group. Before two-flap palatoplasty was performed, the cleft's width was measured. The patients in the PRF group underwent an intraoperative collection of 5 ml venous blood, which was centrifugated and pressed onto an A-PRF + membrane. Subsequently, the membrane was placed between the oral and nasal mucosal layers. The control group underwent the same procedure without the addition of A-PRF+. The need for transfusions or postoperative intensive care was registered. All children were followed up at 10 days, 1, 2, 3, and 6 months, and after more than 6 months and the occurrence of fistulae and need for a second palatal operation was then evaluated. After more than six months postoperatively, only two fistulae (10%) remained and had to undergo secondary palatoplasty (p = 1.00). Moreover, the blood transfusion rate did not differ significantly (p = 1.00). A-PRF + might be beneficial in cleft closure, but further randomized studies with larger patient cohort are needed.

Does the adjunctive use of autologous platelet concentrate during secondary alveolar bone grafting reduce the risk of wound dehiscence? A systematic review and meta-analysis

Wound dehiscence is a common complication after secondary alveolar bone grafting (SABG), leading to unfavourable surgical outcomes. Studies have shown that autologous platelet concentrates (APC) may enhance wound healing and improve outcomes. Therefore, this review aimed to evaluate in patients with alveolar clefts, whether using APC and iliac crest bone graft can mitigate the likelihood of wound dehiscence formation compared with those who underwent iliac bone grafting only following SABG. A comprehensive literature search was conducted using various electronic databases, including PubMed, Embase, Scopus, Web of Science, EBSCOhost, Ovid MEDLINE, LILACS, Cochrane Library, and grey literature, to include studies until July 31, 2023, without any restriction to language and time of publication. Only randomized (RCT) and controlled (CCT) clinical trials were included. Two independent reviewers screened the studies based on the predefined criteria, after which a qualitative and quantitative analysis was conducted. The search yielded 821 studies, of which seven were deemed eligible for systematic review. The risk of bias assessment done using "The Cochrane collaboration tool for risk of bias assessment" for six RCTs and the "Risk of Bias in Non-randomized Studies - of Interventions" for one CCT revealed a moderate to high risk of bias. The meta-analysis of five studies showed that the overall risk of developing wound dehiscence was lower in the APC group (RR = 0.33; 95% CI: 0.16, 0.71; p = 0.005; χ2 = 0.82; I2 = 0%). Subgroup analyses based on study design further supported these findings. Although the adjuvant use of APC for alveolar cleft reconstruction reduces the risk of wound dehiscence, more studies with increased scientific rigour and fewer confounding variables are warranted.

Effect of adjuvant autologous platelet concentrates on secondary repair of alveolar clefts: A systematic review and meta-analysis

OBJECTIVE

To review the existing evidence on the adjuvant use of autologous platelet concentrates (APCs) with iliac crest bone graft (ICBG) in the reconstruction of the secondary alveolar cleft.

METHODS

Electronic databases were searched systematically until November 2022. Clinical trials comparing the three-dimensional radiological outcomes of patients who underwent secondary alveolar bone grafting (SABG) with ICBG and APCs to those with ICBG alone and the radiological outcomes assessed 6 months after surgery were included. Two authors performed the study selection and the assessment of the risk of bias. Meta-analysis was performed using the random-effects model to determine the risk ratio (RR) for developing wound dehiscence and the mean difference (MD) with a 95% confidence interval (CI) for the percentage of newly formed bone.

RESULTS

Nine studies (seven RCT and two CCT) were included with a low to high risk of bias. At the 6-month follow-up, the study group revealed insignificant results regarding the percentage of newly formed bone (MD = 6.49; 95% CI: -0.97, 13.94; p = .09; χ2  = 0.01; I2  = 71%). In addition, the overall risk of developing wound dehiscence was lower in the study group (RR = 0.34; 95% CI: 0.15, 0.78; p = .01; χ2  = 0.67; I2  = 0%).

CONCLUSION

Currently, there is insufficient evidence to support the adjuvant use of APCs with ICBG on enhanced bone regeneration following secondary alveolar bone grafting. However, combining ICBG and APCs might be beneficial in reducing the risk of developing wound dehiscence.

The Effect of Platelet-Rich Plasma on Bone Volume in Secondary Alveolar Bone Grafting in Alveolar Cleft Patients: A Systematic Review

This systematic review aims to investigate the impact of platelet-rich plasma (PRP) in conjunction with bone grafting on bone volume outcomes in secondary alveolar bone grafting (SABG) procedures among alveolar cleft patients. An exhaustive search involving PubMed, Cochrane, and Google Scholar databases yielded 20 relevant titles, ultimately leading to the inclusion of four articles meeting all specified criteria. Based on the Cochrane risk of bias in systematic reviews (ROBIS) tool, the studies showed a high risk of bias. The primary outcome, bone volume assessment, was analyzed across these articles. While the Cochrane ROBIS tool deemed the included articles to have a high risk of bias, the comparison between PRP and Non-PRP groups did not reveal a significant difference in bone volume. Radiographic data illustrated an initial three-month period of bone resorption post-graft, regardless of PRP application, followed by a six-month phase of heightened bone density, particularly discernible in the PRP groups. To sum up, our findings indicate an absence of substantial bone density increase in cleft patients undergoing SABG with PRP augmentation. Nonetheless, there was a modest trend that suggests potential incremental bone density improvement with PRP usage, underscoring the need to conduct rigorously designed, randomized controlled trials (RCTs) with low bias to validate these observations.

Effect of Platelet-rich Plasma on the Clinical Success of Alveolar Grafts in Patients With Cleft Lip and Palate: A Systematic Review and Meta-Analysis

OBJECTIVES

This study assessed the effect of platelet-rich plasma (PRP) on the clinical success of alveolar grafts in patients with cleft lip and palate.

MATERIALS AND METHODS

In this meta-analysis, a search of the literature was conducted in Medline, Scopus, ISI Web of Science, and Cochrane Central Register of Controlled Trials for randomized clinical trials using PRP or platelet-rich fibrin (PRF) along with autogenous bone for alveolar ridge grafts in patients with cleft lip and palate. The methodological quality of the studies was analyzed using Cochrane's risk of the bias assessment tool. The extracted data underwent meta-analysis using the random-effects model.

RESULTS

Of a total of 2256 articles retrieved, 12 met the eligibility criteria and were enrolled; out of which 6 did not undergo meta-analysis due to heterogeneous data. The percentage of defects filled by bone graft was 0.648% (95% confidence interval: -0.15 to 1.45), which was not statistically significant ( P =0.115). Subgroup analysis showed no significant difference based on the use of PRF or PRP ( P =0.28), type of cleft (unilateral/bilateral; P =0.56), or type of radiographic modality (3D/2D; P =0.190). Meta-regression analysis showed that the duration of follow-up and the difference in the mean age of patients did not have a significant effect on the results (R=0, I2: high).

CONCLUSION

The application of PRP/PRF in combination with autogenous bone graft did not have a significant effect on the percentage of alveolar cleft filled by a bone graft. Future clinical studies are required to further elucidate the effect of PRP in the regeneration of alveolar clefts.

Reinforcing the Modified Double-Opposing Z-Plasty Approach Using the Pedicled Buccal Fat Flap as an Interpositional Layer for Cleft Palate Repair

Pedicled buccal fat flaps have been adopted in primary Furlow double-opposing Z-plasty palatoplasty to reduce oronasal fistula formation or to attenuate maxillary growth disturbance. We combined both goals in a single intervention. This study describes a series of 33 modified Furlow small double-opposing Z-plasty palatoplasties reinforced with a middle layer of pedicled buccal fat flaps between the oral and nasal layers for full coverage of the dissected palatal surfaces, with rapid mucosalization of lateral relaxing incisions and no dehiscence or fistula formation.

Split Buccal Fat Flap in Modified Furlow Palatoplasty: Surgical Technique and Early Result

SUMMARY

Encouraging results have been described for the use of pedicled buccal fat pad flap in primary cleft palate repair. This retrospective study describes the surgical technique and early results of a technical innovation utilizing the split buccal fat flaps in modified Furlow palatoplasty with small double-opposing Z-plasty. This technique introduces buccal fat tissue for coverage of lateral denuded palate surfaces to reduce the bone exposure and scar formation to potentially attenuate maxillary growth interference and for reinforcement of the palatal areas of high tension or with incomplete closure to decrease the risk of postoperative dehiscence and oronasal fistula formation. Consecutive nonsyndromic patients (n = 56) with cleft palate were treated with this method, all of whom demonstrated fast mucosalization of lateral palatal recipient regions within 3 weeks postoperatively and showed no fistula with 12 months' follow-up. Of 19 patients (33.9 percent) who underwent auditory-perceptual assessment, 15 (78.9 percent) had normal resonance. Surgeons could add this alternative surgical maneuver to their armamentarium during the primary palatoplasty, in which coverage of lateral surfaces and reinforcement with fat tissue in the anterior soft palate space are of paramount relevance.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

Assessment of the New L Pharyngeal Flap for Velopharyngeal Insufficiency

OBJECTIVE

To assess the results of the new L pharyngeal flap for treatment of velopharyngeal insufficiency (VPI).

METHODS

This study included 60 patients who were diagnosed as persistent VPI (for > 1 year without response to speech therapy for 6 months at least). L-shaped superiorly based pharyngeal flap was tailored from oropharynx and inserted into the soft palate through a transverse full-thickness palatal incision 1 cm from the hard palate, then the distal horizontal part of the flap was spread 1 cm anteroposterior direction and 1 cm horizontally into the soft palate. Prior to and after surgery, patients were assessed by oral examination, video nasoendoscopy, and speech evaluation.

RESULTS

Postoperative speech assessment showed significant improvement in nasoendoscopic closure, speech assessment, and nasometric assessments. Grade 4 velopharyngeal valve closure (complete closure) could be achieved in 59 (98.3%) patients at 6 months postoperatively. No patients showed dehiscence (partial or total) of the flap and no obstructive sleep apnea was reported.

CONCLUSION

The newly designed L pharyngeal flap was proved to be highly effective, reliable, and safe in treating patients with persistent VPI with easy applicability and without significant complication.

NiCo2O4 Nano-/Microstructures as High-Performance Biosensors: A Review

Non-enzymatic biosensors based on mixed transition metal oxides are deemed as the most promising devices due to their high sensitivity, selectivity, wide concentration range, low detection limits, and excellent recyclability. Spinel NiCo2O4 mixed oxides have drawn considerable attention recently due to their outstanding advantages including large specific surface area, high permeability, short electron, and ion diffusion pathways. Because of the rapid development of non-enzyme biosensors, the current state of methods for synthesis of pure and composite/hybrid NiCo2O4 materials and their subsequent electrochemical biosensing applications are systematically and comprehensively reviewed herein. Comparative analysis reveals better electrochemical sensing of bioanalytes by one-dimensional and two-dimensional NiCo2O4 nano-/microstructures than other morphologies. Better biosensing efficiency of NiCo2O4 as compared to corresponding individual metal oxides, viz. NiO and Co3O4, is attributed to the close intrinsic-state redox couples of Ni3+/Ni2+ (0.58 V/0.49 V) and Co3+/Co2+ (0.53 V/0.51 V). Biosensing performance of NiCo2O4 is also significantly improved by making the composites of NiCo2O4 with conducting carbonaceous materials like graphene, reduced graphene oxide, carbon nanotubes (single and multi-walled), carbon nanofibers; conducting polymers like polypyrrole (PPy), polyaniline (PANI); metal oxides NiO, Co3O4, SnO2, MnO2; and metals like Au, Pd, etc. Various factors affecting the morphologies and biosensing parameters of the nano-/micro-structured NiCo2O4 are also highlighted. Finally, some drawbacks and future perspectives related to this promising field are outlined.

The clinical evaluation of platelet-rich plasma on free gingival graft's donor site wound healing

Objective

It has been proved that platelet-rich plasma (PRP) can promote wound healing. In this way, PRP can be advantageous in periodontal plastic surgeries, free gingival graft (FGG) being one such surgery.

Materials and Methods

In this randomized split-mouth controlled trial, 10 patients who needed bilateral FGG were selected, and two donor sites were randomly assigned to experience either natural healing or healing-assisted with PRP. The outcome was assessed based on the comparison of the extent of wound closure, Manchester scale, Landry healing scale, visual analog scale, and tissue thickness between the study groups at different time intervals.

Statistical Analysis Used

Repeated measurements of analysis of variance and paired t-test were used. Statistical significance was P ≤ 0.05.

Results

Significant differences between the study groups and also across different time intervals were seen in all parameters except for the changes in tissue thickness.

Conclusion

PRP accelerates the healing process of wounds and reduces the healing time.

Regenerative Effect of Platelet Concentrates in Oral and Craniofacial Regeneration

Platelet concentrates (PCs) are biological autologous products derived from the patient's whole blood and consist mainly of supraphysiologic concentration of platelets and growth factors (GFs). These GFs have anti-inflammatory and healing enhancing properties. Overall, PCs seem to enhance bone and soft tissue healing in alveolar ridge augmentation, periodontal surgery, socket preservation, implant surgery, endodontic regeneration, sinus augmentation, bisphosphonate related osteonecrosis of the jaw (BRONJ), osteoradionecrosis, closure of oroantral communication (OAC), and oral ulcers. On the other hand, no effect was reported for gingival recession and guided tissue regeneration (GTR) procedures. Also, PCs could reduce pain and inflammatory complications in temporomandibular disorders (TMDs), oral ulcers, and extraction sockets. However, these effects have been clinically inconsistent across the literature. Differences in study designs and types of PCs used with variable concentration of platelets, GFs, and leucocytes, as well as different application forms and techniques could explain these contradictory results. This study aims to review the clinical applications of PCs in oral and craniofacial tissue regeneration and the role of their molecular components in tissue healing.

On the Frequency of Oronasal Fistulation After Primary Cleft Palate Repair

Objective:

The aims of the study were to assess the postoperative oronasal fistula rate after 1-stage and 2-stage cleft palate repair and identify risk factors associated with its development.

Design:

Systematic review.

Setting:

Various primary cleft and craniofacial centers in the world.

Patients, Participants:

Syndromic and nonsyndromic cleft lip, alveolus, and palate patients who had undergone primary cleft palate surgery.

Intervention:

Assessment of oronasal fistula frequency and correlation with staging, timing, and technique of repair, gender, and Veau type. The results obtained in this systematic review were compared with those in previous reports.

Outcome:

The main outcome is represented by the occurrence of the oronasal fistula after 1-stage versus 2-stage palatoplasty.

Results:

The mean fistula percentage was 9.94%. In the Veau I, II, III, and IV groups, the respective fistula rates were 2%, 7.3%, 8.3%, and 12.5%. Oronasal fistula locations based on the Pittsburgh Fistula Classification System were soft palate (type II), 16.2%; soft palate–hard palate junction (type III), 29.3%; and hard palate (type IV), 37.3%. There were no statistically significant differences between 1-stage and 2-stage palatoplasty, syndromic and nonsyndromic, or male and female patients. Primary palatoplasty timing was not a significant predictor.

Conclusion:

Some disparities arose when comparing studies, mainly regarding location and types of clefting prone to oronasal fistulation. Interestingly, the fistula rate does not differ between 1- and 2-stage closure, and timing of the repair does not play a role.

Cephalic de-mucosalized superiorly-based pharyngeal flap: A modified mucosa-preserving technique for velopharyngeal insufficiency

INTRODUCTION

Superiorly-based pharyngeal flap (PF) is the most frequently employed surgical technique to correct velopharyngeal insufficiency (VPI). Bared posterior pharyngeal wall might prolong the period of convalescence with throat pain and discomfort. Delayed donor site healing problems and subsequent fibrosis with downward migration of the transposed flap might be one a cause of failure and might necessitate revision.

AIM OF THE WORK

To present a modified technique of PF aiming at dealing with the problems of donor site defects via immediate self-mucosal covering of the cephalic portion of the bed.

METHODS

This case series study was conducted on patients with persistent VPI. All patients underwent the new modified technique of cephalic de-mucosalized pharyngeal flap (CDPF). The basic premise was to harvest a laterally-based mucosal flap from the upper part of the posterior pharyngeal wall. A superiorly-based pharyngeal flap (with a bared cephalic segment and a mucosalized caudal segment) was elevated off the posterior pharyngeal wall and inserted in the soft palate. Then the laterally-based mucosal flap was spread over the superior part of donor site of the posterior pharyngeal wall.

RESULTS

13 VPI patients were included in this study. Their age ranged from 5 to 12 years with a mean of 5.6 ± 1.2. The follow-up period ranged from 8 to 14 months. All flaps and beds were completely healed within 2-3 weeks and no patients showed flap dehiscence, infection or palatal fistula. Postoperative speech assessment showed significant improvement of velopharyngeal function, resonance balance, and reduction in nasal emission.

CONCLUSIONS

The modified technique provides an immediate self-mucosa cover to the superior part of the posterior pharyngeal wall, thus it could promote primary healing at the donor site with a short period of convalescence. CDPF separates the two opposing raw surfaces of the flap and the posterior pharyngeal wall. The mucosal flap might guard against downward migration of the flap.

Topical platelet rich plasma versus hyaluronic acid during fat graft myringoplasty

OBJECTIVES

To evaluate the effect of adding platelet rich plasma (PRP) or Hyaluronic acid (HA) to fat graft myringoplasty (FGM) for medium sized central tympanic membrane (TM) perforations.

METHODS

This is a retrospective study conducted on 69 patients with medium sized central TM perforations. In 21 patients, PRP was used with the FGM; and in 23 patients, HA was used with the FGM; while in 25 patients, pure FGM was performed without adding an enhancing material.

RESULTS

Successful TM perforation repair was achieved in 18 ears (85.7) with using PRP with FGM and in 20 ears (87%) with using HA with FGM and in 15 ears (60%) with pure FGM.

CONCLUSION

FGM with adding PRP or HA is more successful in closure of TM perforation than pure FGM in case of medium sized central TM perforation.

Single-Stage Repair of Palatal Fistula and Velopharyngeal Incompetence by the New L Flap

OBJECTIVE

To describe and assess the results of use of the new L-shaped posterior pharyngeal flap for repair of both palatal fistula and velopharyngeal incompetence.

METHODS

This study included 10 patients who were diagnosed to have soft palate fistula and persistent velopharyngeal insufficiency (VPI). L-shaped superiorly based pharyngeal flap was harvested from oropharynx and inserted into the soft palate closing the fistula after fistula trimming. The palatal part of the flap (transverse limb) was spread 1 cm horizontally and 1 cm in the anteroposterior direction in soft palate at fistula site closing it without tension. Prior to and after surgery, patients were assessed by examination, video-nasoendoscopy, and speech assessment.

RESULTS

Closure of the palatal fistula could be achieved in all patients. Postoperative speech assessment showed significant improvement in the nasal emission, resonance, intraoral pressure, and articulation defects. Grade 4 velopharyngeal valve closure (complete closure) could be achieved in all patients. No patients showed dehiscence (partial or total) of the flap and no obstructive sleep apnea reported.

CONCLUSION

The new used L-shaped pharyngeal flap could properly close palatal fistula and correct velopharyngeal functions (closure and speech) in patients with persistent VPI with no reported significant complication and without the need for palatal dissection or flaps.

Treatment of thin endometrium with autologous platelet-rich plasma: a pilot study

Endometrium is one of the main factors in pregnancy. During assisted reproductive technology (ART) treatments, some cycles are cancelled due to inadequate endometrial growth. This study was conducted to evaluate the effectiveness of platelet-rich plasma (PRP) in the treatment of thin endometrium. Ten patients with history of inadequate endometrial growth in frozen-thawed embryo transfer (FET) cycles were recruited into the study. Intrauterine infusion of PRP was performed. Endometrial thickness was assessed. Chemical and clinical pregnancies were reported. In all patients, endometrial thickness increased after PRP and embryo transfer was done in all of them. Five patients were pregnant. According to this study, it seems that PRP was effective for endometrial growth in patient with thin endometrium.