Fall 2018

Smoother Wound Healing

Seeking a way to prevent scarring after cleft lip surgeries.

By Heather Stephenson

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Illustration: Stuart Bradford

Cleft lip affects about one of every seven hundred babies born in the United States, and the condition is usually surgically repaired before a child’s first birthday. But research suggests scars develop in about half of cases, requiring years of follow-up surgeries. The raised scars, characterized by excess collagen build-up, are more than an aesthetic problem: they can prevent children’s lips from functioning properly, making it difficult even to smile. New research by a professor at Tufts School of Dental Medicine shows promise for preventing the development of such scars and reducing the need for additional repair surgeries.

Evangelos Papathanasiou, DG11, DI16, assistant professor of periodontology, has been awarded a five-year career development grant from the National Institutes of Health to focus on wound healing after cleft lip repair. Studies suggest that inflammation plays a major role in the development of scars, but current treatments that block inflammation—such as steroids—have not been effective in preventing scar formation after cleft lip surgery, Papathanasiou said.

That’s why he’s focusing on a different approach: rather than block inflammation, he wants to help the body clear it up. Using animal models, he is testing the topical application of novel compounds known as resolvins, which have been shown to promote resolution of inflammation in periodontal disease and other inflammatory conditions but have not been previously studied for cleft lip repair.

At the same time, Papathanasiou will analyze wound-site fluids collected from babies undergoing cleft lip repair by Andrew Scott, director of the cleft lip and palate program at Tufts Medical Center. By documenting the lipids and proteins that are naturally present, and following up to see which children develop scars, he hopes to better understand the healing process after cleft lip repair and discover new therapeutic targets to prevent scarring. His larger goal is to eliminate the need for lip revision surgery after the initial cleft lip repair.

“Surgeries can increase stress for patients and families, and have financial and societal costs,” Papathanasiou said. Health expenses for children born with cleft lip (with or without cleft palate) are eight times higher, on average, than for other kids over the first ten years of their lives.

For the children affected by scarring, this research could be life-changing, said Carroll Ann Trotman, professor and chair of orthodontics, who is Papathanasiou’s primary mentor on the project. “The face is the first thing you see when somebody presents themselves. If things don’t look normal, that can be problematic,” Trotman said. “If we can prevent the scar tissue from forming, that will have tremendous impact.”

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