Microbial Colonization of the Cleft
Authors:
W. Urbanová 1; M. Koťová 1; E. Leamerová 2; J. Dvořáková 2; M. Tomášková 3
Authors‘ workplace:
Stomatologická klinika 3. LF UK a FNKV, Oddělení ortodoncie a rozštěpových vad, Praha
1; Klinika plastické chirurgie 3. LF UK a FNKV, Praha
2; Studentka 3. LF UK, obor Dentální hygienistka, Praha
3
Published in:
Česká stomatologie / Praktické zubní lékařství, ročník 113, 2013, 4, s. 104-111
Category:
Casual study
Věnováno MUDr. Magdaleně Koťové, Ph.D., k významnému životnímu jubileu
Overview
Introduction:
Surgical reconstruction of soft and hard tissues of the middle face and functional rehabilitation are keystones of the treatment of facial clefts. The surgical treatment is followed by orthodontic, phoniatric and dental treatment, also speech therapy is indicated. The patient is further regularly treated at otorhinolaryngology and at the other departments as needed. After primary surgery of the clefted upper lip and palate closure during the first year of the patient‘s live the cleft defect of the vestibule and alveolar process persists as oronasal fistula. The reconstruction of clefted alveolar ridge is indicated around ninth year of life, orthodontist determines the timing according to the developmental stage of the permanent canine on the cleft side. The rugged surface of the mucosal folds inside the cleft defect creates the optimal environment for bacterial growth. Nevertheless, data on microbial colonization of the persistent cleft gap and its impact on postoperative wound healing in the literature are lacking.
Aim:
The aim of this research is to determine microbial colonization of the persistent cleft gap before surgical reconstruction of the alveolar process.
Material and Methods:
In twenty patients who were scheduled for surgical reconstruction of the clefted alveolar ridge, the swabs from the cleft gap, nose and throat were taken before surgery was performed.
Results:
In twelve patients from the tested group in at least one of the swabs pathogenic microorganisms were found. Six examined patients had positive result only from the cleft fissure. Among the bacteria found in the cleft dehiscence were Staphylococcus aureus, Streptococcus pyogenes, Proteus mirabilis and Pseudomonas aeruginosa.
Conclusion:
It is necessary to consider the clinical impact of latent infection and the occurrence of potential pathogens in the oronasal fisstulae on the healing and on the incidence of postoperative complications. Prospective study including swabs from cleft defect and detailed postoperative monitoring along with control of the quantity of supplemented healing bone is needed.
Key words:
cleft – microbial population – oronasal fistula
Sources
1. Abyholm, F. E., Borchgrevink, H. H., Eskeland, G.: Palatal fistulae following cleft palate surgery. Scand. J. Plast. Reconstr. Surg., roč. 13, 1979, č. 2, s. 295–300.
2. Almasri, M.: Reconstruction of the alveolar cleft: effect of preoperative extraction of deciduous teeth at the sites of clefts on the incidence of postoperative complications. Br. J. Oral. Maxillofac. Surg., roč. 50, 2012, č. 2, s. 154–156.
3. Amland, P. F., Andenaes, K., Samdal, F., Lingaas, E., Sandsmark, M., Abyholm, F., Giercksky, K. E.: A prospective, double-blind, placebo-controlled trial of a single dose of azithromycin on post-operative wound infections in plastic surgery. Plast. Reconstr. Surg., roč. 96, 1995, č. 6, s. 1378–1383.
4. Arief, E. M., Mohamed, Z., Idris, F. M.: Study of viridans streptococci and staphylococcus species in cleft lip and palate patients before and after surgery. Cleft Palate Craniofac. J., roč. 42, 2005, č. 3, s. 277–279.
5. Arosarena, O. A.: Cleft lip and palate. Otolaryngol. Clin. North. Am., roč. 40, 2007, č. 1, s. 27–60.
6. Brennan, P. A., Markus, A. F., Flood, T. R., Downie, I. P., Uppal, R.: Do oral flora colonize the nasal floor of patients with oronasal fistulae? Cleft Palate Craniofac. J., roč. 38, 2001, č. 4, s. 399–400.
7. Brennan, P. A., Willy, P., Anand, R., Markus, A. F.: Colonization of the cleft nasal floor by anaerobic oral flora in patients with oronasal fistulae. Cleft Palate Craniofac. J., roč. 40, 2003, č. 4, s. 431–432.
8. Bureau, S., Penko, M., McFadden, L.: Speech outcome after closure of oronasal fistulas with bone grafts. J. Oral. Maxillofac. Surg., roč. 59, 2001, č. 12, s. 1408–1414.
9. Cocco, J. F., Antonetti, J. W., Burns, J. L., Heggers, J. P., Blackwell, S. J.: Characterization of the nasal, sublingual, and oropharyngeal mucosa microbiota in cleft lip and palate individuals before and after surgical repair. Cleft Palate Craniofac. J., roč. 47, 2010, č. 2, s. 151–155.
10. Dowd, S. E., Delton Hanson, J., Rees, E., Wolcott, R. D., Zischau, A. M., et al: Survey of fungi and yeast in polymicrobial infections in chronic wounds. J. Wound Care, roč. 20, 2011, č. 1, s. 40–47.
11. Dušková, M. Pokroky v sekundární léčbě nemocných s rozštěpem. 1. vyd. Hradec Králové: Olga Čermáková, 2007.
12. Eufinger, H., Machtens, E. Microsurgical tissue transfer for rehabilitation of the patient with cleft lip and palate. Cleft Palate Craniofac. J., roč. 39, 2002, č. 5, s. 560–567.
13. Emory, R. E. Jr., Clay, R. P., Bite, U., Jackson, I. T.: Fistula formation and repair after palatal closure: an institutional perspective. Plast. Reconstr. Surg., roč. 99, 1997, č. 6, s. 1535–1538.
14. Hupkens, P., Lauret, G., Dubelaar, I., Hartman, E., Spauwen, P.: Prevention of wound dehiscence in palatal surgery by preoperative identification of group A Streptococcus and Staphylococcus aureus. Eur. J. Plast. Surg., 2007, č. 29, s. 321–325.
15. Chuo, C. B., Timmons, M. J.: The bacteriology of children before primary cleft lip and palate surgery. Cleft Palate Craniofac. J., roč. 42, 2005, č. 3, s. 272–276.
16. Jolleys, A., Savage, J.: Healing defects in cleft palate surgery – the role of infection. Brit. J. Plast. Surg., 1963, č. 16, s. 134–139.
17. Marsh, P., Martin, M.: Oral microbiology. 33
rd ed. London, Chapman & Hall, 1992.
18. Meazzini, M. C., Bozzetti, A., Brusati, R., Mazzoleni, F., Garattini, G., Felisati, G., Lalatta, F., Rezzinico, A.: Craniofacial anomalies: surgical-orthodontic management. Bologna, Edizioni Martina, 2011.
19. Mercer, N. S.: The use of preoperative swabs in cleft lip and palate repair. Br. J. Plast. Surg., roč. 55, 2002, č. 2, s. 176–177.
20. Mombelli, A., Brägger, U., Lang, N. P.: Microbiota associated with residual clefts and neighboring teeth in patients with cleft lip, alveolus, and palate. Cleft Palate Craniofac. J., roč. 29, 1992, č. 5, s. 463–469.
21. Murphy, T. C., Willmot, D. R.: Image analysis of oronasal fistulas in cleft palate patients acquired with an intraoral camera. Plast. Reconstr. Surg., roč. 115, 2005, č. 1, s. 31–37.
22. Mÿburgh, H. P., Bütow, K. W.: Cleft soft palate reconstruction: prospective study on infection and antibiotics. Int. J. Oral. Maxillofac. Surg., roč. 38, 2009, č. 9, s. 928–932.
23. Narinesingh, S. P., Whitby, D. J., Davenport, P. J.: Moraxella catarrhalis: an unrecognized pathogen of the oral cavity? Cleft Palate Craniofac. J., roč. 48, 2011, č. 4, s. 462–464.
24. Rawashdeh, M. A., Ayesh, J. A., Darwazeh, A. M.: Oral candidal colonization in cleft patients as a function of age, gender, surgery, type of cleft, and oral health. J. Oral Maxillofac. Surg., roč. 69, 2011, č. 4, s. 1207–1213.
25. Rennie, A., Treharne, L. J., Richard, B.: Throat swabs taken on the operating table prior to cleft palate repair and their relevance to outcome: a prospective study. Cleft Palate Craniofac. J., roč. 46, 2009, č. 3, s. 275–279.
26. Schuster, G. S.: Oral microbiology and infectious disease. 3rd ed. Philadelphia, Decker, 1990.
27. Smyth, A. G., Knepil, G. J.: Prophylactic antibiotics and surgery for primary clefts. Br. J. Oral. Maxillofac. Surg., roč. 46, 2008, č. 2, s. 107–109.
28. Švestková, S.: Přínos mokré terapie v léčbě ran. Medical tribune, roč. 8, 2012, č. 4, s. 2.
29. Thomas, G. P., Sibley, J., Goodacre, T. E., Cadier, M. M.: The value of microbiological screening in cleft lip and palate surgery. Cleft Palate Craniofac. J., roč. 49, 2012, č. 6, s. 708–713.
30. Thurzo, A.: Aktivátory v ortodoncii – vývoj, uplatnenie, modifikácie a mechanizmy účinku. Stomatológ, roč. 18, 2008, č. 2, s. 3–12.
31. Tuna, E. B.,Topçuoglu, N., Ilhan, B., Gençay, K., Kulekçi, G.: Staphylococcus aureus transmission through oronasal fistula in children with cleft lip and palate. Cleft Palate Craniofac. J., roč. 45, 2008, č. 5, s. 477–480.
32. Urbanová, W., Vaňková, Z., Koťová, M.: Incidence of the orofacial clefts in the Czech Republic in years 1994–2008. Bratislava Med. J., 2013 (v tisku).
33. Urbanová, W., Koťová, M. Ortodontická léčba pacienta s obličejovým rozštěpem (1. část) Čes. Stomat., roč. 110, 2010, č. 1, s. 9–13.
34. Van der Velden, U., Winkelhoff, A. J., Abbas, F., De Graff, J.: The habitat of periodontopathic microorganisms. J. Clin. Periodontol., roč. 13, 1986, č. 3, s. 243–248.
Labels
Maxillofacial surgery Orthodontics Dental medicineArticle was published in
Czech Dental Journal
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