Microbial Colonization of the Cleft

Abstract

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.

Keywords

• cleft
• microbial population
• oronasal fistula