Burden-Reduced Cleft Lip and Palate Care and Healing
Orofacial clefts, or cleft lip and palate, are the most frequent craniofacial malformations in newborns (1:700 births) with no existing effective preventive measures. The project aims to develop a smartphone image-based method for a three-dimensional (3D) shape computation of the cleft. This enables three ground-breaking new treatment regimes: 1) A quantifiable correlation between the cleft shape, the optimal time point for surgery and its outcome; 2) A fully digital fabrication of individualized orthopaedic palatal plates that help to reduce the cleft size before surgery; 3) The closure of the malformation of lip and palate in one single surgical intervention instead of multiple ones.
Collaborative research for the project focuses on an optimal treatment strategy with minimal burden for the patient and healthcare system. Currently there are many treatment strategies used for cleft lip and palate repair. Most commonly, surgical interventions are performed in multiple steps (2 -4 steps), sometimes combined with the use of an individualized palatal orthopaedic plate from birth to surgery. The palatal plate keeps the tongue out of the cleft space and passively narrows the palatal cleft. This facilitates the surgical repair and makes it less extensive. However, currently palatal shape documentation and the plate production necessitates a palatal impression at birth which endangers the child’s airway. Thus, the project aims to develop a digital and risk-free strategy for the palatal shape recognition as well as plate production.
The digital 3D shape of the cleft will be reconstructed with photogrammetry and data-driven algorithms, guiding the computation of individualized palatal orthopaedic plates that can then be fabricated with 3D printing. A neural network will be added to compute the 3D geometry from sparse or single-view inputs. To support the data-driven algorithms, we will construct a large data set of intraoral images and corresponding plaster casts from palatal impressions. The 3D printing of palatal plates and surgical method for one-step surgical repair are already in clinical use in the involved clinics in Basel and Warsaw. Thus, the novel treatment regimen will be ready for clinical use and scalability directly after successful development of the innovation of a touchless cleft shape computation.
Not only will this project reduce the treatment burden and cost, increasing its applicability in low-income settings, it further allows for optimal social reintegration of children with cleft lip and palate.
Banner image above: A surgeon examines an intraoral scan of a patient's cleft palate.
A mother holds her child with double cleft lip and palate in Hyderabad, India. Photo: Gosla Reddy
A plaster cast from a palatal impression of a child with a cleft lip and palate is processed in a 3D scanner. This digital information will be combined with intraoral images to create a large data set which will be used in algorithms to compute a 3D construction of a palate using 2D images from smartphones.
A researcher discusses images of a complete cleft lip and palate, pictured on the right, and a partially fused palate with incomplete cleft, pictured on the left.
A 3D mesh rendering of a child's cleft palate. Image: Daniel Dorda and Lasse Lingens
The project aims to develop a smartphone image-based method for a 3D shape computation of the cleft palate. Visual: Andreas Mueller and Barbara Solenthaler
Surgeons work to close the malformation of lip and palate in a single surgical intervention. A single intervention is usually possible in combination with a pre-surgery therapy using an orthopaedic palatal plate.
- The research is part of the BRCCH Multi-Investigator Programme.
- The consortium is led by investigators Dr Andreas Mueller and Dr Barbara Solenthaler.
- Additional investigators and collaborators include Prof Andrzej Brudnicki, Prof Marcus Gross and Prof Gosla Reddy. Consortium members include Dr Benito Benitez, Daniel Dorda, Julian Erkert, Dr Paulo Gotardo, Laura Kiser, Dr Yoriko Lill, Lasse Lingens, Dr Prasad Nalabothu and Dr Maren Roche.