Hippokratia 2003; 7(2):59-80
N.A Papadopulos, M. A Papadopoulos
Dpt of Plastic and Reconstructive Surgery, Klinikum rechts der iIsar, Technical University, Munich, Germany
Dpt of Orthodontics, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
It has already been shown that some congenital anomalies are amenable to intrauterine surgical correction, which may be life-saving. However, postoperative premature labour and its extreme invasiveness are considered as major drawbacks for "open" intrauterine surgery, mainly due to the performed hysterotomy. More recently the merger of fetoscopy and advanced video-endoscopic surgery leave to expect a possible application of the feto-endoscopic surgical approaches in the future also by non life-threatening conditions, such as the cranio-facial malformations (i.e. cleft lip and palate).
The intrauterine intervention presents the following advantages: (a) scarless wound healing in mid-gestation, (b) interruption of the malformation's cascade of detrimental secondary effects (no occurrence of secondary maxillary growth restrictions), (c) reduction or minimal need of secondary corrections or additional post-natal treatments, and (d) minor morbidity, at least when the endoscopic approach is applied. These advantages would lessen the psychological and financial burden of multiple surgeries and therapies for the young patient with a cleft lip and palate, the patient's family, and the society in general.
Nevertheless, further research is needed to make intrauterine procedures safer, and to achieve such results that would minimize or even eliminate the need of additional post-natal treatments. This way it could be possible to provide a better quality of life to these patients and their families.
Keywords: intrauterine surgery, quality of life, cleft lip, cleft palate