Orofacial cleft repair: A clinical model for studying genetic contribution to scar severity

Scars resulting from surgical repair of cleft lip and palate provide a unique model in humans for studying factors that affect the severity of scarring. Anatomically, clefts of the lip and palate are consistent in location and are treated surgically with similar methods and timing. This contrasts with the considerably greater variability observed in traumatic injuries, burns or emergency surgical procedures and the scars resulting from these cause tissue damage. Clinical audit protocols for cleft lip and palate ensure that data on outcomes for appearance, function and wellbeing are collected at standard points in a child's development and are followed-up over time, permitting cross sectional and longitudinal analysis of scarring. Therefore, enhancing our understanding of the impact of genetics and environmental factors on scar severity following surgical repair of clefts can provide information on factors that may be associated with scarring from other insults, where uniform data are not available. Animal models offer opportunities to investigate factors that could influence scar severity and overall repair quality. In this review, we will discuss the possibilities for scarring research in cohorts of children born with cleft defects and the advantages of using different animal models for studying the mechanistic drivers of variation in scar severity.