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 much greater variability of traumatic injuries, burns or emergency surgical procedures and the scars resulting from these forms of tissue damage. Clinical audit protocols for cleft lip and palate mean that data on outcomes for appearance, function and wellbeing are available at standard points in a child’s development and are followed over time, permitting both cross sectional and longitudinal analysis of scarring. Developing our understanding of the impact of genetics and environmental factors on scar severity following surgical repair of clefts can provide information on the factors that may be associated with scarring from other insults, where less uniform data are available. Animal models offer opportunities to investigate these 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 a cleft and the advantages of different animal models for the study of mechanistic drivers of variation in scar severity.