A Comparative Analysis of rhBMP-2/DBM vs. ICBG for Secondary Alveolar Bone Grafts in Patients with Cleft Lip and Palate: Review of 501 Cases.

BACKGROUND: Alveolar cleft reconstruction using iliac crest bone graft(ICBG) is considered standard of care for children with complete cleft lip and palate at the time of mixed dentition. Harvesting bone may result in donor site morbidity, additional operating time and length of hospitalization. Recombinant human bone morphogenetic protein(rhBMP)-2 with a demineralized bone matrix(DBM) was used as an alternative bone source for alveolar cleft reconstruction. We investigate the outcomes of rhBMP-2/DBM versus ICBG for alveolar cleft reconstruction by reviewing postoperative surgical complications and cleft closure. METHODS: A retrospective chart review was conducted for 258 rhBMP-2/DBM and 243 ICBG procedures on 414 patients over a 12-year period with a mean follow-up of 2.9 years (rhBMP-2/DBM) and 4.1 years(ICBG). We compared the complications, canine eruption and alveolar cleft closure between the two groups. RESULTS: In the rhBMP-2/DBM group, one patient required prolonged intubation due to intraoperative airway swelling not thought to be caused by rhBMP-2, 36 reported facial swelling and one required outpatient steroids as treatment, 12 had dehiscence; however, half of these complications resolved without intervention. 23/228 of the rhBMP-2/DBM and 28/242 of the ICBG groups required repeat surgery for alveolar cleft repair. The findings of canine tooth eruption into the cleft site through the graft were similar between the two groups. CONCLUSIONS: rhBMP-2/DBM appears to be an acceptable alternative for alveolar cleft repair. We found no increase in serious adverse events with the use of this material. Local complications, such as swelling and minor wound dehiscence predominantly improved without intervention. (C)2017American Society of Plastic Surgeons

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