Three-Dimensional Changes of Maxilla after Secondary Alveolar Cleft Repair

Abstract

Background:Recombinant human bone morphogenetic protein (rhBMP)-2 has been used as an alternative to autologous bone transferring, a standard method of treatment. However, its potential adverse effect on anterior maxillary arch is unknown. Thus, the purpose of this study was to quantify sagittal and transversal changes of anterior maxilla after secondary alveolar cleft repair using traditional iliac crest bone grafting versus rhBMP-2.Methods:Twelve unilateral complete cleft lip and palate patients were randomly divided into 2 groups. In group 1, patients underwent traditional iliac crest bone grafting transferring (n = 4), and in group 2, patients underwent alveolar cleft reconstruction using collagen matrix with lyophilized rhBMP-2 (n = 8). Computed tomography (CT) imaging was performed preoperatively and at 1 year postoperatively, using a previously standardized protocol. A three-dimensional (3D) CT cephalometric analysis of the linear and angular measurements of the sagittal and transverse maxilla planes was performed to assess intra- and intergroup maxillary changes.Results:Intra- and intergroup comparisons of the pre- and postoperative 3D CT cephalometric linear and angular measurements of the sagittal and transverse maxilla planes showed no significant (all P > 0.05) differences among all studied variables.Conclusions:There were no significant anterior maxilla changes after maxillary cleft repair either using iliac crest bone grafting or rhBMP-2.

Safety and Efficacy of Recombinant Human Bone Morphogenetic Protein-2 (rhBMP-2) in Craniofacial Surgery

“…The clinical data on the effect of rhBMP-2 on craniofacial growth are very limited. Studies by Alonso et al 54 and Raposo-Amaral et al 57,59 found no significant difference in nasal symmetry at 6 postoperative months, and no significant changes in upper lip and nostril anatomy or maxillary cephalometric proportions on three-dimensional CT at 1 year. Longer-term follow-up is lacking, and the studies had small sample sizes unequally randomized into rhBMP-2 and ICBG groups, with an even smaller number of patients undergoing imaging.…”