AAPS, American Association of Plastic Surgeons
AAPS, American Association of Plastic Surgeons
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2008 Annual Meeting Abstracts

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Primary Alveolar Cleft Repair with Alveolar Molding, Gingivoperiosteoplasty and rhBMP-2
James P. Bradley, M.D., Navanjun Grewal, MD, PhD, Reza Jarrahy, MD.
University of California, Los Angeles, Los Angeles, CA, USA.

Background & Purpose: Previous work from NYU revealed that following nasoalveolar molding and gingivoperiosteoplasty 60% of patients did not require an alveolar bone graft. Using a similar procedure but with BMP-2 on a resorbable matrix, we studied the closure of alveolar clefts in the newborn period. Prior to our clinical work, we studied the bony healing and subsequent growth in an animal model. Our objective was to document our animal growth studies after BMP-2 healed alveolar clefts and to review the early management of patients with cleft alveolar defects.
Methods: Part I: Surgically created alveolar clefts in 40 day old Sprague Dawley rats were treated with 1) BMP-2 on a resorbable matrix, 2) matrix only or 3) gingivoperiosteoplasty only (n=30). For bone healing: histology and microCT scans were analyzed at 6, 12, 24 weeks. For growth: serial cephalograms were performed using a cephalostat. Part II: Newborns with unilateral cleft lip and palates underwent nasoalveolar molding and either 1) GPP only (control) or 2) GPP with BMP-2 (Infuse) (study group) (n=13). Preoperative and follow-up New-Tom scans were performed and perioperative data was considered.
Results: Part I: Rat alveolar cleft defects healed 85% faster and with 25% more final bone fill with BMP-2 than the control groups. No significant differences occurred in cephalometric measured midface growth with the BMP-2 group compared with the control groups. Part II: Perioperative data, including complications, were similar in both GPP only and BMP-2 groups. Bone healing was superior in the BMP-2 group at 6 months (84% fill (BMP-2) compared to 22% fill (GPP only); Complete bone healing: BMP-2=60% patients and GPP only 0% patients. Facial growth data is presently being recorded.
Conclusions: 1) Midface animal growth was not detrimentally affected after BMP-2 healing of alveolar clefts occured; 2) treatment of unilateral alveolar clefts with nasoalveolar molding, gingivoperiosteoplasty augmented with BMP-2 showed improved bony healing but longer-term growth outcomes and larger sample sizes are needed before this is an accepted technique. This study documents our group’s current approach to treatment of primary alveolar clefts with the use of gingivoperiosteoplasty, BMP-2 and a collagen scaffold as an alternative technique to traditional care.


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