Bone morphogenetic protein (rhBMP-2) and iliac crest bone grafting in cleft lip and palate patients: a cost analysis evaluation

Abstract

The reconstruction of the developing craniofacial skeleton, between 2 and 10 years of age, poses a significant challenge for plastic surgeons. Local autogenous bone is largely unavailable, distant bone grafts are fraught with significant morbidity, and alloplastic materials are incompatible with the growing facial skeleton. However, with the development of tissue engineering, the osteogenesis by bone morphogenetic protein (rhBMP-2) has become a potential solution to the bone shortage of the pediatric patient. Through chemical signaling including chemotaxis, migration, proliferation and differentiation of mesenchymal stem cells, rhBMP-2 has induced new bone formation with significant reduction of morbidity. In this prospective and randomly study, the use of rhBMP-2 will be compared with that of the traditional iliac crest bone graft as an alternative for the secondary alveolar cleft repair in unilateral cleft lip and palate patients, estimating and comparing the direct medical cost. Forty patients, aged 8 to 12 years, will be selected and submitted to preoperative orthodontic expansion. For both groups, surgical procedure will be performed in a standardized manner according to Boyne's technique. For outcome analysis, computed tomography of the face and orthodontic documentation including maxillary casts and cephalometry will be performed. Oral wound healing and occurrence of complications will be assessed and recorded. (AU)