PSRC 69th Annual Meeting 2024

Recombinant Human Bone Morphogenetic Protein-2 (rhBMP-2) as an Alternative to Autologous Bone Graft in Pediatric Craniofacial Reconstruction: A Systematic Review

Daniel Lee¹, Laiba Murad¹, Jesse Chou, MD², and Martin Hoard, MD, DDS²

1: University of Virginia School of Medicine, Charlottesville, VA

2: Department of Plastic and Maxillofacial Surgery, University of Virginia, Charlottesville, VA

BACKGROUND & AIMS: Pediatric craniofacial reconstruction is often accomplished through autologous bone grafts from sites such as the iliac crest. The off-label use of recombinant human bone morphogenic protein (rhBMP-2) infused allografts as an alternative may spare patients from increased OR time and donor-site morbidity. This review assesses whether rhBMP-2 can serve as an appropriate alternative.

METHODS: Literature search was conducted via Pubmed/Medline, Ovid, and Web of Science for publications between January 2008 and May 2023. Included were RCTs, prospective or retrospective case series, and case reports on pediatric craniofacial reconstruction with rhBMP-2 grafting. Reviews, animal studies, and basic science studies were excluded.

Overall, 211 articles were screened, 21 of which met inclusion criteria. rhBMP-2 grafting was utilized for alveolar cleft repair in 18 studies, calvarial defect repair in 2 studies, and mandibular continuity defect repair in 1 study. In alveolar cleft repair studies, iliac crest bone graft (ICBG) patients were included as controls. rhBMP-2 and ICBG were compared based on osteogenesis, complications, OR time, hospitalization time, and cost.

RESULTS:

•Figure 1: Among 12 studies comparing osteogenesis, 4 favored rhBMP-2, 1 favored ICBG, and 7 showed no difference.

•Figure 2: Among 11 studies evaluating complication rates, 2 observed more adverse effects with rhBMP-2, 5 observed more adverse effects with ICBG, and 4 showed no difference.

•Figures 3 & 4: The most common complications with rhBMP-2 were prolonged facial edema and dehiscence, and the most common complications with ICBG were donor-site pain, postoperative infection, and dehiscence.

•Figure 5: 5 studies compared OR time, and all 5 revealed significantly shorter OR time in the rhBMP-2 group.

•Figure 6: Among 8 studies that compared hospitalization time, 7 reported significantly shorter length of stay in the rhBMP-2 group, and 1 showed no significant difference.

Figure 7: Among 4 studies that compared cost burden, rhBMP-2 was more costly in 1 study, ICBG had increased cost in 2 studies, and there was no cost difference in 1 study.

CONCLUSIONS: With regards to osteogenic efficacy, complications, hospital resource burden, and costs, rhBMP-2 grafting appears to be a comparable, if not favorable, alternative to ICBG in pediatric alveolar cleft repair. However, long-term follow-up data remains lacking to definitively recommend rhBMP-2 infused allografts. Also, its use in other pediatric craniofacial reconstruction procedures, such as calvarial or mandibular defect repair, warrants further study.

PSRC 69th Annual Meeting 2024

Recombinant Human Bone Morphogenetic Protein-2 (rhBMP-2) As An Alternative To Autologous Bone Graft In Pediatric Craniofacial Reconstruction: A Systematic Review

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