Bone Generation Within the Hard Palate Utilizing Recombinant Bone Morphogenetic Protein (rhBMP-2): A Novel Approach to Cleft Palate Repair

Objective. This study was conducted to quantify bone generation within the secondary palate following osteoinduction with rhBMP-2 at the time of palatoplasty. Background. Standard palatoplasty consists solely of soft tissue closure. The lack of a normal bony palate often results in collapse of the dental arch. An innovative approach to cleft palate repair is described. Methods. A retrospective review of thirteen patients (n = 13) with cleft lip and/or palate was performed. Patients had rhBMP-2 placed with either demineralized bone matrix (n = 8) or corticocancellous bone chips (n = 5) at the time of palatoplasty. CT scans were obtained postoperatively, and several months following surgery. Image J software was used to trace and calculate the percentage of bone within the secondary palate by two examiners. Six standardized reference lines were examined to determine the presence of transpalatal bone. Results. Follow-up CT scans demonstrated significant bone generation across the hard palate defect (p < 0.001). The mean initial bone present within the secondary palate was 68.6% ± 12.3% and increased to 94.1% ± 7.0% in postoperative scans. Representing a 78.8% increase in transpalatal bone. Patients treated with demineralized bone matrix had more transpalatal bone present (p < 0.001) compared to corticocancellous bone (p < 0.01). CT analysis showed no alteration in tooth development or eruption pattern, the incisive foramen remained patent and no ectopic bone was observed. Conclusion. The use of rhBMP-2 at the time of palatoplasty is a promising adjunctive technique to traditional cleft repair.