Congenital craniofacial abnormalities and pediatric maxillofacial trauma present special management challenges for the reconstructive surgeon. The presenting structures of a child are naturally quite small. Many of the conditions require multiple staged surgeries throughout the lifetime of the patient to compensate for continued growth. If reconstruction of the pediatric patient is carried out, this will only provide a temporary solution, as children outgrow their correction through maturation and normal development. One alternative to carrying out multiple surgeries is to wait for skeletal maturity. However, the negative psychologic and social impact of the deformity must be taken into consideration when delaying surgery. In current practice, a reconstructive surgeon replaces missing bone with harvested autogenous bone to help provide for structural support and strength. The problem with harvesting bone in a child is the limited amount of available bone, the creation of a second surgical site in the patient, the additional time for rehabilitation, and the increase in morbidity. Further, when future surgeries are necessary the available bone volume is compromised by the prior harvesting. Some patients simply run out of viable sites from which bone can be obtained. rhBMP-2 technology is a new and exciting clinical solution that may alleviate the need for harvesting the patient’s own bone. Studies have shown that new bone can be grown predictability. In the studies where INFUSE Bone Graft (Medtronic, Memphis, TN) was used as a bone graft material before placement of dental implants, the bone formed by rhBMP-2/ACS was able to successfully accept and support implants. It behaved like normal bone and continued to become more dense in response to loads, osseointegrated with the implants, and had equivalent functional loading rates to the autograft control group. Histologic samples provided further evidence of this normal bone formation. No studies have been undertaken, however, to specifically evaluate the response of this regenerated bone to subsequent surgery for distraction. Although there has been concern about the potential for antibody formation, there has been little antibody response when measured in clinical trials (0.7% to 6%), and the antibody response was transitory and h a d n o clinical effects. In a recent review assessing patients who received 2 separate exposures to rhBMP-2, no clinical complications or effects were reported although antibodies were not measured 3 (Dr Y.A. Cillo, personal communication, April 2007). This article presents a case of mandibular bone that has been generated entirely with rhBMP-2. This mandible has subsequently been osteotomized and distracted again with consolidation and growth of this bone.
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