Fisher Mark, Yee Kristen, Alba Brandon, Tanna Neil, Bastidas Nicholas, Bradley James P
Division of Plastic and Reconstructive Surgery, Northwell Health, Great Neck, NY.
Department of Plastic and Reconstructive Surgery, UCSF Benioff Children's Hospital Oakland, Oakland, CA.
J Craniofac Surg. 2019 Oct;30(7):1952-1959. doi: 10.1097/SCS.0000000000005586.
Large defects of the craniofacial skeleton can be exceedingly difficult to reconstruct since autologous bone grafts are limited by donor site morbidity and alloplastic implants have low biocompatibility. Bone morphogenetic proteins (BMPs) in craniofacial reconstruction have been used with mixed outcomes and complication concerns; however, results for specific indications have been promising.In alveolar clefts, cranial vault defects, mandibular defects, and rare Tessier craniofacial clefts, BMP-2 impregnated in collagen matrix was looked at as an alternative therapy for challenging cases. In cases where structural support was required, BMP-2 was used as part of a construct with bio-resorbable plates. Demineralized bone was added in certain cases.The authors described specific indications, detailed surgical techniques, and a review of the current literature regarding the use of BMP-2 in craniofacial reconstruction. BMP-2 is a viable option for craniofacial reconstruction to decrease donor-site morbidity or when alternatives are contraindicated. It is not recommended for routine use or in the oncologic setting but should currently be reserved as an alternative therapy for complex cases with limited options.Bone morphogenetic proteins are a promising, emerging option for complex craniofacial reconstruction. Future directions of BMP-2 therapies will become apparent as data from prospective randomized trials emerges.
颅面骨骼的大缺损极难重建，因为自体骨移植受供区并发症限制，而异体植入物的生物相容性较低。颅面重建中使用的骨形态发生蛋白（BMPs）效果不一，且存在并发症问题；然而，特定适应症的结果很有前景。在牙槽裂、颅骨穹窿缺损、下颌骨缺损以及罕见的特西尔颅面裂中，浸渍于胶原基质中的BMP-2被视为复杂病例的替代治疗方法。在需要结构支撑的病例中，BMP-2被用作生物可吸收板构建物的一部分。某些情况下会添加脱矿骨。作者描述了特定适应症、详细的手术技术，并回顾了目前关于BMP-2在颅面重建中应用的文献。BMP-2是颅面重建的一个可行选择，可减少供区并发症，或在其他替代方法禁忌时使用。不建议常规使用或用于肿瘤学情况，但目前应保留作为选择有限的复杂病例的替代治疗方法。骨形态发生蛋白是复杂颅面重建中一个有前景的新兴选择。随着前瞻性随机试验数据的出现，BMP-2治疗的未来方向将变得清晰。
