Reconstruction of #7 facial cleft with distraction-assisted in situ osteogenesis (DISO): role of recombinant human bone morphogenetic protein-2 with Helistat-activated collagen implant.
A case involving concomitant presentation of a #7 lateral facial cleft with a complete cleft of the ipsilateral lip, alveolus, and palate is presented. The mandibular defect was Pruzansky III with a foreshortened body, absent ramus and absent masseter. Taking advantage of developmental field theory, reconstruction of the osseous defect was undertaken using the autogenous periosteum as a source of mesenchymal stem cells. Expansion of the periosteum was followed by implantation of Helistat (Integra Life Sciences, Plainsboro, NJ) collagen sponge saturated with recombinant human bone morphogenetic protein-2. Stimulation of this distraction-induced envelope by rhBMP-2 resulted in abundant production of bicortical membranous bone in situ within 12 weeks. The neoramus was subsequently suspended from the cranial base, and a temporalis muscle transfer was used to provide motor control of the jaw. Synthesis of bone in this manner is termed DISO (distraction-assisted in situ osteogenesis). The biologic rationale and clinical implications of DISO are discussed.
Carstens
Michael H
MH
Division of Plastic Surgery, Saint Louis University, St. Louis, Missouri 63110, USA. michaelcarstens@mac.com
Chin
Martin
M
Ng
Theodore
T
Tom
William K
WK
D000539:Alveolar Process / Q000002:abnormalities; D001672:Biocompatible Materials / Q000627:therapeutic use*; D055396:Bone Morphogenetic Protein 2; D019485:Bone Morphogenetic Proteins / Q000627:therapeutic use*; D002971:Cleft Lip / Q000601:surgery; D002972:Cleft Palate / Q000601:surgery; D003094:Collagen / Q000627:therapeutic use*; D005145:Face / Q000002:abnormalities* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005781:Gelatin Sponge, Absorbable / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D008334:Mandible / Q000002:abnormalities / Q000601:surgery; D008406:Masseter Muscle / Q000002:abnormalities / Q000601:surgery; D045164:Mesenchymal Stem Cell Transplantation; D010012:Osteogenesis / Q000187:drug effects / Q000502:physiology; D019857:Osteogenesis, Distraction / Q000379:methods*; D010521:Periosteum / Q000637:transplantation; D011994:Recombinant Proteins; D013703:Temporal Muscle / Q000637:transplantation; D016212:Transforming Growth Factor beta / Q000627:therapeutic use*
C525718:BMP2 protein, human; D001672:Biocompatible Materials; D055396:Bone Morphogenetic Protein 2; D019485:Bone Morphogenetic Proteins; D011994:Recombinant Proteins; D016212:Transforming Growth Factor beta; D003094:Collagen