Abstract
Background
Raising mucoperiosteal flaps in traditional palatoplasty impairs mid-facial growth.
Hyaluronic acid-based hydrogels have been successfully tested for minimally invasive
craniofacial bone generation in vivo as carriers of bone morphogenetic protein-2 (BMP-2). We aimed to develop a novel
flapless technique for cleft palate repair by injecting a BMP-2 containing hydrogel.
Material and methods
Dog pups with congenital cleft palate were either non-treated (n=4) or treated with two-flap palatoplasty (n=6) or with the proposed injection/adhesion technique (n=5). The experimental approach was to inject a hyaluronic acid-based hydrogel containing
hydroxyapatite and BMP-2 subperiosteally at the cleft palate margins of pups aged
six weeks. At week ten, a thin strip of the medial edge mucosa was removed and the
margins were closed directly. Occlusal photographs and computed tomography (CT) scans
were obtained up to week 20.
Results
Four weeks after the gel injection the cleft palate margins had reached the midline
and engineered bone had enlarged the palatal bones. Removal of the medial edge mucosa
and suturing allowed complete closure of the cleft. Compared to traditional palatoplasty,
the injection/adhesion technique was easier, and the post-surgical recovery was faster.
CT on week 20 revealed some overlapping or “bending” of palatal shelves in the two-flap
repair group, which was not observed in the experimental nor control groups.
Conclusion
A minimally invasive technique for cleft palate repair upon injectable scaffolds in
a dog model of congenital cleft palate is feasible. Results suggest better growth
of palatal bones. This represents an attractive clinical alternative to traditional
palatoplasty for cleft palate patients.
Keywords
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References
- Cleft lip and palate.Lancet. 2009; 374: 1773
- Cleft palate repair: art and issues.Clin Plast Surg. 2004; 31: 231
- Palatoplasty: evolution and controversies.Chang Gung Med J. 2008; 31: 335
- In vitro manipulation of cleft palate connective tissue: setting the bases of a proposed new treatment.J Surg Res. 2007; 138: 111
- Osteoinduction in the palatal submucosa by injecting BMP-2 on 2 different carriers.J Craniofac Surg. 2012; 23: 594
- Maxillary alveolar cleft repair in dogs using recombinant human bone morphogenetic protein-2 and a polymer carrier.Plast Reconstr Surg. 1996; 98: 247
- Animal research.Plast Reconstr Surg. 1997; 100: 1361
- Experiments using animals.Plast Reconstr Surg. 1998; 102: 926
- A new technique for feeding dogs with a congenital cleft palate for surgical research.Lab Anim. 2011; 45: 70
- Repair of alveolar clefts with recombinant human bone morphogenetic protein (rhBMP-2) in patients with clefts.J Craniofac Surg. 2005; 16: 778
- Bone morphogenetic protein-induced repair of the pre-maxillary cleft.J Oral Maxillofac Surg. 2007; 65: 2136
- Reduced morbidity and improved healing with bone morphogenetic protein-2 in older patients with alveolar cleft defects.Plast Reconstr Surg. 2008; 121: 209
- Evaluation of maxillary alveolar reconstruction using a resorbable collagen sponge with recombinant human bone morphogenetic protein-2 in cleft lip and palate patients.Tissue Eng Part C Methods. 2010; 16: 1183
- Injectable cell-free template for bone-tissue formation.J Biomed Mater Res A. 2009; 91: 1111
- Bone morphogenetic protein-2 delivered by hyaluronan-based hydrogel induces massive bone formation and healing of cranial defects in minipigs.Plast Reconstr Surg. 2010; 125: 1383
- Calcium phosphates compounds in conjunction with hydrogel as carrier for BMP-2: a study on ectopic bone formation in rats.Acta Biomater. 2011; 7: 3042
- Bone reservoir: injectable hyaluronic acid hydrogel for minimal invasive bone augmentation.J Control Release. 2011; 152: 232
- Minimally invasive mandibular bone augmentation using injectable hydrogels.J Tissue Eng Regen Med. 2012; https://doi.org/10.1002/term.1593
- Classificaçao das fisuras labiopalatinas: breve histórico, consideraciones clínicas e sugestão de modificação.Rev Bras Cir. 1992; 82: 50
- Smart design of stable extracellular matrix mimetic hydrogel: synthesis, characterisation, and in vitro and in vivo evaluation for tissue engineering.Adv Funct Mater. 2012; https://doi.org/10.1002/adfm.201201698
- Alveolar bone healing accompanied by severe swelling in cleft children treated with bone morphogenetic protein-2 delivered by hydrogel.J Plast Reconstr Aesthet Surg. 2012; https://doi.org/10.1016/j.bjps.2012.08.015
- High doses of bone morphogenetic protein 2 induce structurally abnormal bone and inflammation in vivo.Tissue Eng Part A. 2011; 17: 1389
- Maxillary growth of adult patients with unoperated cleft: answers to the debates.J Plast Reconstr Aesthet Surg. 2007; 60: 407
- Does BMP-2 Really Cause Cancer? A Systematic Review of the Literature.Spine J. 2012; 12: 143S
- BMP7 influences proliferation, migration, and invasion of breast cancer cells.Cancer Lett. 2009; 275: 35
- BMPs and their clinical potentials.BMB Rep. 2011; 44: 619
- Inhibitory effect of BMP-2 on the proliferation of breast cancer cells.Mol Med Report. 2012; 6: 615
- Formation of painful seroma and oedema after the use of recombinant human bone morphogenetic protein-2 in osterolateral lumbar spine fusions.Neurosurgery. 2010; 66: 1044
- Recombinant human bone morphogenetic protein 2-induced heterotopic ossification of the retroperitoneum, psoas muscle, pelvis and abdominal wall following lumbar spinal fusion.Skeletal Radiol. 2010; 39: 501
- A critical review of recombinant human bone morphogenetic protein-2 trials in spinal surgery: emerging safety concerns and lessons learned.Spine J. 2011; 11: 471
Article info
Publication history
Published online: March 25, 2013
Accepted:
March 1,
2013
Received in revised form:
February 26,
2013
Received:
January 13,
2013
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
