Recombinant Human Bone Morphogenetic Protein-2 (rhBMP-2) as an Alternative to Autologous Bone Graft in Pediatric Craniofacial Reconstruction

BACKGROUND: Craniofacial reconstruction in pediatricpatients commonly uses autologous bone grafts, such as iliac crest bone grafts (ICBG). Recombinant human bone morphogenetic protein-2 (rhBMP-2) infused allografts may reduce operative time and donor-site morbidity. This review assesses whether rhBMP-2 is a viable alternative. METHODS: A literature search of PubMed, Ovid, and Web of Science (2008-2023) identified studies on rhBMP-2 in pediatric craniofacial reconstruction. Randomized controlled trials, prospective or retrospective case series, and case reports were included; reviews, animal, and basic science studies were excluded. RESULTS: Of 211 screened articles, 21 met the inclusion criteria (6 RCTs, 2 prospective, 10 retrospective, 3 case reports). rhBMP-2 was used for alveolar cleft repair (18 studies), calvarial defect reconstruction (2), and mandibular continuity defect reconstruction (1). In alveolar cleft repair, rhBMP-2 was compared with ICBG in bone formation efficacy, complications, operative time, length of hospitalization, and financial burden. Four of 12 studies favored rhBMP-2 for bone formation, 1 favored ICBG, and 7 found no difference. Among 12 studies on complications, 2 reported more adverse effects with rhBMP-2, 5 with ICBG, and 4 found no difference. Facial edema was the most common rhBMP-2 complication; donor-site morbidity was the most common for ICBG. All 5 studies comparing operative time found it shorter with rhBMP-2. Of 8 studies on hospitalization, 7 showed shorter stays with rhBMP-2. Cost analysis was mixed across 4 studies. CONCLUSIONS: rhBMP-2 appears comparable, if not favorable, to ICBG for alveolar cleft repair in pediatric patients, reducing operative time and hospital stays. However, long-term follow-up is needed to confirm efficacy and safety, particularly for other craniofacial reconstruction procedures.