Plastic Surgery Research Council
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PSRC 60th Annual Meeting
Program and Abstracts

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BMP-2 Use In Alveolar Cleft Repair Is Associated With An Increased Incidence Of Postoperative Nasal Stenosis
Jeremy A. Goss, BA, Margie S. Hunter, BS, Alexander Y. Lin, MD.
Saint Louis University School of Medicine, St. Louis, MO, USA.

PURPOSE:
A previous surgeon at our institution repaired alveolar clefts with bone morphogenetic protein-2 (BMP-2). Clinically, these patients appeared to have higher rates of postoperative nasal stenosis. Nasal stenosis was considered as a possible complication following alveolar cleft repair and its incidence was tracked between patients whose alveolar clefts were repaired with BMP-2 and those whose were not.
METHODS:
For 14 months, patients were prospectively enrolled in our IRB-approved study to assess clinical outcomes following cleft-craniofacial repair with BMP-2 by the previous surgeon compared to his patients who did not receive BMP-2. Each surgery was examined for postoperative outcomes by content analysis of cleft team members’ notes related to the immediately preceding surgery. Nasal stenosis was defined as any mention of clinical signs of stenosis; indeterminate responses were counted as no stenosis. To avoid any confounding nasal stenosis diagnosis, we excluded patients who had pre-existing nasal stenosis before their alveolar repairs. We focused only on repairs of the alveolar cleft and in doing so, we excluded patients with isolated cleft palates as they were unlikely to have alveolar involvement. We also excluded secondary palatoplasties and all non-cleft procedures. Continuous variables were compared with t-tests and categorical variables were compared with Fisher exact tests. The influence of our categorical variables and their interaction was further investigated using two-way ANOVA and logistic regression.
RESULTS:
60 consecutively enrolled patients underwent 115 surgeries that met our criteria: surgeries involving BMP-2 (BY) 48%, those without BMP-2 (BN) 52%. The average patient age at surgery in years was: BY 3.53, BN 3.43 (p=0.890). The incidence of postoperative nasal stenosis was: BY 62%, BN 30% (***p<0.001). We noted that some surgeries involved a concurrent nasal repair with a frequency of: BY 69%, BN 32%, (***p<0.001). A two-way ANOVA using BMP-2 status and concurrent nasal repair status as predictors showed a predictive overall effect (**p=0.002), with significant main effect from BMP-2 (**p=0.007), but no significant effect from concurrent nasal repair (p=0.112), or their interaction (p=0.799). Logistic regression with these predictor variables revealed an effect of BMP-2 status (*p=0.040), but not of concurrent nasal repair (p=0.168) or their interaction (p=0.741).
CONCLUSION:
In patients receiving BMP-2 during alveolar cleft repair by a former surgeon at our institution, it appeared that these patients had a higher rate of nasal stenosis than those who had alveolar cleft surgery without BMP-2. However, there was also a higher rate of surgeries involving concurrent nasal repair in patients who received BMP-2. Nasal stenosis outcomes were explored by two-way ANOVA and logistic regression models, and both indicate that there is a more significant main effect of BMP-2, but the main effect of concurrent nasal surgery did not achieve statistical significance. These results suggest that BMP-2 use in alveolar cleft surgery may lead to increased rates of postoperative stenosis.


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