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Higher Dosages of BMP-2 Result in Higher Rates of Postoperative Nasal Stenosis When Used in Alveolar Cleft Repair
Jeremy A. Goss, BA1, Margie S. Hunter, BS1, Eric S. Armbrecht, PhD2, Alexander Y. Lin, MD1.
1Saint Louis University School of Medicine, St. Louis, MO, USA, 2Saint Louis University Center for Outcomes Research, St. Louis, MO, USA.

PURPOSE:
A former surgeon at our institution frequently used bone morphogenetic protein-2 (BMP-2) instead of autograft for alveolar bone reconstruction (ABR). Patients with BMP-2 ABR appeared to have higher rates of postoperative nasal stenosis. Different dosages of BMP-2 were compared to determine if there was a dose-dependent relationship.
METHODS:
We retrospectively reviewed cleft patients who underwent ABR. We excluded patients with pre-existing nasal stenosis. Six concentrations of BMP-2 were used in the alveolar cleft (mg/mL): 0, 1.05, 2.1, 4.2, 8.4, 12.
RESULTS:
60 patients underwent 115 surgeries meeting criteria: surgeries involving BMP-2 (BY) 48%, no BMP-2 (BN) 52%. Postoperative nasal stenosis was BY (62%), BN (30%),***P < 0.001. However, BY were more likely to involve concurrent nasal repairs ***P < 0.001. Logistic regression using the predictor variables BMP-2 status, concurrent nasal repair status, showed that only BMP-2 status was predictive for postoperative nasal stenosis: OR 3.49 (95% CI = 1.06, 11.46) *P = 0.04. When BMP-2 concentration was used as a predictor variable with 6 ordinal levels in a logistic regression that adjusted for concurrent nasal surgery, BMP-2 dose level is a dose-dependent predictor of postoperative nasal stenosis: OR 1.244 (CI = 1.030, 1.503), *P = 0.023.
CONCLUSION:
In patients receiving BMP-2 during alveolar cleft repair, higher rates of postoperative nasal stenosis were observed as greater doses of BMP-2 were used.


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