Successful closure of alveolar cleft defect with rhBMP-2

A 6 year old boy with bilateral cleft lip and palate was brought to our hospital with the complaints of escape of food and water to the nose while eating and slurred speech due to escape of  air to the nose through the hole in the teeth bearing region of the upper jaw. Primary cleft lip and palate repair was done elsewhere.

After thorough clinical and radiographic examination Maxillofacial Surgeon Dr. S. M. Balaji diagnosed that in the previous cleft surgery the Surgeon has removed the premaxilla completely along with the developing tooth buds. Thus a part of alveolus along with the few teeth was missing which led to huge cleft defect in the midline of the upper jaw bone.  Dr. Balaji skillfully planned to close the cleft alveolar defect with the miracle protein rhBMP-2.

A gingivomucoperiosteal flap was raised and the cleft defect was exposed and miracle protein rhBMP-2 was placed in the alveolar cleft defect region and the flap was approximated with sutures. This protein helps the body’s own cells to form new bone at the site of placement. After 3 months achieving complete union of the segmented alveolar bone into a single complete maxilla, replacement of missing teeth followed by orthodontic treatment will be planned. 

Pre operative intra oral view showing missing teeth in the upper anterior region due to cleft alveolar defect

During procedure, huge alveolar cleft defect exposed due to missing premaxillary segment

Miracle protein rhBMP-2 placed in the alveolar cleft defect to induce own body cells into bone forming cells

Water tight closure of the gingivomucoperiosteal flap