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Novel procedure helps patient grow cheek bones using BMP, allograft and stem cells
Investigators are cautiously optimistic at 4-months and await the results of longer follow-up exams.
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Surgeons at Cincinnati Children’s Hospital Medical Center have performed a new procedure that combines adipose-derived stem cells, bone morphogenic proteins and allograft surrounded by a vascularized periosteal sleeve to grow new cheek bones in a 14-year-old patient with Treacher Collins syndrome.
“The clinical implications of this are massive,” Jesse A. Taylor, MD, a surgeon and researcher in the division of craniofacial and pediatric plastic surgery at the center, told Orthopedics Today. “There are probably 6 or 7 million people in the United States who have what would be termed a critical size bone defect.”
He noted that the current procedures to correct these defects are long and often produce suboptimal results. Some alternatives also pose geometric limitations when working with craniofacial bones.
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Images: Cincinnati Children’s Hospital Medical Center |
Taylor said the new procedure, which uses cadaveric bone that can be tailored to fit a specific shape and the patient’s own stem cells, can result in a shorter, less morbid procedure that should be more effective in the long term.
Multiple techniques
The procedure is one of the first to combine many techniques that are used or being studied for repairing bone defects, according to a press release from the center.
Femoral allograft
During the 7-hour procedure, surgeons carved femoral allograft, which served as a template for the new bone. They then drilled holes into the allografts and filled them with the patient’s own mesenchymal stem cells. Finally, they injected the allografts with 12 mg of bone morphogenic protein-2 (Infuse, Medtronic) and wrapped the allograft bone in periosteum from the patient’s thigh.
“Probably, the technically difficult parts of this procedure were carving the allograft femur that we used into cheek bones and then fixating them well,” Taylor said. The other challenging aspect of the procedure was stretching the soft tissues over the construct.
Well-consolidated bone
At 4-months follow-up, Taylor said the patient has done amazingly well.
“I am really pleased,” Taylor said. “On physical exam, you can tell that this bone has become solid and is well-consolidated.”
The patient will undergo an additional eyelid surgery. During that procedure, Taylor will biopsy the bone in order to perform histological testing.
“Things are looking good, but the proof really will not be in the pudding until 5 or 6 years down the road when this bone is healthy and vibrant,” Taylor said. “The pictures are pretty amazing, and based on my physical examination, I am confident that is going to happen.
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These CT scans show the patient preoperatively (left) and at postoperative follow-up (right). The patient will undergo an additional procedure on his eyelids. |
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“But, until that happens, certainly no one from my group is going to say this is a total success. ‘Cautious optimism’ is the phrase of the day,” he said.
For more information:
- Jesse A. Taylor, MD, can be reached at Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, Ohio 45229; 513-636-4141; e-mail: Jesse.taylor@ccmc.org. He has indicated that he has no disclosures related to this study.
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