APPLICATION OF PURIFIED BONE MORPHOGENETIC PROTEIN (BMP) PREPARATIONSIN CRANIO-MAXILLO-FACIAL SURGERY - RECONSTRUCTION IN CRANIOFACIAL MALFORMATIONS AND POSTTRAUMATIC OR OPERATIVE DEFECTS OF THE SKULL WITH LYOPHILIZED CARTILAGE AND BMP

New ways of craniofacial reconstruction in old post-traumatic or fresh donor site craniectomy defects and in congenital malformations (Apert 's and Crouzon's syndromes) are described. In all instances a stacked composite of lyophilized cartilage strips interspersed with BMP layers was applied to fill the defects and indentations or used in combinati on with autologous bone struts to rebuild the cranium completely in sy nostotic malformations. The stratified implants interlaced with BMP in duced early bone formation, and in addition were rigid enough from the beginning to serve as bridging elements over and between autologous b one struts in the cage-like forehead reconstructions. The reconstructe d areas became clinically solid after a few months. CT images taken in 4 cases showed progressive calcification starting in the BMP layers, sometimes already visible after a few weeks. These results indicate th at the usual slow process of calcification/ossification of lyocartilag e alone is considerably accelerated by the combination with BMP. From intermediate term observations (more than one year) we conclude that c omplete consolidation of the whole implants, so far without signs of r esorption, will consistently be the final outcome of this type of reco nstruction.