Immediate Trans-oral Allogeneic bone grafting for large mandibular defects. Less morbidity, more bone. A paradigm in benign tumor mandibular reconstruction?

Publication date: Available online 6 October 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): James C. Melville, Nader N. Nassari, Issa A. Hanna, Jonathan W. Shum, Mark E. Wong, Simon Young
Reconstruction of hard tissue continuity defects caused by ablative tumor surgery has been traditionally reconstructed with autogenous bone grafts or microvascular free flaps. Although results have been predictable from both methods of reconstruction, the morbidity associated with bone harvest is quite significant for the patient. Predictable results have been obtained with using a combination of 100% cadaver bone, bone marrow aspirate concentrate (BMAC) and rhBMP-2 in immediate reconstruction for benign tumor extirpations via the extra-oral approach. In light of these successful outcomes, the same combination was evaluated with an intraoral approach. This study aims to evaluate the success of immediate mandibular reconstruction via intra-oral approach without any autogenous bone harvesting.Patients and MethodsThe aim of this retrospective study is to share our experience with the use of 100% allogeneic bone in combination with BMP and BMAC via trans-oral approach for immediate reconstruction of continuity defects resulted from benign tumor surgery. A retrospective chart review was performed of all patients undergoing bone graft reconstruction at UTHealth oral & maxillofacial surgery, between December 2014 to January 2016. Inclusion criteria are the following: biopsy proven benign tumors, ASA I/II health status and adequate intraoral soft tissue for primary closure determined during initial consultation.Results5 patients who underwent this procedure at University of Texas Health Sciences Center at Houston (UTHealth) Oral &Maxillofacial surgery, between December 2014 to January 2016, are presented. We report a 100% success rate. All patients demonstrated excellent bone quality both clinically as well as radiographically for endosseous dental implant placement. With the trans-oral approach and no autogenous bone harvesting, the average operating time was 3.4 hours and hospital stay was 2.4 days.ConclusionsComposite allogeneic tissue engineering is effective and predictable technique for immediate reconstruction of continuity defects from ablative benign tumor surgery. Overall, we had no donor site morbidity, less intraoperative time, fewer admission days and overall reduction in total costs compared to traditional methods.



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