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Original Article |

Use of Recombinant Human Bone Morphogenetic Protein 2 for Mandible Reconstruction

Shaun C. Desai, MD; Alan Sclaroff, DDS; Brian Nussenbaum, MD
JAMA Facial Plast Surg. 2013;15(3):204-209. doi:10.1001/jamafacial.2013.650.
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Background Microvascular osseous free tissue transfer is the standard of care for reconstructing significant mandibulectomy defects; however, this procedure can carry a significant rate of morbidity.

Objectives To describe the use of recombinant human bone morphogenetic protein 2 (rhBMP-2) as an option for segmental or near-complete rim mandibulectomy defects in a select group of patients, precluding the need for free tissue transfer.

Methods A retrospective review was performed of 6 patients who had undergone repair of a mandible defect using rhBMP-2 with beta-tricalcium phosphate matrix or a cadaveric bone graft at a single tertiary care institution. The defects resulted from resection of benign neoplasms or from previous trauma. Reconstruction success was defined as no hardware problems, healing without infection, no need for further surgical procedures, and imaging evidence of healing and union without resorption. The median follow-up period was 37.5 months (range, 12-51 months).

Results Five of 6 patients underwent successful restoration of the mandibulectomy defect. One patient with a compromised immune system developed a significant postoperative wound infection requiring further reconstructive surgery.

Conclusion The use of an rhBMP-2–based reconstructive approach is a feasible option for segmental or near-complete rim mandibulectomy defects in a select group of patients.

Level of Evidence 4.

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Figures

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Figure 1. Patient 2, a 57-year-old man with a segmental mandibulectomy defect. A, Intraoperative view of the mandibular defect with the reconstructive plate already in place. B, Axial view of the allogenic cadaveric fibular bone with bovine type I collagen sponges to be placed in the marrow space. C, Two pieces of allogenic cadaveric fibula bone with collagen sponges soaked in recombinant human bone morphogenetic protein 2 fixated to the reconstruction plate. D, Nine-month postoperative 3-dimensional computed tomography image showing osteoinduction and union. E, Nine-month postoperative bone image showing viable new bone in the anteroposterior and left lateral views.

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Figure 2. Patient 5, a 46-year-old man having a near-complete rim mandibulectomy defect treated with recombinant human bone morphogenetic protein 2 (rhBMP-2) with a beta-tricalcium phosphate onlay graft. A, Preoperative radiographic evaluation (Panorex CDRPANX; Schick) showing odontogenic keratocyst with a thin inferior rim of bone. B, Intraoperative view of the near-complete rim mandibulectomy defect with the reconstructive plate already in place. C, Intraoperative view after placement of the onlay rhBMP-2 graft. D, Nine-month postoperative radiogram (Panorex) showing complete osteogenesis and healing.

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