Growth factor aids mandible reconstruction

By Lynda Williams, Senior medwireNews Reporter

Surgeons have used recombinant human bone morphogenetic protein (rhBMP)-2 to successfully restore mandibulectomy defects with few adverse effects.

Five of six patients who underwent mandible repair using rhBMP-2 with beta-tricalcium phosphate matrix or a cadaver bone graft healed without infection, resorption, or other complications, report Brian Nussenbaum and co-workers from Washington University in St Louis, Missouri, USA.

They believe the growth factor treatment could offer a "potential alternative" for patients without malignancy who are unsuitable for or unwilling to undergo the current standard of care, microvascular osseous free tissue transfer.

"From our experience, the use of rhBMP-2 avoids donor-site morbidity, decreases surgical complexity, and allows for quicker recovery and shorter hospital stays," the team writes in JAMA Facial Plastic Surgery.

However, they add: ""Future studies are needed to determine practical issues such as the need for a scaffold, the exact dose per defect size, the potential for dental restoration, and the most optimal approach and insertion technique, as well as to provide a comparative cost analysis."

Between 2004 and 2009, six patients, aged between 45 and 59 years old, underwent mandible repair for segmental (n=3) or near-complete rim mandibulectomy defects (n=3) which were caused by benign neoplasm (n=5) or trauma (n=1). The patients had refused segmental resection or osseous free tissue transfer, or were unable to undergo tissue transfer due to comorbidity.

Using an extraoral approach where possible, the surgeons repaired segmental defects using cadaveric fibula bone containing collagen sponges soaked in rhBMP-2. Demineralized bone matrix was used to fill any gaps. For patients with near-complete rim defects, a beta-tricalcium phosphate matrix containing rhBMP-2 was shaped and layered onto the remaining bone and a reconstruction plate added.

After a median of 37.5 months, five of the patients had a successful outcome, defined as freedom from hardware problems and infection, no need for further surgery, and bone scintigraphy results showing healing and union without resorption.

The sixth patient required further reconstructive surgery due to postoperative infection, associated with a compromised immune system.

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