The Utilization of Allogeneic Bone, Bone Morphogenetic Protein and Bone Marrow Aspirate Concentrate for Immediate Reconstruction of Benign Tumor continuity defects

The Utilization of Allogeneic Bone, Bone Morphogenetic Protein and Bone Marrow Aspirate Concentrate for Immediate Reconstruction of Benign Tumor continuity defects.

• Abstract:  Reconstruction of hard tissue continuity defects caused by ablative tumor surgery has been traditionally reconstructed with autogenous cancellous marrow 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. With the advances made in tissue engineering, it is our opinion that successful and predictable results can be obtained with using a combination of 100% cadaver bone, Bone Marrow Aspirate Concentrate (BMAC) and rhBMP in immediate reconstruction for benign tumor extirpations.

• MATERIAL AND METHODS: The aim of this retrospective study is to share our experience with the use of 100% allogeneic bone in combination with BMP and BMAC for immediate reconstruction of continuity defects resulted from benign tumor surgery. The present study reviewed patients treated at the University of Miami Oral and Maxillofacial Surgery Department, during a four-year period between 2010 and 2014. We identified 9 patients, (5 men, 4 women) With a mean age of 23.7 year old with 3 patients under the age of 17.  All patents were presented to the University of Miami Department of Oral and Maxillofacial with benign tumors, ( Ameloblastoma, OKC, Myxoma, Ossifying Fibroma and Central Giant Cell Tumor).  All patients were ASA I or II with no history of chemotherapy or radiation or prior ablative surgery. All patients had adequate soft tissue for primary closure following oncological principles.  All defects range from 4cm to 12cm Our criteria for success with these cases are as follows.1) Unity of bony defect, 2)  >3cm bone height and >1cm width, 3) Arch coordination, 4) Implantable bone, 5) Maintenance of osseous content for >18 months, and 6) Restoration of Acceptable facial form. All oral perforations were sutured with a horizontal mattress fashion as well as Lempert sutures to obtain a “water tight closure” In two cases immediate bone grafting was deferred due to large stellate perforation that we were not obtain a water tight closure, These patients were excluded from our study. The freeze dried cortical cancellous bone was obtained from the University of Miami Tissue bank and used in combination with a 12mg of rhBMP-2/ACS and 120cc of Bone Marrow Aspirate Concentrate obtained from the patients anterior hip.  We used the traditional 10 cc of crushed cortical cancellous bone for each 1 cm of defect. Out of the 9 patients all but 1 had maxillomandibular fixation for 3 week.

 

• RESULTS: We report a 100% success rate related to reconstruction with our rigid criteria as previously stated. All patients demonstrated excellent bone quality both clinically as well as radiographically. All patients under 17 years old were subsequently underwent orthodontic treatment while patients > 17 years old have or in the process of definitive dental rehabilitation. 

 

• CONCLUSIONS:  The combination of 100% Allogenic bone, Bone Marrow concentrate and Bone Morphogenetic protein is an effective and predictable technique for reconstruction of continuity defects from ablative benign tumor surgery. Patient selection is critical in using this method. All patients were ASA I or II with no history of chemotherapy, radiation or previous ablative surgery. If the patient has been medically compromised related to wound healing or has a history of chemotherapy or radiation treatment we still advocate the use of some albeit and small amount of autogenous cancellous bone graft or a microvascular free flaps as the current standards for jaw reconstruction. Overall we had less patient morbidity, less time operating time, less inpatient hospital stay and overall reduction in total costs.