The purpose of this abstract is to describe reconstruction of a post traumatic maxillary alveolar ridge defect using a microvascular free flap combined with a immediate avascular allogeneic bone graft with Bone Morphogenetic Protein and Bone Marrow Aspirate.
Materials and Methods:
A 45-year-old woman presented to the University of Miami Department of Oral and Maxillofacial Surgery status post four months after a motor vehicle accident and subsequent repair of her facial fractures. On initial presentation she was noted to have deficient projection of left malar region. Loss of left maxillary ridge alveolar bone and upper eyelid ptosis and lower lid ectropion. As a staged reconstruction, we started our initial repair with the reconstruction of her alveolar ridge. The surgical technique involves the use of a radial forearm free flap and immediate allogeneic avascular bone graft augmented with Bone Morphogenetic Protein and Bone Marrow Concentrate Aspirate. A Poly-DL-Lactic Acid Mesh was use a containment unit for the bone graft
The patient was successfully treated with viable radial forearm free flap for soft tissue and regeneration of bone with adequate height and width, which allowed the placement of 3 dental implants with excellent arch coordination.
Post traumatic Maxillary alveolar ridge can be a challenge to reconstruct due to the lack of healthy soft tissue, fibrosis and, proximity to the nasal floor. A traditional reconstruction technique such as avascular bone grafting requires soft tissue, which is often scarred, inadequate or absent in post traumatic or post oncologic defects. Alternatively osteocutaneous flaps such as free fibula provided both vascular soft tissue and bone but often have too much bulk for proper prosthetic restoration. This case report will demonstrate a novel approach to reconstructing these difficult defects with a combination of free vascular tissue transfer with addition of avascular bone graft, which allowed the bone to be molded and contoured in to the correct anatomic position.
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