Reconstruction of Mandibular Continuity Defects Using Recombinant Human Bone Morphogenetic Protein 2: A Note of Caution in an Atmosphere of Exuberance

Legacy Emanuel Hospital and Health Center, Oregon Health & Science University, Portland, OR, USA.
Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons (Impact Factor: 1.43). 12/2009; 67(12):2673-8. DOI: 10.1016/j.joms.2009.07.085
Source: PubMed
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  • Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 12/2009; 67(12):2557-8. DOI:10.1016/j.joms.2009.10.019 · 1.43 Impact Factor
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    ABSTRACT: This article reviews literature pertaining to advances in oromandibular reconstruction in the context of a 30-year background of microvascular free tissue transfer, which still represents the current standard of care. Most literature reiterates established patterns of reconstruction. Notable exceptions address these key areas: the use of computer-assisted modeling to more closely and efficiently design the excision of the mandible, to produce the template and to contour the fibula bone to fit the defect; the evolution of plating techniques to maximize the bony repair; distraction osteogenesis; tissue engineering; and optimal techniques for dealing with osteonecrosis, from both radiation and bisphosphonate use. Osteocutaneous free flaps remain the standard of care. The fibula flap has emerged as the accepted favorite among these flaps. Evolution of fibula flap reconstruction constitutes a major portion of the current literature. Improvements upon free tissue transfer are currently elusive, largely due to associated radiation. Tissue engineering holds promise as the next plateau but is not yet readily applicable.
    Current opinion in otolaryngology & head and neck surgery 02/2011; 19(2):119-24. DOI:10.1097/MOO.0b013e328344a569 · 1.84 Impact Factor
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    ABSTRACT: This article reviews a few of the commonly used types of vascularized osseous free flaps in maxillofacial reconstruction, which still represents the gold standard of restoration. We also discuss the developing concepts in maxillofacial reconstruction. Most of the literature reconfirms the established patterns of reconstruction with the aid of vascularized osseous free flaps. This method of free-tissue transfer is also feasible in cases of osteoradionecrosis or bisphosphonate-related osteonecrosis of the jaw. These flaps are also suitable for prosthetic restoration using osseointegrated dental implants. Vascularized osseous free flaps still remain the standard of care. Improvements upon the free-tissue transfer method employing vascularized osseous free flaps, such as distraction osteogenesis, tissue engineering, and imaging techniques, currently require further development, but these technologies could lead to improved outcomes of maxillofacial reconstruction in the near future.
    Asian Pacific journal of cancer prevention: APJCP 02/2012; 13(2):553-38. DOI:10.7314/APJCP.2012.13.2.553 · 2.51 Impact Factor
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