5 Years follow up of patient treated with rhBMP2 for large mandibulary bone defects

1126 Abstracts the cases but only one resulted in the loss of the graft. The commonest complication at the donor site was abnormal gait. Majority of the patients were satisfied with the aesthetic outcome of their mandibular reconstruction. Conclusion: Non-vascularised iliac crest bone graft, though it may be limited in its versatility, appears to have satisfactory aesthetic outcome with relatively few complications. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.335

73 Intraoral microsurgical anastomosis of the free bony flaps – report on two cases M. Rysz ∗ , J. Jaworowski Memorial Cancer Center, Warsaw, Poland

Introduction: In many cases of the oral tumors it is technically possible to perform intraoral resection. If reconstruction with free flap is necessary, we need to expose donor vessels usually on the neck or in naso-labial fold producing skin scars. We would like to present our experiences with intraoral technic for facial vessels exposer and microsurgical anastomosis. Material and methods: 33 years old female with ameloblastoma of the alveolar process underwent partial maxillectomy and reconstruction with Iliac Crest Free Flap. Through buccal mucosa cut 3 cm distally to the labial angle we exposed facial vessels and microsurgical anastomosis was performed intraoraly. Bone segment was fixed with reconstructive titanium plate. Palate defect was covered with oblique abdominal muscles raised with iliac bone segment. Second case was 16 years old patient with mandible angel ameloblastoma qualified for Fibula Free Flap reconstruction. After intraoral resection facial vessels were exposed and anastomosed as described above. Fibula flap was fixed to the remaining mandible segments with reconstructive titanium plate. Oral mucosa was primary closed over flap. Results: In first case flap heal properly and we haven’t observed any complications. Patient was sent to prosthodontics for further dental rehabilitation. In second case we lost flap due to infection. Conclusions: Intraoral technic for tumor resection and reconstruction with microsurgical flaps is a promising method. It can be used in selected cases mostly for benign neoplasms. For better control of the

vascularization part of the flap should be available for inspection. Conflict of interest: None declared.

75 5 Years follow up of patient treated with rhBMP2 for large mandibulary bone defects

doi:10.1016/j.ijom.2011.07.336

A.S. Herford, E. Stoffella, M. Cicciù ∗ Oral and Maxillofacial Surgery Department, Loma Linda University, Loma Linda, CA, USA

74 Complementary surgeries after free fibula flap for oral rehabilitation: classification system F. Agudiak ∗ , F. Klurfan, R. Adan Head and Neck Surgery, Instituto de Oncologia Angel H. Roffo, Universidad de Buenos Aires, Buenos Aires, Argentina

Nowadays, it is well known that microsurgical jaw reconstruction with free fibula flap is a reliable therapeutic method. Only 25% of the patients obtain a complete oral rehabilitation and the average number of surgeries required is four after the primary reconstruction. Objective: The aim of this study was to introduce a classification system of complementary surgeries after free fibula flap reconstruction for complete oral prosthesis rehabilitation. Study design: The authors analyzed 11 reconstructive surgeries of the jaws with fibula free flaps during the period of one year. Only in 4 cases a complete oral rehabilitation was reached. The additional surgeries required were: 1 tongue reconstruction, 2 vestibuloplasty, 2 skin graft, 1 distraction osteogenesis, 1 corrective osteotomy and 17 implants were placed. Results: The average number of surgeries performed in each patient was 3; 1 implant didn’t osseintegrated and 2 could not be used (sleep implant). Conclusion: After the primary reconstructive surgery the main problems in oral rehabilitation were the inadequate soft tissue and unfavorable bone flap positioning. Although the results were satisfactory, more emphasis should be placed during initial planning in the first reconstructive surgery. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.337

Introduction: Mandibular continuity defects are frequently caused by tumour removal or significant trauma. Reconstructive procedures of segmental mandible defects often require bone graft harvesting, which results in donor site morbidity; the use of tissue-engineered bone might mitigate this problem. Aim of this study is to clinically and radiographically evaluates the long-term results of the rhBMP2 and ACS placing in a case of severe and large mandibulary bone defect. Materials and methods: 5 patients with lesions of the body and angle of the mandible resulting from neoplastic diseases were treated with rhBMP-2, used alone with the collagen carrier without concomitant bone materials. Cases were followed over a period from 3 to 5 years. Radiographic and clinical exams show a good healing with non-significant complication. Discussion and conclusion: For mandibular continuity defects not associated with significant soft tissue loss, non-vascularized autogenous bone has been shown to provide excellent results. The advantages compared with microvascular free-tissue transfer is on the more limited donor site. An ideal osseous grafting treatment should involve use of a bone inductive material that would be reliable, biocompatible, long-lasting, and capable of restoring mandibular continuity with minimal morbidity. In the cases we described important success were obtained using rhMBP2, in 5 cases of mandibulary reconstruction after resection of large portion of the angle of the mandible. The osteoinductive capabilities of rhBMP-2 have been widely studied in different bone healing environments. The aim of this work is to confirm the predictability of the use of rhBMP-2 in mandibular reconstruction. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.338