The Role of Stem Cells in Mandibular Reconstruction

Objectives: Reconstruction of mandibular continuity defects caused by trauma, infectiom or oncological 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. The aim of this retrospective study is to share our experience with the use of concentrated stem cells (Bone Marrow Aspirate Concentrate), allogeneic bone and Bone Morphogeneic Protein (rhBMP) via trans-oral and extra-oral approach for reconstruction of mandibular continuity defects as well as maxillary defects.
Methods: A retrospective chart review was performed of all who patients who underwent allogeneic bone graft reconstruction utilizing concentrated stem cells at UTHealth Oral & Maxillofacial Surgery, between July 2014 to September 2016. Inclusion criteria are the following, ASA I/II health status, no previous radiation on chemotherapy and adequate soft tissue for primary closure determined during initial consultation
Results: 10 patients who underwent this procedure at University of Texas Health Sciences Center at Houston (UTHealth) Oral &Maxillofacial surgery, between July 2014 to October 2016, are presented. We report a 100% success rate. All patients demonstrated excellent bone quality both clinically as well as radiographically for endosseous dental implant placement. With the trans-oral approach and no autogenous bone harvesting the average operating time was 3.4 hours and hospital stay was 2.4 days. Extra-oral approach had a longer operating time 4.5 hours and longer hospital stay of 5.4 days.
Conclusions: Composite allogeneic tissue engineering utilizing stem cells is an effective and predictable technique reconstruction of continuity defects from trauma and ablative surgery. Overall we had no donor site morbidity, less intraoperative time, fewer admission days and overall reduction in total costs compared to traditional methods.