Use of recombinant bone morphogenetic protein 2 in free flap reconstruction for osteonecrosis of the mandible

J Oral Maxillofac Surg. 2012 Aug;70(8):1991-6. doi: 10.1016/j.joms.2011.08.037. Epub 2011 Dec 16.


Purpose: Osteoradionecrosis of the mandible is a debilitating consequence of radiation therapy for head-and-neck malignancy. It can result in pain, bone exposure, fistula formation, and pathologic fracture. Recombinant human bone morphogenetic protein 2 (rhBMP-2) has shown promise in reconstruction of bone defects. The purpose of this study is to determine whether the addition of rhBMP-2 at the union of vascularized bone and native bone improves surgical outcomes in patients with osteonecrosis of the mandible.

Materials and methods: This study was a retrospective analysis of patients who were treated between 2006 and 2010 for osteonecrosis of the mandible. Patients requiring definitive reconstruction after failure of a course of conservative management were included. Patients were divided into 2 cohorts depending on whether rhBMP-2 was used during the reconstruction. The primary outcome measure was defined as stable mandibular union.

Results: Seventeen patients were included. The development of malunion was similar in both groups (13% for rhBMP-2 group vs 11% for non-rhBMP-2 group). Infectious complications were similar between the groups (25% in rhBMP-2 group vs 56% in non-rhBMP-2 group, P = .33). The rates of hardware removal were similar for the 2 groups (33% in non-rhBMP-2 group vs 25% in rhBMP-2 group, P = .10). No cancer recurrences were observed in patients receiving rhBMP-2.

Conclusions: The use of rhBMP-2 is safe in free flap reconstruction of the mandible, but its ability to significantly improve patient outcomes, as measured by rates of malunion, reoperation, or infection, is still unknown.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Bone Morphogenetic Protein 2 / therapeutic use*
  • Bone Plates
  • Bone Transplantation / methods
  • Bone Transplantation / pathology
  • Carcinoma, Squamous Cell / radiotherapy
  • Cohort Studies
  • Device Removal
  • Female
  • Follow-Up Studies
  • Free Tissue Flaps*
  • Head and Neck Neoplasms / radiotherapy
  • Humans
  • Male
  • Mandible / surgery
  • Mandibular Diseases / surgery*
  • Middle Aged
  • Osteoradionecrosis / surgery*
  • Osteotomy / instrumentation
  • Osteotomy / methods
  • Postoperative Complications
  • Recombinant Proteins / therapeutic use
  • Reconstructive Surgical Procedures / methods*
  • Retrospective Studies
  • Skin Transplantation / methods
  • Surgical Wound Dehiscence / etiology
  • Surgical Wound Infection / etiology
  • Transforming Growth Factor beta / therapeutic use*
  • Treatment Outcome
  • Wound Healing / drug effects


  • Bone Morphogenetic Protein 2
  • Recombinant Proteins
  • Transforming Growth Factor beta
  • recombinant human bone morphogenetic protein-2