Mandibular Reconstruction Using a Tray With Particulate Cancellous Bone and Marrow and Platelet-Rich Plasma by an Intraoral Approach

Purpose: To evaluate the possibility of immediate mandibular reconstruction using particulate cancellous bone and marrow (PCBM), platelet-rich plasma (PRP), and a tray, we compared the postsurgical infection rate and bone formation in patients who received mandibular reconstruction with this method using either an intraoral or extraoral approach. Patients and Methods: We conducted a retrospective study of a series of 18 patients who underwent the mandibular reconstruction procedure using a mesh tray with PCBM and PRP, all performed by 1 surgeon. These cases were further divided into those treated by the intraoral approach and those treated by the extraoral approach. Clinical data, postoperative bone formation, and complications in the 2 groups were evaluated. The chi(2) examination and the Mann-Whitney U test were used for statistical analysis. Results: We could not detect any statistically significant differences in clinical data between the 2 groups, except for the timing of reconstruction. There were postoperative complications such as wound dehiscence and tray exposure, as well as infection of the reconstructed bone. The overall complication rate of the recipient sites in the intraoral group was 30% (3 of 10), whereas in the extraoral group, it was 0%. However, satisfactory bone formation was seen in all cases in the intraoral group (100% [10 of 10]) but only 87.5% (7 of 8) in the extraoral group. Conclusion: We conclude that mandibular reconstruction using a tray with PCBM and PRP is a safe and reliable method for cases of benign tumor and trauma, even if immediate reconstruction is performed by an intraoral approach. (C) 2011 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 69:1807-1814, 2011