Use of beta‐tricalcium phosphate as a reconstructive tool for small bony defects in the mandible

Objective: To determine if the osteoconductive material ChronOS beta-tricalcium phosphate block (beta-TCP) made by Synthes, a synthetic bone substitute made of beta-tricalcium phosphate, is a viable choice for bone grafting. Methods: We prospectively evaluated the use of the beta TCP in a 50-year-old male with a T4N1M0 stage IV squamous cell carcinoma of the right alveolar ridge who underwent wide local excision with segmental mandibulectomy from ramus to ipsilateral parasymphysis and selective neck dissection. The patient was primarily reconstructed with an osseous fibula free flap. His parasymphyseal bone margin was found to be positive on permanent section, and the patient underwent a second segmental mandibulectomy, leaving him with a 2.0 cm anterior defect at the symphysis of the mandible. A beta TCP block was utilized to fill the bony gap in the anterior mandible from the fibula to the native mandible. Results: The patient healed well postoperatively and was started on a soft diet 1 week post op. He started chemoradiation 4 weeks post op. He is now 20 months post op without any evidence of disease, and has maintained his preoperative occlusion. His postoperative CT scan shows bony fusion at the reconstructed site. Conclusions: The beta TCP block is a useful adjunct for the reconstructive surgeon in small mandibular defects <2.0 cm, and osseous growth is still possible even with postoperative chemoradiation therapy. Use of beta-tricalcium phosphate as a reconstructive tool for small bony defects in the mandible Anya Li, MD1 and Tamer Ghanem, MD PhD1 1Department of Otolaryngology Head & Neck Surgery Henry Ford Hospital, Detroit, MI