Dr. Robert E. Johnson is a resident in the Department of Oral and Maxillofacial Surgery at the University of Washington, Seattle, WA. He earned his dental degree, from Tufts University School of Dental Medicine, and medical degree from the University of Washington School of Medicine. His research interests pertain to surgical safety, anesthesia, and maxillofacial reconstruction. Dr. Johnson has received awards for his research including the American Association of Oral and Maxillofacial Surgeons (AAOMS) Resident Scientific Research Award and has authored numerous studies published in the Journal of Oral and Maxillofacial Surgery.
Reconstruction of mandibular defects secondary to osteomyelitis presents a common, severe, and challenging problem for oral and maxillofacial surgeons. The off-label use of recombinant human bone morphogenetic protein-2 (rhBMP-2) for mandibular bone regeneration has become an accepted and reliable method of reconstruction, however, active infection at the operative site is a contraindication to its use. As such, the clinical utility of rhBMP-2 for mandibular reconstruction in settings of active infection is unknown. Immediate reconstruction of mandibular osteomyelitis defects with rhBMP-2 may allow for improved patient outcomes and a faster return to function by obviating the need for a secondary reconstruction procedure and the morbidity associated with an autologous bone donor site. The purpose of this study will be to answer the following clinical question: Among patients with mandibular osteomyelitis treated with surgical debridement and immediate reconstruction with rhBMP-2, are there any significant histologic, histomorphometric or immunohistochemical differences between native and reconstructed bone after complete bone healing? The investigators hypothesize that after complete bone healing, defined as > 6-months post-reconstruction, there are no significant histologic, histomorphometric or immunohistochemical differences between native and reconstructed bone. The specific aims of this study will be to: 1) evaluate the histologic, histomorphometric and immunohistochemical features of mandibular bone regenerated with rhBMP-2 placed immediately into an area of active infection; and 2) compare the histologic, histomorphometric and immunohistochemical characteristics of regenerated bone with native bone. If mandibular bone reconstructed with rhBMP-2 in a site of active infection is found to be comparable to native bone, this could lead to expanded clinical indications for its use and a paradigm shift in the reconstruction of mandibular osteomyelitis defects.