Mund-, Kiefer- und Gesichtschirurgie

, Volume 9, Issue 4, pp 225–232 | Cite as

Therapie knöcherner und fibröser Kontrakturen sowie Wangendefekte nach NOMA mit dem M.-temporalis-Lappen

Originalien
First Online:

Zusammenfassung

Methode

In einer prospektiv angelegten Pilotstudie wurde bei 12 Patienten geprüft, ob sich der M.-temporalis-Lappen unter den erschwerten Bedingungen eines Entwicklungslandes als sicheres und einzeitiges Verfahren eignet, Wangendefekte kombiniert mit fibrösen oder ossären Kontrakturen des Kiefergelenks zu therapieren. Die Eingriffe erfolgten in den Jahren 1998, 1999 und 2000 im Hospital National du Niamey (Republik Niger).

Ergebnisse

Alle Transplantate heilten primär ein. 7 Patienten konnten 12 bzw. 24 Monate später klinisch und röntgenologisch vor Ort (Niger) nachuntersucht werden. Die Mundöffnung betrug konstant mindestens 1,5 cm, obwohl physiotherapeutische Maßnahmen zur Vermeidung der Narbenschrumpfung praktisch nicht angewendet wurden.

Diskussion

Im Gegensatz zu kostenaufwändigen und chirurgisch komplexeren Rekonstruktionen kann mit dem von uns angewendeten Verfahren auch unter Verzicht auf maximalmedizinische Bedingungen dauerhaft ein zufrieden stellendes funktionell-ästhetisches Resultat erzielt werden.

Schlüsselwörter

Noma Wangendefekt Rekonstruktion Temporalislappen Entwicklungsland 

Therapy of bony and fibrous contractures and buccal defects after noma using the temporalis muscle flap

Abstract

Methods

A prospective pilot study was conducted on 12 patients to establish whether, under the difficult conditions prevailing in a developing country, the temporalis muscle flap is suitable as a safe and single-stage procedure for the repair of buccal defects combined with fibrous or osseous contractures of the temporomandibular joint.

Results

The surgical procedures were performed from 1998 to 2000 in the Hôpital National du Niamey (Republic of Niger). Primary healing was achieved with all grafts. Local clinical and radiological follow-up (in Niger) was performed on seven patients after 12 and 24 months. Mouth opening of at least 1.5 cm was achieved in all cases, although there was virtually no use of physiotherapy to prevent scar contracture.

Discussion

By contrast with expensive and surgically more complex reconstructions, our use of this procedure shows that even where medical conditions are less than ideal, a satisfactory functional and cosmetic result can be achieved in the long-term.

Keywords

Noma Defect Reconstruction Temporalis flap Developing country 
This is a preview of subscription content, log in to check access.

Literatur

  1. 1.
    Adams RW, James JH (1992) Cancrum oris: functional and cosmetic reconstruction in patients with ankylosis of the jaws [see comments]. Br J Plast Surg 45: 193–198PubMedGoogle Scholar
  2. 2.
    Adekeye EO, Ord RA (1983) Cancrum oris: principles of management and reconstructive surgery. J Maxillofac Surg 11: 160–170PubMedGoogle Scholar
  3. 3.
    Adekeye EO, Lavery KM, Nasser NA (1986) The versatility of pectoralis major and latissimus dorsi myocutaneous flaps in the reconstruction of cancrum oris defects of children and adolescents. J Maxillofac Surg 14: 99–102PubMedGoogle Scholar
  4. 4.
    Adolph HP, Yugueros P, Woods JE (1996) Noma: a review. Ann Plast Surg 37: 657–668PubMedGoogle Scholar
  5. 5.
    Arole G (1988) Experience with medially based deltopectoral skin flap and tongue flap in the reconstruction of cancrum oris cheek defect. Afr Dent J 2: 15–21PubMedGoogle Scholar
  6. 6.
    Barmes DE, Enwonwu CO, Leclercq MH, Bourgeois D, Falkler WA (1997) The need for action against oro-facial gangrene (noma) [editorial]. Trop Med Int Health 2: 1111–1114CrossRefPubMedGoogle Scholar
  7. 7.
    Barthelemy I, Martin D, Sannajust JP, Marck KW, Pistre V, Mondie JM (2002) Prefabricated superficial temporal fascia flap combined with a submental flap in noma surgery. Plast Reconstr Surg 109: 936–940CrossRefPubMedGoogle Scholar
  8. 8.
    Bradley P, Brockbank J (1981) The temporalis muscle flap in oral reconstruction. A cadaveric, animal and clinical study. J Maxillofac Surg 9: 139–145PubMedGoogle Scholar
  9. 9.
    Dean JA, Magee W (1997) One-stage reconstruction for defects caused by cancrum oris (noma). Ann Plast Surg 38: 29–35PubMedGoogle Scholar
  10. 10.
    Dijkstra R (1992) Cancrum oris reconstruction [letter; comment]. Br J Plast Surg 45: 619PubMedGoogle Scholar
  11. 11.
    Durrani KM (1973) Surgical repair of defects from noma (cancrum oris). Plast Reconstr Surg 52: 629–634PubMedGoogle Scholar
  12. 12.
    Enwonwu CO, Falkler WA, Idigbe EO, Afolabi BM, Ibrahim M, Onwujeke D, Savage O, Meeks VI (1999) Noma: a neglected scourge of children in sub-Saharan Africa. Am J Trop Med Hyg 60: 223–232PubMedGoogle Scholar
  13. 13.
    Erdmann D, Schierle H, Sauerbier M, Germann G, Lemperle G (1998) Reconstruction of severe facial defects due to noma. Chirurg 69: 1257–1262CrossRefPubMedGoogle Scholar
  14. 14.
    Kaimenyi JT, Guthua SW (1994) Residual facial deformity resulting from cancrum oris: a case report. East Afr Med J 71: 476–478PubMedGoogle Scholar
  15. 15.
    Marck KW, De Bruijn HP (1999) Surgical treatment for noma. Oral Dis 2: 167–171Google Scholar
  16. 16.
    Montandon D (2002) Prefabricated superficial temporal fascia flap combined with submental flap in Noma surgery. Plast Reconstr Surg 109: 941–942CrossRefGoogle Scholar
  17. 17.
    Montandon D, Pittet B (2002) The surgical treatment of noma. Ann Chir Plast Esthet 47: 520–535CrossRefPubMedGoogle Scholar
  18. 18.
    Nath S, Jovic G (1998) Cancrum oris: management, incidence, and implications of human immunodeficiency virus in Zambia. Plast Reconstr Surg 102: 350–357PubMedGoogle Scholar
  19. 19.
    Pittet B, Jaquinet A, Montandon D (2001) Clinical experience in the treatment of noma sequelae. J Craniofac Surg 12: 273–283CrossRefPubMedGoogle Scholar
  20. 20.
    Tempest MN (1966) Cancrum oris. Br J Surg 53: 949–969PubMedGoogle Scholar
  21. 21.
    Valadas G, Leal MJ (1998) Cancrum oris (noma) in children. Eur J Pediatr Surg 8: 47–51PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  1. 1.Praxis Mund-, Kiefer- und Gesichtschirurgie, Plastische OperationenStraubing
  2. 2.Klinik für Anästhesie und IntensivmedizinUniversität Regensburg
  3. 3.Klinik HNO-KrankheitenUniversität Regensburg
  4. 4.Praxis Mund-, Kiefer- und Gesichtschirurgie, Plastische OperationenStraubing

Personalised recommendations