Zusammenfassung
Hintergrund
Der hart- und weichgewebige Verlust von Strukturen des Mittelgesichts durch Resektion oder Trauma ist mit substanziellen funktionellen und ästhetischen Defiziten verbunden. Deren Rekonstruktion erfordert neben einer Rekonstruktion knöcherner Konturen von Orbita und Jochbeinbeinprominenz zum Erhalt von Bulbusposition und Gesichtssymmetrie nicht selten auch die simultane Verpflanzung von Weichgewebe zur Trennung von Nasen- und Mundhöhle und Auffüllung weichgewebiger Volumendefekte.
Patienten und Methoden
Anhand von 10 exemplarischen Fällen soll ein in unserer Klinik etabliertes Verfahren dargestellt werden, bei welchem durch den Einsatz von computerassistierten Techniken Titangitter einer individuellen Defektsituation angepasst und im Bedarfsfall durch Weichgewebetransplantate ergänzt werden können.
Ergebnisse
Nach unseren Erfahrungen bietet dieses Verfahren sowohl in funktioneller als auch in ästhetischer Hinsicht zufriedenstellende Ergebnisse. Insbesondere bei Patienten mit Verlust von knöchernen Strukturen der Orbita und Erhalt des Orbitainhalts schafft dieses Verfahren durch Beibehaltung des ursprünglichen Orbitavolumens optimale Voraussetzungen, die Ausbildung von Diplopie und Enophthalmus zu verhindern.
Schlussfolgerung
Individualisierte Titangitter sollten in der klinischen Routine zur Versorgung komplexer Mittelgesichtsdefekte häufiger eingesetzt werden.
Abstract
Background
Loss of hard and soft tissue structures of the midface due to resection or trauma is associated with substancial functional and aesthetic deficits. Besides reconstruction of bony contours for preservation of orbit position and facial symmetry, reconstruction often requires simultaneous transplantation of soft tissue flaps for separation of nasal and oral cavities and refilling of soft tissue volume deficits.
Patients and methods
A well-established procedure of our institution will be demonstrated in 10 exemplary patients, in which titanium meshes are customized for individual defect situations using computer-assisted techniques in combination with soft tissue transfer if required.
Results
According to our experience, this procedure provides satisfactory results in functional as well as in aesthetic respects. Especially in patients with loss of bony structures of the orbit and preservation of orbital contents, this procedure forms optimal preconditions for prevention of enophthalmos and diplopia by preservation of the original orbital volume.
Conclusion
Individualized titanium implants should be used more frequently in clinical routine for reconstruction of complex midfacial defects.
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Kokemüller, H., von See, C., Essig, H. et al. Rekonstruktion komplexer Mittelgesichtsdefekte durch individualisierte Titanimplantate. HNO 59, 319–326 (2011). https://doi.org/10.1007/s00106-011-2280-5
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DOI: https://doi.org/10.1007/s00106-011-2280-5
Schlüsselwörter
- Orbitaimplantate
- Komplexe Mittelgesichtsdefekte
- Mittelgesichtsrekonstruktion
- Navigation
- Computerassistierte Chirurgie