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Die primäre Kalottenosteoplastik bei Lippen-Kiefer-Gaumen-Spalten

Gibt es Evidenz?

Calvarial bone graft for primary alveolar cleft repair

Is there evidence?

  • Leitthema
  • Published:
Der MKG-Chirurg Aims and scope

Zusammenfassung

Die Therapie von Lippen‑, Kiefer‑, Gaumen-Spalten erfordert eine Vielzahl interdisziplinär abgestimmter Behandlungsschritte. Im Rahmen des Rehabilitationskomplexes dieser Fehlbildungen besteht insbesondere um die Kieferspaltosteoplastik eine rege, teils kontroverse Debatte hinsichtlich der richtigen Behandlungsmodalitäten. Dieser Übersichtsartikel stellt die literaturbasierten Erkenntnisse zu Operationszeitpunkt und Entnahmeregion im Rahmen der Kieferspaltosteoplastik dar und soll eine Diskussion zur primären Kalottenosteoplastik anstoßen. Bei der Wahl des optimalen Operationszeitpunkts zur Rekonstruktion einer Kieferspalte ist die primäre Kieferspaltosteoplastik dann indiziert, wenn sie in der Phase des Durchbruchs des lateralen spaltnahen Milchinzisivus die osteogene Potenz dieses Vorgangs für eine optimale Ausformung des Alveolarfortsatzes nutzen kann. Zusätzlich sollte die Spaltbreite durch die therapeutische Vorbehandlung des Lippenspaltverschlusses nur noch wenige Millimeter betragen. Die Kalottenosteoplastik eignet sich insbesondere in diesen Fällen mit leichten Vorteilen bei der Entnahmemorbidität gegenüber der Beckenkammentnahme.

Abstract

Treatment of cleft lip and palate requires multiple interdisciplinary treatment steps. Concerning rehabilitation of this deformity, there is a heightened and in part controversial debate regarding the correct treatment modalities, particularly for alveolar cleft reconstruction. The aim of this review article is to present the literature-based findings for the timing of surgery and the donor site for alveolar cleft repair and to provide a basis for discussion of primary alveoloplasty with calvarial bone. Regarding optimal timing for osseous reconstruction of the alveolus in cleft lip and palate management, primary alveolar cleft repair is indicated during eruption of the cleft-proximal lateral incisor to benefit from the osteogenic potency of this process, thus promoting optimal stabilization of the alveolar process. Additionally, the width of the alveolar cleft should be minimalized by the therapeutic pretreatment of cleft lip closure to a few millimetres. The calvarial bone graft is particularly suitable in these cases, with slight advantages in donor site morbidity compared to the iliac crest.

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  1. Klinik für Mund‑, Kiefer‑, Gesichtschirurgie, Diakovere Henriettenstift gGmbH, Marienstr. 72–90, 30171, Hannover, Deutschland

    A. Gröbe

  2. Praxis für Mund-, Kiefer-, Gesichtschirurgie, Bultstr. 6, 30159, Hannover, Deutschland

    G. Gehrke

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Gröbe, A., Gehrke, G. Die primäre Kalottenosteoplastik bei Lippen-Kiefer-Gaumen-Spalten. MKG-Chirurg 11, 234–242 (2018). https://doi.org/10.1007/s12285-018-0175-0

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