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Virtuelle Planung komplexer mikrovaskulärer knöcherner Rekonstruktionen in der MKG-Chirurgie

Virtual planning of complex osseous microvascular reconstructions in oral and maxillofacial surgery

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

Zusammenfassung

Das Gesicht gilt mit seiner Vielzahl an unterschiedlichen Funktionen als einer der komplexesten Teile des menschlichen Körpers. Erhebliche knöcherne Defekte in der Mund‑, Kiefer- und Gesichtsregion werden häufig durch onkologische Resektionen oder Traumata verursacht. Aufgrund der Ausdehnung sind diese meistens nicht mehr suffizient durch lokale Lappenplastiken, sondern nur durch mikrochirurgische Transplantate zu therapieren. In der Regel werden dazu Beckenkamm‑, Fibula- und Scapulatransplantate verwendet. Die virtuelle Planung der Rekonstruktion erfolgt auf Basis importierter dreidimensionaler Bilddaten des Defekts und der Spenderregion im DICOM-Format. Anschließend besteht die Möglichkeit, die virtuelle Planung durch den Clinical Engineer in einem Webmeeting durchführen zu lassen oder bei entsprechender technischer und personeller Ausstattung die virtuelle Planung am eigenen Computer durchzuführen. In einem weiteren Schritt werden Operationsschablonen und ggf. auch individuelle Osteosyntheseplatten hergestellt. Auch wenn die virtuelle Planung zeit- und personalintensiv ist, kann durch ihre Verwendung die Genauigkeit der Rekonstruktion erhöht und die Ischämiezeit des Transplantats gesenkt werden.

Abstract

With its variety of different functions, the face is considered as one of the most complex parts of the human body. Significant bony defects in the maxillofacial region are often caused by oncological resections or trauma. Due to their extension, adequate treatment is usually not possible using local flaps, and microsurgical transplants are necessary. Generally, deep circumflex iliac artery (DCIA), fibula and scapula transplants are used. Virtual planning of the reconstruction is achieved by importing three-dimensional image data of the defect and donor regions in DICOM-format. Hereafter it is possible to have the virtual planning carried out by a clinical engineer in a web-meeting or, if appropriate technical and personnel requirements are available, the virtual planning can be performed on an in-house computer. In a further step, surgical templates and optionally customized osteosynthesis plates are produced. Even if the virtual planning process is costly in terms of time and personnel, it can increase the accuracy of the reconstruction and reduce the ischemic time of the flap.

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Authors and Affiliations

  1. Klinik und Poliklinik für Mund‑, Kiefer- und Gesichtschirurgie, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland

    A. Modabber MBA, FEBOMFS, F. Peters, S. Raith, N. Ayoub & F. Hölzle

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  1. A. Modabber MBA, FEBOMFS
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  2. F. Peters
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  3. S. Raith
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Correspondence to A. Modabber MBA, FEBOMFS.

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A. Modabber, F. Peters, S. Raith, N. Ayoub und F. Hölzle geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben.

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S. Haßfeld, Dortmund

K. Dawirs, Essen

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Modabber, A., Peters, F., Raith, S. et al. Virtuelle Planung komplexer mikrovaskulärer knöcherner Rekonstruktionen in der MKG-Chirurgie. MKG-Chirurg 10, 272–283 (2017). https://doi.org/10.1007/s12285-017-0120-7

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  • DOI: https://doi.org/10.1007/s12285-017-0120-7

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