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Knöcherne Rekonstruktionen des Ober- und Unterkiefers – Grundprinzipien, virtuelle Planung und intraoperative Umsetzung

Bony reconstruction of the maxilla and mandible—principles, virtual planning, and interoperative implementation

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Zusammenfassung

Insbesondere nach ausgedehnter Tumorresektion im Kopf-Hals-Bereich stellt der mikrovaskuläre Gewebetransfer den Goldstandard in der rekonstruktiven Chirurgie dar. Durch den gestiegenen Anspruch an die postoperative Lebensqualität kommt es zu einem erhöhten Bedarf an funktionell und ästhetisch ansprechenden rekonstruktiven Maßnahmen. Hierfür steht je nach Ausdehnung und Struktur des Defekts eine Vielzahl unterschiedlicher mikrovaskulärer Transplantate zur Verfügung. In der Mund‑, Kiefer- und Gesichtschirurgie spielt v. a. die knöcherne Rekonstruktion des Ober- und Unterkiefers eine wichtige Rolle mit dem Ziel, essenzielle Funktionen wie Artikulation, Phonation sowie die Kau- und Schluckfunktion zu erhalten oder wiederherzustellen. Hier hat sich insbesondere durch den Einsatz der virtuellen Planung und deren Übertragung in den Operationssaal mittels Resektions- oder Osteotomieschablonen und den Einsatz patientenspezifischer Implantate ein hohes Maß an Präzision entwickelt, was die Vorhersagbarkeit des Rekonstruktionsergebnisses entscheidend verbessert hat. Die adäquate kaufunktionelle Rehabilitation nach einer knöchernen Rekonstruktion erfordert i. d. R. die Insertion dentaler Implantate zur Verankerung eines Zahnersatzes, was oft mit einem hohen zeitlichen Aufwand bis zur vollständigen prothetischen Versorgung verbunden ist. Hier bietet der „Jaw-in-a-day-Ansatz“, bei dem die vollständige dentale Rehabilitation simultan zur Kieferrekonstruktion erfolgt, eine vielversprechende Technik an. Diese setzt jedoch eine sorgfältige Patientenselektion voraus und muss noch im Langzeitverlauf abschließend beurteilt werden.

Abstract

Particularly after ablative surgery for head and neck cancer, microvascular free flaps represent the gold standard in reconstructive surgery. The increasing demand for improved postoperative quality of life requires a high standard of functional and esthetic reconstructive results. Depending on the nature of the defect, a huge variety of different free flaps are suitable for reconstruction. In oral and maxillofacial surgery, bony reconstruction is essential for restoring critical functions including speech, mastication, and swallowing. Here, virtual surgical planning and its translation to the operation using prefabricated surgical resection or osteotomy guides in combination with patient-specific implants has contributed to a high level of accuracy, leading to more precise prediction of the reconstructive result. Usually, complete dental rehabilitation after bony reconstruction includes insertion of dental implants, a process which can often take a significant amount of time before the definitive prosthetic restoration can be attached. Hence, the jaw-in-a-day concept provides the possibility of full dental rehabilitation simultaneously with the bony reconstruction. However, this promising tool requires careful patient selection and remains to be evaluated in the long term.

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Authors and Affiliations

  1. Klinik und Poliklinik für Mund‑, Kiefer- und Gesichtschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland

    Christian Freudlsperger, Julius Moratin, Christian Mertens, Reinald Kühle, Oliver Ristow, Michael Engel & Jürgen Hoffmann

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  1. Christian Freudlsperger
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Correspondence to Christian Freudlsperger.

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Interessenkonflikt

C. Freudlsperger, J. Moratin, C. Mertens, R. Kühle, O. Ristow, M. Engel und J. Hoffmann geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Freudlsperger, C., Moratin, J., Mertens, C. et al. Knöcherne Rekonstruktionen des Ober- und Unterkiefers – Grundprinzipien, virtuelle Planung und intraoperative Umsetzung. MKG-Chirurg 14, 199–211 (2021). https://doi.org/10.1007/s12285-021-00312-7

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