"Two stage"-procedure for rekonstruktion af maksil efter hemimaxillektomi
Baggrund – Rekonstruktion af maksillen efter større excisioner i forbindelse med cancer eller tumorer er en stor udfordring for kirurgen grundet ansigtets komplekse anatomi. Samtidig er genopbygningen af normalstrukturer afgørende for patientens funktion, komfort og æstetiske velbefindende. Patienttilfælde – Der præsenteres et patienttilfælde samt en teknik for en ”two stage”-procedure for rekonstruktion af defekter efter partiel maxillektomi. Initialt dækkes resektionsdefekten af en temporalislap for at lukke forbindelsen mellem den orale kavitet, sinus maxillaris og næsehulen. Efterfølgende foretages knogletransplantation fra hoften til maksillen, og sluttelig foretages den dentale rehabilitering med implantater og tænder. Konklusion – Anvendelse af musculus temporalis, knogletransplantat og implantater til rekonstruktion af maksillen efter hemimaxillektomi i forbindelse med tumorkirurgi er en kirurgisk skånsom og effektiv metode til at opnå normal funktion og æstetik.
Klinisk relevans:
Reconstruction of surgical defects after partial maxillectomy: Background – The reconstruction of the maxilla after massive excisions for cancer and tumours is a challenging problem due to the anatomical complexity of the region. Nevertheless, the reconstruction is crucial to offer the patient a functional, comfortable and aesthetic outcome. Case study – The article presents a patient who was referred from the oto-rhino-laryngologists for reconstruction after hemimaxillectomy due to sarcoma. Primary reconstruction with a temporalis flap was performed. Bone was harvested from the anterior iliac crest and from an intraoral approach adapted as a bicortical block to the left maxilla through a dissection in the temporalis flap. Finally, a reconstruction with two dental implants and a titanium composite bridge was performed. Seven years after reconstruction the patient is still satisfied and the bone level in relation to the implants is maintained. Conclusion – Within the limitations of the few patients we have treated with this technique, we find that rehabilitation of patients following hemimaxillectomy with the two stage procedure is a reliable and safe alternative to the primary reconstruction procedure.
