Uporaba fibularnog režnja u rekonstrukciji donje čeljusti

master's thesis

• Title (english): Use of fibula free flap in lower jaw reconstruction
• Author: Mateo Čukman
• Mentor: Ivica Lukšić (mentor)
• Committee member: Emil Dediol (predsjednik povjerenstva)
• Committee member: Narandža Aljinović-Ratković (član povjerenstva)
• Committee member: Ivica Lukšić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Maxillofacial Surgery and Dentistry); Zagreb
• Defense date and country: 2018-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Indikacije i prednosti primjene fibularnog režnja u rekonstrukciji donje čeljusti dobro su opisane u literaturi. Čvrsta kompaktna bikortikalna građa, duljina koštanog režnja, mogućnost multiplih osteotomija kosti, mogućnost simultanog rada dvaju kirurških timova te niska učestalost komplikacija i morbiditeta donorskog mjesta, značajke su koje fibularni režanj podižu na vrh rekonstrukcijske ljestvice za defekte donje čeljusti. Fibularni režanj vrlo je pogodan i za ugradnju dentalnih implantata, čime se postiže potpuna dentalna rehabilitacija. Ovaj rad je retrospektivna analiza desetogodišnjeg iskustva u rekonstrukcijama donje čeljusti fibularnim slobodnim režnjem. Prikazane su 44 mikrokirurške rekonstrukcije u onkoloških bolesnika kod kojih je resekcija primarnog malignog tumora usne šupljine uključivala i segmentalnu resekciju mandibule. Fibularni režanj se pokazao kao pouzdan te funkcijski i estetski izvrstan izbor u rekonstrukciji donje čeljusti. Unatoč brojnim prednostima fibularnog režnja, pri odabiru rekonstrukcijske metode u obzir se uzimaju i drugi parametri zdravstvenog stanja bolesnika, komorbiditet i navike. U starijih bolesnika s većim komorbiditetom mikrokirurška rekonstrukcijska metoda može predstavljati veći rizik za uspjeh liječenja.
Značajan broj bolesnika s karcinomom usne šupljine su dugogodišnji pušači cigareta i konzumenti alkoholnih pića s izraženim aterosklerotskim bolestima što može biti važan razlog pri odabiru rekonstrukcijske metode. Individualiziran i multidisciplinaran pristup, adekvatno onkološko liječenje te optimalan odabir rekonstrukcijske i rehabilitacijske metode, u bolesnika liječenih od tumora usne šupljine, faktori su uspješnosti u kirurškom liječenju i kvaliteti života onkoloških bolesnika.

Abstract (english)

Benefits and possibilities of applying fibular free flap in lower jaw reconstruction are well described in literature. The solid compact bicortical bone structure, the length of the bony segment, the possibility of multiple osteotomies, the possibility of two surgical teams approach and a low incidence of complications and morbidity of the donor site, are characteristics which
raise fibular free flap to the top of the reconstructive ladder for mandibular defects. It is very suitable for dental implants placement, thus achieving complete oral rehabilitation. This report is a retrospective analysis of ten years of experience in reconstructions of the lower jaw with fibula free flap. There were 44 reconstructions in oncological patients following surgical
treatment of the primary oral cancer, which involved segmental mandibular resection. Fibular flap has proven to be a reliable, functionally and aesthetically excellent method for lower jaw reconstruction. It is important to understand the reconstructive ladder and reconstruction varieties, while the best choice is not necessarily the most sophisticated method. In older, severe oncological patients with numerous comorbidities, microsurgical reconstruction may sometimes bring too much risk for a patient. This is very important to emphasize, especially in lower jaw reconstructive surgery, where oncological patients are in many cases smokers and alcohol consumers with atherosclerotic illnesses. In patients treated with head and neck tumors, the crucial factors for good results and patient satisfaction are individualized and multidisciplinary approaches, proper oncological treatment and deliberate choice of reconstruction and rehabilitation methods.

• Keywords: fibularni režanj; rekonstrukcija donje čeljusti; rekonstrukcijska ljestvica
• Keywords (english): fibular free flap; lower jaw reconstruction; reconstructive ladder
• Language: croatian
• URN:NBN: urn:nbn:hr:105:671110
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2019-03-21 10:32:05