| Abstract | Trauma, onkološka resekcija, upale ili kongenitalne malformacije samo su neki od uzroka nastanka oromandibularnih defekata. Najčešći razlog onkološke resekcije je planocelularni karcinom usne šupljine i orofarinksa. Najčešća sijela planocelularnog karcinoma usne šupljine su dno usne šupljine i jezik. Pravodobno prepoznavanje prekanceroznih lezija i početnih stadija tumora, utječe na bolju prognozu bolesti. U manjoj ili većoj mjeri svi ti uzroci djeluju na estetski izgled lica, ali i funkciju usne šupljine. Složeni defekti glave i vrata potaknuli su kirurge glave i vrata na razmišljanje kako što bolje rekonstruirati oromandibularnu regiju i koja tkiva su pogodna za takvu rekonstrukciju. Prije svega važno je klasificirati oromandibularne defekte, neovisno jesu li oni urođeni ili stečeni, po veličini koštanog defekta koji nastaje, ali i količini mekotkivne komponente koja nedostaje i pokušati procjeniti funkcionalne nedostatke koji mogu nastati. Klasifikacije olakšavaju planiranje rekonstruktivnih zahvata i izbor adekvatne vrste tkiva za rekonstrukciju. Od svih kompozitnih slobodnih režnjeva, režanj fibularne arterije zauzima najvažnije mjesto u oromandibularnoj rekonstrukciji. Osim njega dobre alternative, a nekad i primarni izbor za neke defekte su režanj grebena crijevne kosti, režanj supskapularne arterije i oseokutani radijalni režanj podlaktice. Za planiranje rekonstrukcije, precizniju izradu i oblikovanje kostiju, kao i prilagođavanje implantata i prostetike, danas se koriste CAD (engl. computer-aided design) i CAM (engl. computer-aided manufacturing) 3D tehnologija, koja olakšava navedene aspekte rekonstrukcije. Osim toga, ova tehnologija može planirati i olakšati odabir pravog režnja kao opcije za rekonstruktivne zahvate, ali i omogućiti relativno zadovoljavajuću predikciju postoperativnog ishoda kod pacijenta. Mogu se napraviti 3D dizajnirane i precizno izmjerene mrežice i pločice od titana koje služe kao pomagala i prostetika u rekonstruktivnim zahvatima. Napradak tehnika bioinjžinjeringa tkiva i to sustavima za ispis tkiva donosi nove mogućnosti u rekonstruktivnu praksu, a u bližoj budućnosti velika je vjerojatnost uporabe VR tehnologije u operacijama. |
| Abstract (english) | Trauma, oncological resection, inflammation or congenital malformations are just some of the causes of oromandibular defects. The most common reason for oncological resection is squamous cell carcinoma of the oral cavity and oropharynx. The most common sites of squamous cell carcinoma of the oral cavity are the floor of the oral cavity and the tongue. Timely recognition of precancerous lesions and initial stages of tumors affects a better prognosis of the disease. To a greater or lesser extent, all these causes affect the aesthetic appearance of the face, as well as the function of the oral cavity. Complex head and neck defects have encouraged head and neck surgeons to think about reconstructing the oromandibular region as best as possible and which tissues are suitable for such reconstruction. First of all, it is important to classify oromandibular defects, regardless of whether they are congenital or acquired, according to the size of the resulting bone defect, but also the amount of missing soft tissue component, and try to assess the functional defects that may arise. The classifications facilitate the planning of reconstructive procedures and the selection of an adequate type of tissue for reconstruction. Of all composite free flaps, the fibular artery flap occupies the most important place in oromandibular reconstruction. Apart from that, good alternatives, and sometimes the primary choice for some defects, are the iliac crest flap, the subscapular artery flap and the osseous radial forearm flap. Today, CAD (computer-aided design) and CAM (computer-aided manufacturing) 3D technologies are used for reconstruction planning, more precise creation and shaping of bones, as well as adaptation of implants and prosthetics, which facilitates the mentioned aspects of reconstruction. In addition, this technology can plan and facilitate the selection of the right flap as an option for reconstructive procedures, but also enable a relatively satisfactory prediction of the patient's postoperative outcome. 3D-designed and precisely measured meshes and titanium plates can be made that serve as aids and prosthetics in reconstructive procedures. The development of tissue bioengineering techniques and tissue printing systems brings new possibilities to reconstructive practice, and soon there is a high probability of using VR technology in operations. |
