Title Kirurško liječenje mikrotije Title (english) Surgical treatment of microtia Author Danijela Filipović Mentor Ivan Rašić (mentor) Committee member Livije Kalogjera (predsjednik povjerenstva)Committee member Mihael Ries (član povjerenstva)Committee member Ivan Rašić (član povjerenstva) Granter University of Zagreb Defense date and country 2020-07-17, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Mikrotija je kongenitalna malformacija srednjeg i vanjskog uha koja nastaje poremećajem u embrionalnom razvoju. Najčešće je riječ o jednostranoj mikrotiji koju prati ipsilateralni gubitak sluha te mandibularna i facijalna displazija. U manjem broju slučajeva (15-20%) javlja se obostrana mikrotija uz koju je veća šansa za dodatne sindrome, od kojih je najpoznatiji okulo-aurikulo-vertebralni sindrom ili Goldenharov sindrom. Etiologija mikrotije uključuje i genetsku pozadinu i utjecaj brojnih okolišnih čimbenika, a kao glavne dvije hipoteze o nastanku su vaskularna disrupcija i oštećenje stanica neuralnog grebena. Glavni pristup liječenju je kirurški, a najprimjenjivanija metoda i danas je autologna rekonstrukcija uške s rebrenim hrskavicama. Nagata, stavljajući fokus na probleme koje su imale postojeće konvencionalne metode, uvodi novu rekonstruktivnu tehniku koja daje puno bolje funkcionalne i estetske rezultate. Njegova metoda sastoji se od dvije faze, od kojih se prva odnosi na izradu trodimenzionalnog hrskavičnog okvira, a druga na operaciju podizanja uha. Prije izrade hrskavičnog okvira, potrebno je skupiti hrskavice od šestog do devetog rebra, pri čemu će se hrskavica šestog rebra iskoristiti kasnije za operaciju podizanja uha, dok se za izradu dijelova okvira koriste preostale tri rebrene hrskavice. Druga faza započinje otprilike šest mjeseci nakon prve, a njena svrha je da podigne ušku u normalan položaj, zakrenutu prema natrag za 10-15°. Postoje brojne modifikacije Nagatine metode, a kao jedna od najpoznatijih ističe se ona prema Siegertu i Magritzu. Osim autologne rekonstrukcije s rebrenim hrskavicama, u kirurške metode liječenja mikrotije ubrajaju se još i ugradnja implantata (Medpora) i preostetička rekonstrukcija. Ugradnja implantata daje iznimno dobre estetske rezultate uz smanjenu pojavu postoperativnih komplikacija, dok ušna proteza iako ima dobre rezultate, predstavlja dosta skupu opciju s obzirom na održavanje i mijenjanje proteza tokom cijelog života.
Abstract (english) Microtia is a congenital malformation of the middle and outer ear caused by a disorder in embryonic development. Most commonly, it is a unilateral microtia followed by ipsilateral hearing loss and mandibular and facial dysplasia. In a smaller number of cases (15-20%), bilateral microtia occurs, with a higher chance of additional syndromes, of which the most known is the oculo-auriculo-vertebral syndrome or Goldenhar’s syndrome. The etiology of microtia includes both the genetic background and the influence of various environmental factors, and the two main hypotheses about its origin are vascular disruption and damage of neural crest cells. The main approach to treatment is surgical and the most applied method even today is the autologous reconstruction of the ear with rib cartilage. Nagata, focusing on the problems of existing conventional methods, introduces a new reconstructive technique that gives much better functional and aesthetic results. His method consists of two stages, where first one refers to the making of a three-dimensional cartilaginous frame, and the second to the operation of lifting the auricle. Before making the cartilage frame, it is necessary to collect the cartilage from the sixth to the ninth rib, with the sixth rib cartilage being used later for ear lift surgery, while the remaining three rib cartilages are used to make the frame parts. The second stage begins approximately six months after the first and its purpose is to raise the auricle to its normal position, rotate posteriorly to 10-15°. There are numerous modifications to Nagata’s method and one of the most well-known ones is Seigert and Magritz. In addition to autologous reconstruction with rib cartilage, surgical methods for treating microtia include implant reconstruction (Medpor) and prosthetic reconstruction. Implant placement give extremely good aesthetic results with reduced occurrence of postoperative complications, while ear prosthesis, although having good results, is a rather expensive option considering the maintenance and replacement throughout life.
Keywords
mikrotija
Goldenharov sindrom
autologna rekonstrukcija
Nagatina metoda
implantat (Medpor)
prostetička rekonstrukcija
Keywords (english)
microtia
Goldenhar's syndrome
autologous reconstruction
Nagata's method
implantat (Medpor)
prostetic reconstruction
Language croatian URN:NBN urn:nbn:hr:105:526251 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2021-08-30 08:12:31
