Title Upotreba hrskavice rebra u operativnim rekonstrukcijskim zahvatima glave i vrata Title (english) The usage of the rib cartilage in head and neck reconstructive surgeries Author Andro Kurtić 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 2021-07-16, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Rekonstrukcijska kirurgija glave i vrata predstavlja kompleksno područje kirurgije u kojoj različiti materijali mogu služiti za rekonstrukciju različitih defekata. Vrlo čest materijal kao presadak u rekonstrukciji koristi se hrskavica rebra koja se može primijeniti za rekonstrukciju različitih defekata i deformiteta u području uha, nosa, traheje i ostalih dijelova glave i vrata.
Rekonstrukcija različitih kongenitalnih i stečenih defekata je osnovna i česta praksa u rekonstrukcijskoj kirurgiji glave i vrata. Upotreba različitih vrsta autolognih presatka smanjilo je učestalost funkcionalnih i estetskih problema povezanih s ovakvim defektima. Hrskavica rebra predstavlja zamjenu kako i hrskavičnu tako i za koštanu komponentu. Kod rekonstrukcije uške kod pacijenata s mikrotijom, hrskavica rebra kao izbor presatka je pokazala značajne rezultate. Tako Nagatina metoda u dvije faze, a to su izrada trodimenzionalnog hrskavičnog okvira i operacija podizanje uha, daje znatne estetske i funkcionalne rezultate u rekonstrukciji uške. Postoje brojne modifikacije Nagatine metode, kao što je metoda po Siegertu i Magritzu koja imaju povoljan ishod u rekonstrukciji atrezije zvukovoda i povratku normalnog sluha kod pacijenta. U rekonstrukcijskoj kirurgiji nosa, odnosno rinoplastike, važno je detaljno analizirati i odrediti veličinu, položaj, oblik defekta i količinu rebrene i septalne hrskavice. Tako često kirurzi posežu za hrskavicom rebre u rinoplastici kada nema dovoljno septalne hrskavice koja bi se mogla koristiti za rekonstrukciju. Također prednost rebrene hrskavice daje se u sekundarnoj rinoplastici kada su strukture nosa već oštećene prijašnjim kriruškim zahvatom, a tada se može koristiti rebrena hrskavica za povoljni estetski i funkcionalni izgled pomoću nekoliko kirurških metoda, od kojih su najpoznatiji dorsal augmentation, spreader graft i koncept tronošca. Također, hrskavica rebra može se koristiti kao i presadak za rekonstrukciji defekata u području larinksa. Tako se prikuplja hrskavica rebra, specifično oblikuje u elipsu te se postavlja u prednjim i stražnjim strukturama glotisa i subglotisa u svrhu njegove rekonstrukcije. Mnogi zahvati u kojima se koristi hrskavica rebra pokazuju veliki uspjeh u rekonstrukciji, ali dodatno je nekad i potrebna revizija zbog traume, iskrivljenja hrskavice i postoperacijskih komplikacija.
Abstract (english) Head and neck reconstruction represents a complex area of surgery in which many grafting materials are available for reconstructing variable defects. One of the most common grafting material is a rib cartilage which are used to reconstruct variable deformities and defects in the nose, trachea and auricle. The reconstruction of different types of defects or deformities of congenital or acquired etiology is a fundamental and frequent practice in head and neck surgery. The use of different types of autogenous grafting and alloplastic materials has minimized the resultant functional and cosmetic problems associated with such defects and deformities. In ear reconstruction in patients with microtia, rib cartilage as a graft choice showed significant results. Thus, Nagata's method in two phases, namely the production of a three-dimensional cartilaginous frame and ear lifting operations, gives significant aesthetic and functional results in the reconstruction of the ear. There are numerous modifications of the Nagata method, such as the Siegert and Magritz method, which have a favorable outcome in the reconstruction of ear canal atresia and the return of normal hearing in the patient. In reconstructive surgery of the nose, rhinoplasty, it is important to analyze in detail and determine the size, position, shape of the defect and the amount of rib and septal cartilage. The rib cartilage is harvested in rhinoplasty when there is not enough septal cartilage that could be used for reconstruction. Also, rib cartilage is preferred in secondary rhinoplasty when the structures of the nose are already damaged by a previous surgical procedures and then rib cartilage can be used for more favorable aesthetic and functional appearance using several surgical methods, the most famous of which are dorsal augmentation, spreader graft and tripod concept. Also, rib cartilage can be used as a graft to reconstruct defects in the laryngeal area. Thus, the cartilage of the ribs is collected, specifically shaped into an ellipse, and placed in the anterior and posterior structures of the glottis and subglottis for the purpose of its reconstruction. Most of the procedures show a high efficiency in the usage of rib cartilage as a grafting material, but in some cases revision or replacement secondary to trauma, warping and post-surgical complications of the graft was required as well.
Keywords
hrskavica rebra
graft
rekonstrukcija defekata uške
Nagatina metoda
sekundarna rinoplastika
dorsal augmentation
tripod concept
rekonstrukcija laringealnih defekata
Keywords (english)
rib cartilage
graft
auricular defect reconstruction
Nagata method
rhinoplasty
dorsal augmentation
tripod concept
laryngeal reconstruction
Language croatian URN:NBN urn:nbn:hr:105:980004 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2022-03-07 10:20:53
