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OP-Journal 2018; 34(01): 61-67
DOI: 10.1055/s-0043-123614
Fachwissen
Georg Thieme Verlag KG Stuttgart · New York

Knochenentnahme am Becken aus Sicht der Mund-, Kiefer- und Gesichtschirurgie

Bone From the Pelvis: Application to Oral and Maxillofacial Surgery
Nora Lautner
,
Frank Hölzle
,
Ali Modabber
Further Information

Publication History

Publication Date:
26 April 2018 (online)

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Zusammenfassung

Autologer Knochen bietet durch seine positiven Eigenschaften wie Osteoinduktion, -konduktion und -genese unter Vermeidung immunologischer Risiken die idealen Voraussetzungen zur erfolgreichen Augmentation oder Rekonstruktion im mund-, kiefer- und gesichtschirurgischen Bereich. Der anteriore Beckenkamm stellt aufgrund seiner vielen Vorteile wie gute Verfügbarkeit, ausreichendes Knochenangebot und mannigfaltiger Auswahl an Knochenqualitäten (kortikal, kortikospongiös, spongiös) sowie der geringen Entnahmemorbidität den „Goldstandard“ dar. Die Entnahme aus dem posterioren Beckenkamm bietet die Möglichkeit, bei ausgeprägtem Augmentationsbedarf größere Mengen freien Knochens zu transplantieren. Diese geht jedoch gleichzeitig mit dem Nachteil der Patientenumpositionierung und dem damit verbundenen erhöhten intraoperativen Zeitaufwand einher. Durch die Verwendung eines mikrochirurgischen Beckenkammtransplantats können große, bis zur Unterkiefermitte reichende Knochenanteile des Unterkiefers rekonstruiert werden. Im späteren Verlauf ermöglicht der Einsatz enossaler Implantate eine erfolgreiche mastikatorische Rehabilitation. Die Art und Qualität jedes einzelnen Knochentransplantats – unabhängig davon, ob frei oder mikrovaskulär – sollte immer sorgfältig geprüft und entsprechend dem Bedarf eines jeden Patienten individuell ausgewählt sowie sorgsam durchgeführt werden.

Abstract

Autologous iliac crest bone grafts are the gold standard for augmenting bone in oral and maxillofacial surgery. The principles of osteoinduction, osteoconduction, and osteogenesis can be used to optimise the long-term results. Histocompatible bone grafts of the same individual help to prevent immune reactions and transmission of infectious diseases. Iliac crest grafting rapidly became popular during World War I and II for maxillofacial reconstruction. Advantages of iliac crest bone include a short healing period and decreased susceptibility to infections. The anterior iliac crest has always been a commonly used donor site. The posterior crest can be chosen if large amounts of bone are needed. Other sources to harvest autologous bone – such as tibia, femur, or ribs – are widely described in the literature. Therapeutic bone reconstruction depends on the approach, the amount, the nature of the graft (free graft vs. microvascular bone flap), and the quality of bone (cortical, corticocancellous or cancellous bone) and should be chosen for each patient individually.

Schlüsselwörter

Mikrovaskuläres Beckenkammtransplantat - Kieferrekonstruktion - Beckenkammknochen - Kieferaugmentation - Beckenkamm

Key words

DCIA Flap - jaw reconstruction - iliac bone graft - jaw augmentation - iliac crest
 

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