Rekonstruktion von Oberkieferdefekten mit einem freien Skapula-angle-Lappen

Zusammenfassung: Hintergrund: Neben der prothetischen Versorgung von Maxilladefekten gibt es Möglichkeiten der chirurgischen Rekonstruktion: die Weichgeweberekonstruktion mit einem Radialis- oder Latissimus-dorsi-Lappen und die knöcherne Rekonstruktion mittels Fibula, Beckenkamm oder Skapulalappen. Die Rekonstruktion mit einem Skapulalappen wird unterteilt in den traditionellen Skapulalappen mit der A.scapularis circumflexa und den Skapula-angle-Lappen mit der A.angularis aus der A.thoracodorsalis als versorgendem Gefäß. Material und Methoden: Wir berichten über 4Patienten, die zwischen 2009 und 2011 aufgrund von malignen Tumoren der Maxilla nach erfolgter Resektion eine Rekonstruktion mit einem freien Skapula-angle-Lappen erhalten haben. Ergebnisse: Die Möglichkeit vertikaler Positionierung des Skapula-angle-Lappens erlaubt die Rekonstruktion der fazialen Kontur. Bei horizontaler Ausrichtung des mikrovaskulär anastomosierten Skapula-angle-Lappens ist eine zusätzliche knöcherne Rekonstruktion des Gaumens möglich. Schlussfolgerung: Der Skapula-angle-Lappen eignet sich wegen seiner Variabilität, geringer Donormorbidität und aufgrund seiner Form, die der des Hartgaumens ähnelt, gut zur plastischen Rekonstruktion. Die knöcherne Beschaffenheit für eine dentale Rehabilitation mithilfe von Implantaten wird kontrovers diskutiert. Er stellt eine Alternative zur Versorgung ausgewählter Maxilladefekte ≥ GradI nach Okay mit einer Obturatorprothese da

Rekonstruktion von Oberkieferdefekten mit einem freien Skapula-angle-Lappen [Reconstruction of maxillary defects using a free scapular angle flap].

BACKGROUND: In addition to prosthetic rehabilitation, maxillary defects can also be surgically reconstructed. Soft-tissue reconstruction employs a radial forearm or latissimus dorsi muscle flap, while bony reconstruction can be achieved using a fibula, iliac crest, or scapular flap. Reconstruction using a scapular flap is further divided into two subgroups: the traditional scapular flap with the circumflex scapular artery as the donor vessel and the scapular angle flap with the angular artery originating from the thoracodorsal artery as the donor vessel. MATERIALS AND METHODS: We report on four patients who underwent successful reconstruction with a free scapular angle flap between 2009 and 2011, following maxillary resection due to malignancy. RESULTS: Vertical positioning of the scapular angle flap enables reconstruction of the facial contour, whereas its horizontal alignment and microvascular anastomosis makes a bony reconstruction of the hard palate possible. CONCLUSIONS: The versatility, low rate of donor site morbidity and shape of the scapular angle flap--which resembles that of the hard palate--render it ideal for plastic reconstruction. The suitability of bone quality for dental rehabilitation with implants is a topic of controversial discussion. The scapular angle flap represents an alternative to obturator prosthesis for the reconstruction of maxillary defects ≥ grade I according to Okay et al

Topographic bone thickness maps to evaluate the intuitive placement of titanium miniplates for nasal prostheses

The aim of this study was to evaluate the intuitive placement of titanium miniplates. The hypothesis was that virtual planning can improve miniplate placement. Twenty patients were included in the study. These patients were fitted with 21 titanium miniplates (16 y-plates, three t-plates, and two u-plates) to retain nasal prostheses between 2005 and 2017. Colour-coded topographic bone thickness maps (TBTMs) were created in fused pre- and postoperative computed tomography. Implants were virtually transposed at the position of highest bone thickness. The bone thickness index (BTI) was calculated as the sum of points assigned at each screw (1 point per millimetre up to 4 mm, and 5 points for greater values) divided by the number of screws. One plate broke after 2.8 years, thus plate survival after 5 years was 91% using the Kaplan-Meier method. The BTI for all 21 plates increased from 3.4 to 4.1 points using virtual transposition (P<0.001). No significant changes were observed in t- and u-plates, but the median BTI increased from 3.1 to 4.1 points (P<0.0005) in 16 y-plates. The change was substantial (≥0.5 points) in 9/16 y-plates. Therefore, the hypothesis that virtual planning improves implant placement was accepted

Robotik - Ein Evolutionssprung in der operativen Medizin?

Robots have led to a revolution in industrial production methods. They also entered many aspects of operative medicine. Manipulators are used in laparoscopic and cardiothoracic surgery. Due to their precision, tirelessness and rapidity, robots are used on orthopaedic and trauma surgery. However, they have a great potential for applications in other operative specialities, such as ear, nose and throat surgery as well as head and neck surgery. When robotic systems are further developed and integrated routinely into surgery, they will represent a step forward in the evolution of operative medicine

Tumor DNA-methylome derived epigenetic fingerprint identifies HPV-negative head and neck patients at risk for locoregional recurrence after postoperative radiochemotherapy.

Biomarkers with relevance for loco-regional therapy are needed in Human Papillomavirus negative aka HPV(-) Head and Neck Squamous Cell Carcinoma (HNSCC). Based on the premise that DNA methylation pattern is highly conserved, we sought to develop a reliable and robust methylome-based classifier identifying HPV(-) HNSCC patients at risk for loco-regional recurrence (LR) and all-event progression after postoperative radiochemotherapy (PORT-C). The training cohort consisted of HPVDNA negative HNSCC patients (n=128) homogeneously treated with PORT-C in frame of the German Cancer Consortium - Radiation Oncology Group (DKTK-ROG) multicenter biomarker trial. DNA Methylation analysis was performed using Illumina 450K and 850K-EPIC microarray technology. The performance of the classifier was integrated with a series of biomarkers studied in training set, namely hypoxia-, 5-microRNA (5-miR)-, stem-cell gene-expression signatures and immunohistochemistry (IHC)-based immunological characterization of tumors (CD3/CD8/PD-L1/PD1). Validation occurred in an independent cohort of HPV(-) HNSCC patients, pooled from two German centers (n=125). We identified a 38-methylation probe-based HPV(-) Independent Classifier of disease Recurrence (HICR) with high prognostic value for LR, distant metastases and overall survival (p&lt;10-9 ). HICR remained significant after multivariate analysis adjusting for anatomical site, lymph node extracapsular extension (ECE) and size (T-stage). HICR high-risk tumors were enriched for younger patients with hypoxic tumors (15-gene signature) and elevated 5-miR score. After adjustment for hypoxia and 5-miR covariates, HICR maintained predicting all endpoints. HICR provides a novel mean for assessing the risk of LR in HPV(-) HNSCC patients treated with PORT-C and opens a new opportunity for biomarker-assisted stratification and therapy adaptation in these patients. This article is protected by copyright. All rights reserved