Granström G, Jacobsson C
Department of Otolaryngology, Head and Neck Surgery, and Department of Pedodontics, University of Göteburg, Gothenburg, Sweden.
Clin Implant Dent Relat Res. 1999;1(2):59-69. doi: 10.1111/j.1708-8208.1999.tb00093.x.
The osseointegration concept has dramatically changed the possibility of rehabilitating patients with craniofacial defects due to branchial arch syndromes.
This article describes some problems related to the investigative routines and rehabilitation of individuals with malformations of the first and second branchial arches of the craniofacial region. Animal model systems have increased the knowledge of basic embryonic processes that can explain the extent of the malformations. Though most clinical first and second branchial arch syndromes are likely to be caused by sporadic mutations, inherited syndromes occur and also teratogenically induced syndromes are known. Prenatal diagnosis ruling out heredity and exogenous influence seems possible in the future. The possibility of preventing and alleviating fulminant syndromes prenatally also could be conceivable in the future.
The rehabilitation process starts early after birth and should involve a team of specialists including clinical geneticists, pediatricians, audiologists, plastic surgeons, maxillofacial surgeons, otosurgeons, anaplastologists, speech pathologists, pedodontists, and orthodontists. With the development of the osseointegration concept in which craniofacial prostheses and hearing aids can be adapted on implants anchored in the craniofacial skeleton, a new field in the rehabilitation of these malformations has opened.
Important aspects in the use of the osseointegration concept include determination of the lowest age for implant surgery, accessibility of adequate bone for implants, the growth of the craniofacial skeleton during childhood, and the possibility for the patient and his or her parents to care for the skin penetration. Adverse tissue reactions, durability of craniofacial prostheses, and the possibility of unknown adverse reactions to metal implants in the body over a long time are other aspects of concern.
Patients with branchial arch syndromes benefit from a well-planned multidisciplinary rehabilitation process in which osseointegrated bone-anchored hearing aids and bone-anchored ear prostheses can be useful tools.
骨整合概念极大地改变了因鳃弓综合征导致颅面缺损患者的康复可能性。
本文描述了与颅面区域第一和第二鳃弓畸形个体的调查程序及康复相关的一些问题。动物模型系统增加了对基本胚胎过程的认识，这些过程可以解释畸形的程度。尽管大多数临床第一和第二鳃弓综合征可能由散发性突变引起，但遗传性综合征也会出现，并且已知有致畸剂诱发的综合征。未来，产前诊断排除遗传和外源性影响似乎是可能的。未来也可以设想在产前预防和减轻暴发性综合征的可能性。
康复过程在出生后尽早开始，应包括一组专家，其中有临床遗传学家、儿科医生、听力学家、整形外科医生、颌面外科医生、耳外科医生、整形修复专家、言语病理学家、儿童牙医和正畸医生。随着骨整合概念的发展，颅面假体和助听器可以适配于锚固在颅面骨骼中的植入物，这为这些畸形的康复开辟了一个新领域。
骨整合概念应用中的重要方面包括确定植入手术的最低年龄、植入物可用的充足骨量、儿童期颅面骨骼的生长，以及患者及其父母护理经皮植入物的可能性。不良组织反应、颅面假体的耐用性以及身体对金属植入物长期未知的不良反应可能性是其他需要关注的方面。
鳃弓综合征患者受益于精心规划的多学科康复过程，其中骨整合式骨锚定助听器和骨锚定耳假体可能是有用的工具。
