Gellrich Nils-Claudius, Eckstein Fabian Matthias, Lentge Fritjof, Zeller Alexander-Nicolai, Korn Philippe
Klinik und Poliklinik für Mund‑, Kiefer- und Gesichtschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
Unfallchirurg. 2021 Oct;124(10):807-816. doi: 10.1007/s00113-021-01076-6. Epub 2021 Sep 9.
Posttraumatic reconstruction of the neurocranium and viscerocranium is an essential part of modern oral and maxillofacial surgery, in addition to oncological surgery, surgery of congenital craniofacial deformities and dental surgery. Due to the complex anatomy of the facial skull and significant esthetic and functional demands on its reconstruction, reconstructive trauma surgery in this area places the highest demands on the surgeon. This is all the more true if definitive craniomaxillofacial surgical treatment can sometimes only be performed with considerable delays for the benefit of other life-threatening injuries. In order to take these prerequisites into account, achievements of modern biomedical technology, such as intraoperative real-time navigation, computer-assisted planning and computer-assisted manufacturing (CAD/CAM) of patient-specific biomodels and implants, came up early for use in oral and maxillofacial surgery. In combination with intraoperative three-dimensional imaging, these methods result in a treatment pathway tailored to the individual patient, which is directly checked for quality at every step and thus ensures the best possible result for the patient. The use of these technologies extends far beyond the original indications in the area of orbital reconstruction and restoration of bony defects with simple geometry, such as skull defects. Nowadays, even the most complex pan-facial fractures can be restored esthetically and functionally by means of digitalized preliminary planning and individualized skull, orbital and zygomatic implants as well as total temporomandibular joint prostheses.
除了肿瘤手术、先天性颅面畸形手术和牙科手术外,创伤后颅盖骨和面颅骨重建是现代口腔颌面外科的重要组成部分。由于面颅骨解剖结构复杂,对其重建有很高的美学和功能要求,该领域的重建创伤手术对外科医生的要求极高。如果有时为了处理其他危及生命的损伤而不得不延迟进行确定性的颅颌面外科治疗,情况更是如此。为了考虑到这些前提条件,现代生物医学技术的成果,如术中实时导航、计算机辅助规划以及针对患者的生物模型和植入物的计算机辅助制造(CAD/CAM),很早就开始应用于口腔颌面外科。这些方法与术中三维成像相结合,形成了一条针对个体患者的治疗路径,该路径在每一步都能直接检查质量,从而为患者确保最佳可能的结果。这些技术的应用远远超出了最初在眼眶重建和修复简单几何形状的骨缺损(如颅骨缺损)方面的适应症。如今,即使是最复杂的全颜面骨折,也可以通过数字化的初步规划、个性化的颅骨、眼眶和颧骨植入物以及全颞下颌关节假体,在美学和功能上得到修复。