Rekonštrukcia čela a čelovej dutiny

Rekonštrukcia čela a čelovej dutiny sa robila pri úrazoch, zápaloch a nádoroch v tejtooblasti. Sledovaný súbor tvorí 19 pacientov liečených v rokoch 1996 až 2001 pre úraz čela (12), nádor(6) a zápal (1) v čelovej dutine. Na rekonštrukciu kostenej steny dutiny sa použili titanové minidlahy(6krát), kostný štep z lopaty panvovej kosti (3krát), chrupka z rebra (1krát), alebo sa kostné úlomkyfixovali silonovým stehom (6krát). Pre obliteráciu čelovej dutiny sme sa rozhodli len v prípade aksa rekonštrukcia nedala urobiť (4krát). V prípade frontobazálneho poranenia s poškodením zadnejsteny a mozgových obalov je potrebná spolupráca s neurochirurgom. Revízia vývodu čelovej dutinyje nevyhnutnou súčasťou operácie.

Klíčová slova:
rekonštrukcia čela, frontobazálne poranenie, titanové minidlahy.

Reconstruction of the Forehead and FrontalCavity

Reconstruction of the forehead and frontal cavity is necessary in case of injury, tumourand chronic inflammation in this region. From 1996 to 2001 19 patients were operated on for frontalfracture (12) tumour (6) and frontal sinusitis (1). The postoperative bone defect was reconstructedin all cases. Several approaches were used. In the case of injury with torn skin the operative fieldwas reached through the wound. Eyebrow incision was used in 7 cases, eyebrow incision with skinincision in nasal root in 5 cases, and coronal incision with scalp stripping was used in 5 cases wherewide frontal exposure was desired. Impression fracture of the frontal bone was managed either byelevation and fixation of bony fragments using permanent suture material or metal splints. Initiallya bony graft from the iliac crest, or rib cartilage was used for reconstruction of a large bony defect,now metal titanium minisplints and mesh are used instead. In three cases the anterior frontal wallwas destroyed by big osteoma and there was no healthy bone suitable for reconstruction. On patientsuffered from hyperostosis, which had to be removed. Aesthetic results were very good in all butone patient and a second operation because of sinusitis was required in two patients. In patientswith frontobasal fractures with liquorrhea and a damaged posterior wall cooperation with a neurosurgeon is neccessary. Peroperative revision of the frontonasal duct is recommended.

Key words:
forehead reconstruction, frontobasal injury, titanic minisplints, hyperostosis.

Autoři: P. Doležal; T. Barta; M. Profant ; J. Berkovič; Miroslav Tedla
Působiště autorů: Klinika ORL LF UK, FN a SPAM, Bratislava, prednosta prof. MUDr. M. Profant, CSc.
Vyšlo v časopise: Otorinolaryngol Foniatr, , 2002, No. 2, pp. 130-133.
Kategorie: Články