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Publication
Técnicas de reconstrução mandibular
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Advisor(s)
Abstract(s)
Os defeitos de continuidade da mandíbula podem ter várias etiologias (como tumores, traumas e osteonecrose), mas têm algo em comum: um enorme impacto negativo na vida dos pacientes porque provocam sofrimento físico e psicológico por causa dos problemas funcionais e estéticos que produzem.
A reconstrução de defeito de continuidade da mandíbula é desafiadora devido à complexidade anatómica deste osso e à variedade de funções vitais que a mandíbula participa, tais como respiração, fonação, deglutição e mastigação.
Existem várias técnicas que podem ser utilizadas para reconstruir estes defeitos, tais como reconstruções usando implantes aloplásticos, xenoenxertos, aloenxertos e autoenxertos.
O objetivo deste trabalho foi realizar uma revisão para investigar as vantagens e desvantagens de cada tipo de enxerto, entre as técnicas com aplicação clínica nas reconstruções mandibulares.
Verificamos que existem importantes limitações entre todos os tipos de enxertos, porém os enxertos que oferecem as maiores vantagens são os enxertos autólogos vascularizados. Estes enxertos apresentam uma limitação importante pois podem acarretar sofrimento ao paciente, pois exigem que sejam colhidos tecidos de uma área dadora a fim de usar para reconstruir a mandíbula e existe o risco de morbidade da área. A expectativa é que no futuro, com o avanço dos biomateriais e das tecnologias de engenharia de tecido ósseo, possam surgir opções de tratamento que tenham taxas de sucesso semelhantes aos autoenxertos vascularizados sem a limitação acarretar morbidade da área dadora.
Até à data, o tipo de enxerto que tem mais vantagens para realizar a reconstrução de defeitos de continuidade na mandíbula é o enxerto autógeno vascularizado.
Defects in the continuity of the mandible can have various etiologies (such as tumors, trauma, and osteonecrosis), but they all have one thing in common: they have a devastating effect on the lives of patients because they cause physical and psychological suffering due to the functional and aesthetic issues they entail. The reconstruction of a mandibular continuity defect is difficult due to the anatomical complexity of this bone and the diversity of critical tasks that the mandible performs, including respiration, phonation, swallowing, and chewing. These defects can be reconstructed utilizing a variety of procedures, including alloplastic implant reconstructions, xenografts, allografts, and autografts. The purpose of this study was to explore the advantages and disadvantages of each graft type among the procedures with clinical applicability in mandibular reconstructions. All types of grafts have significant drawbacks, but vascularized autologous grafts give the most benefits. To reconstruct the mandible, these grafts require the harvesting of tissue from a donor site, and there is a danger of morbidity at the donor site. As a result, these grafts present a significant limitation because they may cause significant suffering. With the improvement of biomaterials and bone tissue engineering technologies, it is expected that in the future, therapeutic options with success rates comparable to those of vascularized autografts will become available without creating morbidity in the donor area. To date, the type of graft that has the most advantages for performing the reconstruction of continuity defects in the mandible is the vascular autogenous graft.
Defects in the continuity of the mandible can have various etiologies (such as tumors, trauma, and osteonecrosis), but they all have one thing in common: they have a devastating effect on the lives of patients because they cause physical and psychological suffering due to the functional and aesthetic issues they entail. The reconstruction of a mandibular continuity defect is difficult due to the anatomical complexity of this bone and the diversity of critical tasks that the mandible performs, including respiration, phonation, swallowing, and chewing. These defects can be reconstructed utilizing a variety of procedures, including alloplastic implant reconstructions, xenografts, allografts, and autografts. The purpose of this study was to explore the advantages and disadvantages of each graft type among the procedures with clinical applicability in mandibular reconstructions. All types of grafts have significant drawbacks, but vascularized autologous grafts give the most benefits. To reconstruct the mandible, these grafts require the harvesting of tissue from a donor site, and there is a danger of morbidity at the donor site. As a result, these grafts present a significant limitation because they may cause significant suffering. With the improvement of biomaterials and bone tissue engineering technologies, it is expected that in the future, therapeutic options with success rates comparable to those of vascularized autografts will become available without creating morbidity in the donor area. To date, the type of graft that has the most advantages for performing the reconstruction of continuity defects in the mandible is the vascular autogenous graft.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Reconstrução mandibular Enxerto Defeito mandibular Continuidade