Kompozit Oromandibular Defektlerinin Rekonstrüksiyonu

Amaç: Mandibula defektleri çoğunlukla kemik defekte yumuşak doku defektininde eşlik ettiği kompozit defektler olarak gözlenmektedir. Bu durum rekonstrüksiyon sürecinde seçilecek cerrahi yöntemin belirlenmesinde zorluk yaratabilmektedir. Bu yazının amacı kompozit mandibuler defektlere klinik yaklaşımımızı ve sonuçlarımızı aktarmaktır.Yöntemler: 2011 - 2015 tarihleri arasında kliniğimize başvurun onbir hasta oromandibuler kanser nedeniyle kulak burun boğaz ekibi ile birlikte tek seanslı olarak opere edildi. Hastaların onu erkek biri kadındı. Yaş aralığı 7 ile 54 yaş arasında değişmekteydi (Ortalama yaş 35.5). Bulgular: Tüm hastalarda mandibula rezeksiyonu gerçekleştirilirken altı hastada buna eşlik eden cilt, sekiz hastada mukoza ve dört hastada ağız tabanı rezeksiyonları uygulandı. Oluşan kompozit defektler serbest fibula flebi veya serbest anterolateral thigh flebi ile rekonstrükte edildi. Postoperatif dönemde bir hastada total flep kaybı gözlenirken, bir hastanın flep donör alanında enfeksiyon gelişti. Uzun dönemde iki hastada uzak metastaz bir hastada lokal nüks gözlendi.Sonuç: Kompozit mandibular defektlerin onarımında; fibula serbest flebi sağladığı kemik uzunluğu, osteotomiye uygun oluşu ve düşük donör alan morbiditesi nedeniyle ilk seçenek olarak düşünülebilir. Yinede bu olgularda uygun rekonstrüksiyon yönteminin tespitinde hastanın yaşı, sağlık durumu, defektin yeri ve tipinin göz önünde bulundurulması gerekmektedir

Reconstruction of Composit Oromandibular Defects

Objective: Mandibular defects are generally observed as composite defects which soft tissue defects are accompanied to bone defects. This situation may cause difficulties in choosing the surgical method during the reconstruction period. The purpose of this paper is to convey our clinical approach and results on composite mandibular defects.Methods: Eleven patients, applying to our clinic between 2011 and 2015, were operated in a single session with the team of otorhinolaryngology, because of oromandibular cancer. Ten of the patients were male and one was woman. The age range was between 7 and 54 ages (Average age 35.5).Results: While mandibular resection was performed on all patients, skin resection was performed on six patients, mucosa resection was applied on eight patients; and floor of mouth resections on four patients. The occurring composite defects were reconstructed with free fibular flap or free anterolateral thigh flap. In postoperative period total flap loss was observed in one patient, an infection got developed in the flap donor area of one patient. In the long term, distant metastasis was observed in two patients and local relapse in one patient.Discussion: In the repair of composite mandibular defects, fibula free flap can be considered as the first option with regard to its bone length, suitability for osteotomy and low donor area morbidity. However, in these cases, it is necessary to consider the patient’s age, health condition, location and type of defect in the determination of the suitable reconstruction method

Kaynakça

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