Knochenentnahme am Becken aus Sicht der Mund-, Kiefer- und Gesichtschirurgie

Zusammenfassung

Autologer Knochen bietet durch seine positiven Eigenschaften wie Osteoinduktion, -konduktion und -genese unter Vermeidung immunologischer Risiken die idealen Voraussetzungen zur erfolgreichen Augmentation oder Rekonstruktion im mund-, kiefer- und gesichtschirurgischen Bereich. Der anteriore Beckenkamm stellt aufgrund seiner vielen Vorteile wie gute Verfügbarkeit, ausreichendes Knochenangebot und mannigfaltiger Auswahl an Knochenqualitäten (kortikal, kortikospongiös, spongiös) sowie der geringen Entnahmemorbidität den „Goldstandard“ dar. Die Entnahme aus dem posterioren Beckenkamm bietet die Möglichkeit, bei ausgeprägtem Augmentationsbedarf größere Mengen freien Knochens zu transplantieren. Diese geht jedoch gleichzeitig mit dem Nachteil der Patientenumpositionierung und dem damit verbundenen erhöhten intraoperativen Zeitaufwand einher. Durch die Verwendung eines mikrochirurgischen Beckenkammtransplantats können große, bis zur Unterkiefermitte reichende Knochenanteile des Unterkiefers rekonstruiert werden. Im späteren Verlauf ermöglicht der Einsatz enossaler Implantate eine erfolgreiche mastikatorische Rehabilitation. Die Art und Qualität jedes einzelnen Knochentransplantats – unabhängig davon, ob frei oder mikrovaskulär – sollte immer sorgfältig geprüft und entsprechend dem Bedarf eines jeden Patienten individuell ausgewählt sowie sorgsam durchgeführt werden.

Abstract

Autologous iliac crest bone grafts are the gold standard for augmenting bone in oral and maxillofacial surgery. The principles of osteoinduction, osteoconduction, and osteogenesis can be used to optimise the long-term results. Histocompatible bone grafts of the same individual help to prevent immune reactions and transmission of infectious diseases. Iliac crest grafting rapidly became popular during World War I and II for maxillofacial reconstruction. Advantages of iliac crest bone include a short healing period and decreased susceptibility to infections. The anterior iliac crest has always been a commonly used donor site. The posterior crest can be chosen if large amounts of bone are needed. Other sources to harvest autologous bone – such as tibia, femur, or ribs – are widely described in the literature. Therapeutic bone reconstruction depends on the approach, the amount, the nature of the graft (free graft vs. microvascular bone flap), and the quality of bone (cortical, corticocancellous or cancellous bone) and should be chosen for each patient individually.

Schlüsselwörter

Mikrovaskuläres Beckenkammtransplantat - Kieferrekonstruktion - Beckenkammknochen - Kieferaugmentation - Beckenkamm

Key words

DCIA Flap - jaw reconstruction - iliac bone graft - jaw augmentation - iliac crest

• Literatur

• 1 Albee FH, Weigel EP. Restoration of loss of bone: including an analysis of the first hundred cases of fracture treated by bone graft at US Army General Hospital No. 3, Colonia, NJ. J Am Med Assoc 1920; 74: 589-597
• 2 Mowlem AR. Cancellous chip grafts for the restoration of bone defects. Lancet 1945; ii: 746
• 3 Blocker jr. T, Weiss L. Use of cancellous bone in the repair of defects about the jaws. Ann Surg 1946; 123: 622
• 4 Dimitriou R, Mataliotakis GI, Angoules AG. et al. Complications following autologous bone graft harvesting from the iliac crest and using the RIA: a systematic review. Injury 2011; 42 (Suppl. 02) S3-S15
• 5 Kummoona R. Chondro-osseous iliac crest graft for one stage reconstruction of the ankylosed TMJ in children. J Maxillofac Surg 1986; 14: 215-220
• 6 MacIntosh RB, Henny FA. A spectrum of application of autogenous costochondral grafts. J Maxillofac Surg 1977; 5: 257-267
• 7 Wolford LM, Cottrell DA, Henry C. Sternoclavicular grafts for temporomandibular joint reconstruction. J Oral Maxillofac Surg 1994; 52: 119-128
• 8 Hausamen JE, Machtens E, Reuther J, Eufinger H, Kübler A, Schliephake H. Mund-, Kiefer- und Gesichtschirurgie. Berlin, Heidelberg: Springer; 2012
• 9 Baqain ZH, Anabtawi M, Karaky AA. et al. Morbidity from anterior iliac crest bone harvesting for secondary alveolar bone grafting: an outcome assessment study. J Oral Maxillofac Surg 2009; 67: 570-575
• 10 Thorwarth M, Srour S, Felszeghy E. et al. Stability of autogenous bone grafts after sinus lift procedures: a comparative study between anterior and posterior aspects of the iliac crest and an intraoral donor site. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005; 100: 278-284
• 11 Burk T, Del Valle J, Finn RA. et al. Maximum quantity of bone available for harvest from the anterior iliac crest, posterior iliac crest, and proximal tibia using a standardized surgical approach: a cadaveric study. J Oral Maxillofac Surg 2016; 74: 2532-2548
• 12 Schaaf H, Lendeckel S, Howaldt H-P. et al. Donor site morbidity after bone harvesting from the anterior iliac crest. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109: 52-58
• 13 Swan M, Goodacre T. Morbidity at the iliac crest donor site following bone grafting of the cleft alveolus. Br J Oral Maxillofac Surg 2006; 44: 129-133
• 14 Fretwurst T, Wanner L, Nahles S. et al. A prospective study of factors influencing morbidity after iliac crest harvesting for oral onlay grafting. J Craniomaxillofac Surg 2015; 43: 705-709
• 15 Scott W, Petersen RC, Grant S. A method of procuring iliac bone by trephine curettage. J Bone Joint Surg Am 1949; 31: 860
• 16 Freilich MM, Sándor GK. Ambulatory in-office anterior iliac crest bone harvesting. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 101: 291-298
• 17 Mrazik J, Amato C, Leban S. et al. The ilium as a source of autogenous bone for grafting: clinical considerations. J Oral Surg Am Dent Assoc 1965 1980; 38: 29-32
• 18 Farhood V, Ryan D, Johnson R. A modified approach to the ilium to obtain graft material. J Oral Surg Am Dent Assoc 1965 1978; 36: 784-786
• 19 Kazanjian VH, Converse JM. Kazanjian & Converseʼs surgical treatment of facial injuries (Vol. 1). Baltimore: Williams & Wilkins; 1974: 573-577
• 20 Levy R, Siffert R. Inner table iliac bone graft. Surg Gynecol Obstet 1969; 128: 605
• 21 Hall M, Smith R. The medial approach for obtaining iliac bone. J Oral Surg Am Dent Assoc 1965 1981; 39: 462-465
• 22 Hall MB, Vallerand WP, Thompson D. et al. Comparative anatomic study of anterior and posterior iliac crests as donor sites. J Oral Maxillofac Surg 1991; 49: 560-563
• 23 Ahlmann E, Patzakis M, Roidis N. et al. Comparison of anterior and posterior iliac crest bone grafts in terms of harvest-site morbidity and functional outcomes. J Bone Joint Surg Am 2002; 84: 716-720
• 24 Ebraheim N A, Yang H, Lu J. et al. Anterior iliac crest bone graft: anatomic considerations. Spine 1997; 22: 847-849
• 25 Kurz LT, Garfin SR, Booth jr. RE. Harvesting autogenous iliac bone grafts: a review of complications and techniques. Spine 1989; 14: 1324-1331
• 26 Bloomquist DS, Feldman GR. The posterior ilium as a donor site for maxillo-facial bone grafting. J Maxillofac Surg 1980; 8: 60-64
• 27 Engelstad ME, Morse T. Anterior iliac crest, posterior iliac crest, and proximal tibia donor sites: a comparison of cancellous bone volumes in fresh cadavers. J Oral Maxillofac Surg 2010; 68: 3015-3021
• 28 Sittitavornwong S, Falconer DS, Shah R. et al. Anatomic considerations for posterior iliac crest bone procurement. J Oral Maxillofac Surg 2013; 71: 1777-1788
• 29 Dingman RO. The use of iliac bone in the repair of facial and cranial defects. Plast Reconstr Surg 1950; 6: 179-195
• 30 Kolomvos N, Iatrou I, Theologie-Lygidakis N. et al. Iliac crest morbidity following maxillofacial bone grafting in children: a clinical and radiographic prospective study. J Craniomaxillofac Surg 2010; 38: 293-302
• 31 Modabber A, Peters F, Raith S. et al. Virtuelle Planung komplexer mikrovaskulärer knöcherner Rekonstruktionen in der MKG-Chirurgie. MKG-Chir 2017; 10: 272-283
• 32 Ueba Y, Fujikawa S. Nine yearsʼ follow-up of a free vascularized fibular graft in neurofibromatosis: a case report and literature review. Jpn J Orthop Trauma Surg 1983; 26: 595-600
• 33 Kärcher H, Penkner K. Ergebnisse der freien und gefäßgestielten Knochenrekonstruktion nach Unterkieferkontinuitätsdefekten. Dtsch Z Mund Kiefer Gesichtschir 1991; 15: 285-291
• 34 Bitter K. Bone transplants from the iliac crest to the maxillo-facial region by the microsurgical technique. J Maxillofac Surg 1980; 8: 210-216
• 35 Riediger D. Restoration of masticatory function by microsurgically revascularized iliac crest bone grafts using enosseous implants. Plast Reconstr Surg 1988; 81: 861-876
• 36 Blake F, Bubenheim M, Heiland M. et al. Retrospective assessment of the peri-implant mucosa of implants inserted in reanastomosed or free bone grafts from the fibula or iliac crest. Int J Oral Maxillofac Implants 2008; 23: 1102-1108
• 37 Taylor GI, Daniel RK. The anatomy of several free flap donor sites. Plast Reconstr Surg 1975; 56: 243-253
• 38 Sanders R, Mayou BJ. A new vascularized bone graft transferred by microvascular anastomosis as a free flap. Br J Surg 1979; 66: 787-788
• 39 Bianchi B, Ferri A, Ferrani S. et al. Iliac crest free flap for maxillary reconstruction. J Oral Maxillofac Surg 2010; 68: 2706-2713
• 40 Modabber A, Gerresen M, Ayoub N. et al. Computer-assisted zygoma reconstruction with vascularized iliac crest bone graft. Int J Med Robot 2013; 9: 497-502
• 41 Taylor GI, Watson N. One-stage repair of compound leg defects with free, revascularized flaps of groin skin and iliac bone. Plast Reconstr Surg 1978; 61: 494-506
• 42 Kärcher H. Die Unterkieferrekonstruktion mit freien mikrovaskulären Knochentransplantaten. Acta Chir Austriaca 1986; 33: 251
• 43 Urken ML, Vickery C, Weinberg H. et al. The internal oblique-iliac crest osseomyocutaneous microvascular free flap in head and neck reconstruction. J Reconstr Microsurg 1989; 5: 203-214
• 44 Urken ML, Vickery C, Weinberg H. et al. The internal oblique-iliac crest osseomyocutaneous free flap in oromandibular reconstruction: report of 20 cases. Arch Otolaryngol Neck Surg 1989; 115: 339-349
• 45 Modabber A, Legros C, Rana M. et al. Evaluation of computer-assisted jaw reconstruction with free vascularized fibular flap compared to conventional surgery: a clinical pilot study. Int J Med Robot 2012; 8: 215-220
• 46 Modabber A, Möhlhenrich SC, Ayoub N. et al. Computer-aided mandibular reconstruction with vascularized iliac crest bone flap and simultaneous implant surgery. J Oral Implantol 2015; 41: e189-e194
• 47 Ghassemi A, Ghassemi M, Riediger D. et al. Comparison of donor-site engraftment after harvesting vascularized and nonvascularized iliac bone grafts. J Oral Maxillofac Surg 2009; 67: 1589-1594
• 48 Ayoub N, Ghassemi A, Rana M. et al. Evaluation of computer-assisted mandibular reconstruction with vascularized iliac crest bone graft compared to conventional surgery: a randomized prospective clinical trial. Trials 2014; 15: 114