Estudo anatômico de áreas doadoras de enxertos ósseos da mandíbula e da crista ilíaca anterior, para reconstruções ósseas dos maxilares
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Data
2018-03-02
Autores
Ferreira, Gabriely [UNESP]
Título da Revista
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
As reconstruções maxilofaciais, cada vez mais utilizadas para o reparo das deficiências dos tecidos ósseos na face ou nos maxilares, são cirurgias demasiadamente importantes. Elas não devolvem apenas a função local, mas também, em muitos casos, restabelecem a autoestima do paciente, e assim, melhoram sua qualidade de vida. Para as grandes reconstruções ósseas, a quantidade de tecido ósseo necessário como substrato para a realização do enxerto, muitas vezes é um fator limitante. Este estudo observacional foi planejado, para avaliar a anatomia e a quantidade óssea do processo coronóide da mandíbula, do mento e da crista ilíaca anterior. Quinhentas e dez mandíbulas secas foram analisadas e medidas em pontos pré-determinados, por meio de um paquímetro digital. Após as medidas, foi estabelecida a média da espessura e das medidas lineares do processo coronóide; a media de espessura de pontos do mento e a média de espessura de pontos da crista ilíaca anterior, bem como uma estimativa de volume para este último. Observou-se que a crista ilíaca anterior apresentou uma estimativa média de volume ósseo de 21.347,19 mm3 e 21.125,56 mm3 para o lado esquerdo e direito, respectivamente. O processo coronóide apresentou menor espessura (2,11 mm) e tamanho linear (5,77 mm) em sua porção mais superior e maior espessura (3,63 mm) e tamanho linear (14,51 mm) na sua base, em média. No mento, foi observada maior média de espessura na linha média (12,90 mm), além disso, essa espessura foi 1,57 mm maior no sexo masculino. A crista ilíaca anterior fornece grande quantidade de volume ósseo, comparada com áreas intraorais. O conhecimento das medidas médias destes reparos anatômicos, que são utilizados como doadores de tecido ósseo para as reconstruções faciais, é de grande valia para os cirurgiões. Este trabalho traz uma coleção de dados que visa facilitar a escolha dos cirurgiões quanto a área de escolha para remoção do enxerto e ainda tornar a cirurgia mais segura e previsível.
Maxillofacial reconstructions, used for the repair of boneless areas of the face or jaw, are extremely important surgeries. They restore the local function and in many cases, also restore the patient's self-esteem, and thus, improve their quality of life. For extensive maxillary reconstructions, the amount of bone tissue required as a substrate for grafting is often a limiting factor. This observational study was designed to evaluate the anatomy and the amount of bone found in the coronoid process, chin and anterior iliac crest. Five hundred and ten dry mandibles were analyzed and measured at predetermined points by a digital calypter. After the measurements, the mean thickness and linear measurements of the coronoid process were established; the mean thickness of points of the chin and the mean thickness of points of the anterior iliac crest, as well as an estimate of volume of the iliac crest. It was observed that the anterior iliac crest had an average bone volume estimate of 21,347.19 mm3 and 21.125,56 mm3 for the left and right sides, respectively. The coronoid process had a smaller thickness (2.11 mm) and linear (5.77 mm) in its uppermost portion and greater thickness (3.63 mm) and linear (14.51 mm) in its base, on average. At the chin, a greater mean thickness was observed in the midline (12.90 mm), in addition, this thickness was 1.57 mm greater in males. The anterior iliac crest provides a large amount of bone volume, compared to intra-oral areas. The knowledge of the average measurements of these anatomical structures, which are used as donors of bone tissue for facial reconstructions, is of great value to surgeons. This work brings a collection of data that aims to facilitate the surgeon´s choice of the area for removal of the graft and still make surgery safer and predictable.
Maxillofacial reconstructions, used for the repair of boneless areas of the face or jaw, are extremely important surgeries. They restore the local function and in many cases, also restore the patient's self-esteem, and thus, improve their quality of life. For extensive maxillary reconstructions, the amount of bone tissue required as a substrate for grafting is often a limiting factor. This observational study was designed to evaluate the anatomy and the amount of bone found in the coronoid process, chin and anterior iliac crest. Five hundred and ten dry mandibles were analyzed and measured at predetermined points by a digital calypter. After the measurements, the mean thickness and linear measurements of the coronoid process were established; the mean thickness of points of the chin and the mean thickness of points of the anterior iliac crest, as well as an estimate of volume of the iliac crest. It was observed that the anterior iliac crest had an average bone volume estimate of 21,347.19 mm3 and 21.125,56 mm3 for the left and right sides, respectively. The coronoid process had a smaller thickness (2.11 mm) and linear (5.77 mm) in its uppermost portion and greater thickness (3.63 mm) and linear (14.51 mm) in its base, on average. At the chin, a greater mean thickness was observed in the midline (12.90 mm), in addition, this thickness was 1.57 mm greater in males. The anterior iliac crest provides a large amount of bone volume, compared to intra-oral areas. The knowledge of the average measurements of these anatomical structures, which are used as donors of bone tissue for facial reconstructions, is of great value to surgeons. This work brings a collection of data that aims to facilitate the surgeon´s choice of the area for removal of the graft and still make surgery safer and predictable.
Descrição
Palavras-chave
Transplante ósseo, Mandíbula, Quadril, Bone transplantation, Mandible, Hip