Evaluacija uspješnosti rekonstrukcije usne šupljine podlaktičnim i perforatorskim režnjem [The effectivness of oral cavity reconstruction using forarm and perforator flaps]

Kasumović, Merima (2016) Evaluacija uspješnosti rekonstrukcije usne šupljine podlaktičnim i perforatorskim režnjem [The effectivness of oral cavity reconstruction using forarm and perforator flaps]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

The study included the patients treated at the Clinic for Maxillofacial Surgery at „Dubrava“ Clinic Hospital in Zagreb who were planned for microvascular reconstruction using forearm or thigh perforator flaps. Patients with oral cavity cancer were evaluated and placed in two groups (20 in each group), based on the type of perforator flap used for defect reconstruction. Postoperative functional results were evaluated during regular follow up visits through a specifically designed clinical questionnaire. Moreover, an objective voice analysis was done using the acoustic voice analysis Multi-Dimensional Voice program (MDVP). Oral cavity is a specific region, mostly due to the fact that most structures and functions are closely interrelated. Tumor resection defects are commonly reconstructed with the most adequate free flap which enables the patients to have reasonably normal functions of chewing, swallowing, voice articulation and speech. Postoperative prosthetic rehabilitation, duration of hospitalization, local complications with reconstruction and postoperative activity do not depend on the flap type. Length of hospitalization depended primarily on the general condition of the patient and comorbidity and then on the stage of the ailment. The results of this study show that postoperative decannulation and the duration of feeding through the nasogastric tube depends on the stage of the ailment, regardless of the flap choice for reconstruction. Decannulation was the fastest in stage 1, and statistically significantly faster in women. The fastest postoperative mouth eating was in the patients who had stage 1 disease and postoperative speech ability. Speech ability after surgery is not significantly dependent on the extent of resection and the type of dissection. Postoperative speech in patients in both groups, according to the patients and their physicians, was significantly better in the first months after surgery than a year later. The deterioration of the speech ability can be explained by the scar tissue and flap atrophy itself. The majority of patients were not concerned about the aesthetic appearance of the flap (hair coverage), however, they were mostly concerned about the layout and functionality of the donor region and the overall aesthetic impression. The data showed that the success of oral cavity reconstruction and a better quality of life of patients with tumor of head and neck do not directly depend on the reconstruction method.

Abstract in Croatian

U istraživanje su bili uključeni bolesnici liječeni u Klinici za kirurgiju lica, čeljusti i usta Kliničke bolnice „Dubrava“ u Zagrebu kod kojih je planirana rekonstrukcija podlaktičnim ili perforatorskim režnjem. Ispitanici su bili svrstani u dvije skupine, prema vrsti mikrovaskularnog režnja upotrijebljenog za rekonstrukciju nastalog defekta, a svaka je skupina obuhvaćala minimalno 20 bolesnika. Postoperativni funkcijski rezultati ispitivani su na redovitim kontrolama u ambulanti, inoviranim kliničkim specifičnim upitnikom. Dodatno je bila provedena objektivna analiza glasa programom za akustičku analizu glasa Multi- Dimensional Voice Program (MDVP). Usna šupljina specifična je regija jer su međusobne relacije strukture i funkcije čvrsto povezane. Nakon resekcije tumora nastali se defekt rekonstruira režnjem koji omogućuje postoperativne funkcije žvakanja, gutanja, artikulacije glasova i govora. Postoperativna protetska rehabilitacija, dužina hospitalizacije, lokalna komplikacija rekonstrukcije i postoperativna radna aktivnost ne ovise o tipu režnja. Dužina hospitalizacije ovisila je najprije o općem stanju bolesnika i komorbiditetu pa tek onda o stadiju bolesti. Rezultati ovog istraživanja pokazuju da postoperativni dekanilman i dužina hranjenja na nazogastričnu sondu ovise o stadiju bolesti neovisno o izboru režnja za rekonstrukciju. Dekanilman je najbrži u stadiju I, a statistički je značajno brži u žena. Početak prehrane na usta najbrži je u bolesnika koji su imali I. stadij bolesti te postoperativni govor. Govor poslije operacije nije znatno ovisio o opsegu resekcije i tipu disekcije. U bolesnika u objema skupinama postoperativni je govor, prema navodima bolesnika te prema procjeni liječnika, bio znatno bolji u prvim mjesecima nakon kirurškog zahvata nego godinu dana poslije. Ovo pogoršanje govora može se pojasniti ožiljkastim promjenama i atrofijom samoga režnja. Većini bolesnika nije bio važan estetski izgled režnja (prekrivenost dlakama), koliko im je bio važan izgled i funkcionalnost donorne regije te ukupni estetski dojam. Dobiveni podaci pokazali su da uspjeh rekonstrukcije usne šupljine i bolja kvaliteta života bolesnika s tumorom glave i vrata ne ovise izravno o metodi rekonstrukcije (tipu režnja).

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