Implantes osseointegrados de titânio para reabilitação auricular
relato de caso e revisão da literatura
Palavras-chave:
Deformidades adquiridas da orelha, Neoplasias de cabeça e pescoço, Hemangioma, Próteses e implantes, Avaliação de resultados (cuidados de saúde)Resumo
CONTEXTO E OBJETIVO: Os implantes osseointegrados adquiriram papel importante na reabilitação protética de pacientes com defeitos craniofaciais. As principais indicações são ausência local de tecidos para reconstrução autógena, falha anterior de reconstrução e opção do paciente. Este artigo apresenta um caso clínico e discute as indicações e vantagens da técnica de implantes osseointegrados para a retenção de próteses auriculares. TIPO DE ESTUDO E LOCAL: Relato de caso clínico, Universidade Federal de São Paulo (UNIFESP). MÉTODOS: Paciente do sexo feminino recebeu três implantes na região auricular após ressecção cirúrgica de hemangioma na orelha esquerda. O tempo de osseointegração no osso temporal foi de três meses. Após a confecção de prótese auricular implanto-suportada, a paciente foi observada por 12 meses. RESULTADOS: Os parâmetros clínicos analisados mostraram boa cicatrização pós-operatória, saúde dos tecidos adjacentes ao implante, boa higiene e nenhuma perda de implantes. A boa higiene combinada a pouca espessura e imobilidade dos tecidos moles perimplantares resulta em poucas complicações. A integração dos implantes craniofaciais parece variar conforme o local, e a idade avançada afeta a osseointegração no osso temporal. A frequência de reações adversas cutâneas nos tecidos perimplantares é geralmente baixa. CONCLUSÃO: A técnica cirúrgica para a reabilitação com próteses auriculares implanto-suportadas parece ser simples e está associada a baixos índices de reações cutâneas adversas e complicações no longo prazo. As próteses ancoradas por implantes osseointegrados parecem proporcionar melhor retenção do que as próteses suportadas nas armações de óculos, menor possibilidade de descoloração pelo uso de adesivos e melhores resultados estéticos do que as próteses ancoradas na cavidade cirúrgica.
Downloads
Referências
Dib LL, de Oliveira JA, Neves RI, Sandoval RL, Nannmark U. Auricular rehabilitation by means of bone grafting from the iliac crest in combination with porous extraoral implants: a case report. Clin Implant Dent Relat Res. 2007;9(4):228-32.
Pham TV, Early SV, Park SS. Surgery of the auricle. Facial Plast Surg. 2003;19(1):53-74.
Roumanas E, Nishimura R, Beumer J, Moy PK, Weinlander M, Lorant J. Craniofacial defects and osseointegrated implants: six-year follow-up report on the success rates of craniofacial implants at UCLA. Int J Oral Maxillofac Implants. 1994;9(5):579-85. Available from: http:// www.quintpub.com/journals/abstract.php3?iss2_id=334&article_id=4132. Accessed in 2009 (Jun 19).
Miles BA, Sinn DP, Gion GG. Experience with cranial implant-based prosthetic reconstruc- tion. J Craniofac Surg. 2006;17(5):889-97.
Niparko JK, Langman AW, Cutler DS, Carroll WR. Tissue-integrated prostheses in the rehabilitation of auricular defects: results with percutaneous mastoid implants. Am J Otol. 1993;14(4):343-8.
Granström G. Craniofacial osseointegration. Oral Dis. 2007;13(3):261-9.
Brånemark PI, Albrektsson T. Titanium implants permanently penetrating human skin. Scand J Plast Reconstr Surg. 1982;16(1):17-21.
Volkenstein S, Dazert S, Jahnke K, Schneider M, Neumann A. Epithetische Versorgung von Gewebedefekten in Kopfbereich [Prosthetic supply of tissue defects in head and neck sur- gery. Laryngorhinootologie. 2007;86(12):854-60.
Tjellström A, Yontchev E, Lindström J, Brånemark PI. Five years’ experience with bone-ancho- red auricular prostheses. Otolaryngol Head Neck Surg. 1985;93(3):366-72.
Albrektsson T, Brånemark PI, Jacobsson M, Tjellström A. Present clinical applications of os- seointegrated percutaneous implants. Plast Reconstr Surg. 1987;79(5):721-31.
Tjellström A, Rosenhall U, Lindström J, Hallén O, Albrektsson T, Brånemark PI. Five-year expe- rience with skin-penetrating bone-anchored implants in the temporal bone. Acta Otolaryn- gol. 1983;95(5-6):568-75.
Raghoebar GM, van Oort RP, Roodenburg JL, Reintsema H, Dikkers FG. Fixation of auricular prostheses by osseointegrated implants. J Invest Surg. 1994;7(4):283-90.
Tjellström A. Osseointegrated implants for replacement of absent or defective ears. Clin Plast Surg. 1990;17(2):355-66.
Nishimura RD, Roumanas E, Sugai T, Moy PK. Auricular prostheses and osseointegrated implants: UCLA experience. J Prosthet Dent. 1995;73(6):553-8.
Phillips B, Ball C, Sackett D, et al. Oxford Centre for Evidence-based Medicine - Levels of Evidence (March 2009). Centre for Evidence based Medicine. Available from: http://www. cebm.net/index.aspx?o=1025. Accessed in 2009 (Jun 19).
Wilkes G, Wolfaardt JF. Osseointegrated alloplastic versus autogenous ear reconstruction: criteria for treatment selection. Plast Reconstr Surg. 1994;93(5):967-79.
Thorne CH, Brecht LE, Bradley JP, Levine JP, Hammerschlag P, Longaker MT. Auricular re- construction: indications for autogenous and prosthetic techniques. Plast Reconstr Surg. 2001;107(5):1241-52.
Rotenberg BW, James AL, Fisher D, Anderson J, Papsin BC. Establishment of a bone-anchored auricular prosthesis (BAAP) program. Int J Pediatr Otorhinolaryngol. 2002;66(3):273-9.
van Oort RP, Reintsema H, van Dijk G, Raghoebar GM, Roodenburg JL. Indications for extra- oral implantology. J Invest Surg. 1994;7(4):275-81.
Parel SM, Branemark PI, Tjellstrom A, Gion G. Osseointegration in maxillofacial prosthetics. Part II. Extraoral applications. J Prosthet Dent. 1986;55(5):600-6.
Wolfaardt JF, Wilkes GH, Parel SM, Tjellström A. Craniofacial osseointegration: the Canadian experience. Int J Oral Maxillofac Implants. 1993;8(2):197-204.
Parel SM, Tjellström A. The United States and Swedish experience with osseointegration and facial prostheses. Int J Oral Maxillofac Implants. 1991;6(1):75-9.
Tolman DE, Taylor PF. Bone-anchored craniofacial prosthesis study. Int J Oral Maxillofac Im- plants. 1996;11(2):159-68.
Westin T, Tjellström A, Hammerlid E, Bergström K, Rangert B. Long-term study of quality and safety of osseointegration for the retention of auricular prostheses. Otolaryngol Head Neck Surg. 1999;121(1):133-43.
Abu-Serriah MM, McGowan DA, Moos KF, Bagg J. Outcome of extra-oral craniofacial endos- seous implants. Br J Oral Maxillofac Surg. 2001;39(4):269-75.
Roumanas ED, Freymiller EG, Chang TL, Aghaloo T, Beumer J 3rd. Implant-retained prosthe- ses for facial defects: an up to 14-year follow-up report on the survival rates of implants at UCLA. Int J Prosthodont. 2002;15(4):325-32.
Granström G, Bergström K, Tjellström A, Brånemark PI. A detailed analysis of titanium im- plants lost in irradiated tissues. Int J Oral Maxillofac Implants. 1994;9(6):653-62. Available from: http://www.quintpub.com/journals/abstract.php3?iss2_id=335&article_id=4139. Accessed in 2009 (Jun 19).
Jacobsson M, Tjellstrom A, Fine L, Andersson H. A retrospective study of osseointegrated skin-penetrating titanium fixtures used for retaining facial prostheses. Int J Oral Maxillofac Implants. 1992;7(4):523-8. Available from: http://www.quintpub.com/journals/abstract.php3?iss2_id=323&article_id=3993. Accessed in 2009 (Jun 19).
Nishimura RD, Roumanas E, Moy PK, Sugai T, Freymiller EG. Osseointegrated implants and orbital defects: U.C.L.A. experience. J Prosthet Dent. 1998;79(3):304-9.
Jacobsson M, Tjellström A, Thomsen P, Albrektsson T, Turesson I. Integration of titanium im- plants in irradiated bone. Histologic and clinical study. Ann Otol Rhinol Laryngol. 1988;97(4 Pt 1):337-40.
Tolman DE, Taylor PF. Bone-anchored craniofacial prosthesis study: irradiated patients. Int J Oral Maxillofac Implants. 1996;11(5):612-9.
Granström G, Bergström K, Odersjö M, Tjellström A. Osseointegrated implants in children: experience from our first 100 patients. Otolaryngol Head Neck Surg. 2001;125(1):85-92.
Drinias V, Granström G, Tjellström A. High age at the time of implant installation is correlated with increased loss of osseointegrated implants in the temporal bone. Clin Implant Dent Relat Res. 2007;9(2):94-9.
Heo SJ, Sennerby L, Odersjö M, Granström G, Tjellström A, Meredith N. Stability measure- ments of craniofacial implants by means of resonance frequency analysis. A clinical pilot study. J Laryngol Otol. 1998;112(6):537-42.
Granström G, Tjellström A, Albrektsson T. Postimplantation irradiation for head and neck cancer treatment. Int J Oral Maxillofac Implants. 1993;8(5):495-501.
Granström G. Osseointegration in irradiated cancer patients: an analysis with respect to implant failures. J Oral Maxillofac Surg. 2005;63(5):579-85.
Arcuri MR, LaVelle WE, Fyler E, Jons R. Prosthetic complications of extraoral implants. J Prosthet Dent. 1993;69(3):289-92.
Westin T, Tjellström A, Hammerlid E, Bergström K, Rangert B. Long-term study of quality and safety of osseointegration for the retention of auricular prostheses. Otolaryngol Head Neck Surg. 1999;121(1):133-43.
Reyes RA, Tjellström A, Granström G. Evaluation of implant losses and skin reactions around extraoral bone-anchored implants: A 0- to 8-year follow-up. Otolaryngol Head Neck Surg. 2000;122(2):272-6.
Peiró Ibáñez JL, García-Vaquero JA, Acosta Farina D, Boix-Ochoa J. Reconstrucción aloplás- tica auricular mediante implantes osteointegrados: una nueva opción terapéutica en la microtia [Auricular alloplastic reconstruction with osteointegrated implants: a new therapy option in microtia]. Cir Pediatr. 2000;13(1):25-9.
Wazen JJ, Wright R, Hatfield RB, Asher ES. Auricular rehabilitation with bone-anchored titanium implants. Laryngoscope. 1999;109(4):523-7.
Bille M, Homoe P, Vesterhauge S, Rixen M, Bretlau P. Knogleforankret aurikelprotese [Bone- anchored auricular prosthesis]. Ugeskr Laeger. 1994;156(40):5835-9.
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
