Epitec system을 이용한 인조이개 부착술

Abstract

Osseointegrated alloplastic ear reconstruction has revolutionized ear prosthetic retention. In this report, we evaluate the results of indirect osseointegration using the Epitec system and discuss the degree of the most serious side effect of this system, the adverse skin reactions close to osseointegrated implant post. During a three year period, Osseointegrated prosthetic ear reconstruction was performed to twenty eight patients with microtia(n = 25) and traumatic ear loss(n = 3), 22 males and 6 females aged from 6 to 43 years(mean 18.2 years). The patients, including 12 children, were treated with 58 titanium implant posts of Epitec system. These were inserted into a 3-dimensional carrier-plate which were fixed to the mastoid process with 7 to 12(mean 9.2) screws. Each patient was operated in a one-stage procedure. Two months of osseointegration of the screws was followed by fabrication of the ear prostheses. All implants were stable after follow-up at 20 to 31 months(mean 24.6 months). Fifty four of the 58 implants showed no sign of skin reactions (93.1 percent: 83.3 percent for children; 100 percent for adult). Hypertrophy of soft tissue surrounding the implants were observed only in children(2 out of 12 treated children) and did not recur after subcutaneous reduction and compressive dressing. In adults, the results of the Epitec system are very satisfactory. Use of the Epitec system in children is also promising because hypertrophy of soft tissue surrounding the implants are successfully managed. In addition, the 3-dimensional carrier-plate is well osseointegrated with bone screws and stability of the carrier-plate is reinforced by osseous covering of the thin bars of the carrier-plate by appositional bone growth of the skull. Key Words: Indirect osseointegration ,Ear prosthesis ,Epitec system

저자들은 소이증과 후천적으로 귀를 상실한 28례에서 측두골에 격자형 중계판을 고정시키고 여기에 삽입물을 고정시킨 지 약 2개월 뒤에 인조이개를 만들어 부착시켰다. 모든 삽입물은 요동없이 안정되었으며, 감염된 증례도 없었다. 지대 주위의 피하조직의 비후는 2례(6.9%)에서 관찰되었으며, 피하조직절제술 및 압박으로 잘 치유되었다. 결론을 내리기에 조금 이르지만, Epitec system은 수혜골의 국소적 결손이나 두께가 얇을 때에도 유용하며, 삽입물의 위치를 술후에 조정할 수 있으며, 수술이 빠르고 쉬우며, 삽입물이 골 안으로 전위될 가능성이 적을 뿐만 아니라 격자형 중계판 자체가 부가된 골로 덮여 더 안정적이므로 성인뿐만 아니라 성장기 소아에서도 안전하게 사용할 수 있을 것으로 생각된다.