Method for carrying out operation on glossal root and oral bottom cancer

FIELD: medicine, oncosurgery.

SUBSTANCE: one should perform tracheotomy, fulfill fascial-sheath dissection of jugular fiber at tightening external carotid artery, remove the tumor of glossal root and posterior-lateral departments of oral bottom, make cutaneous incision from submandibular area up to the upper clavicular edge ahead of a nodding muscle, leave median pedicle and a muscular part that covers vascular-nervous bundle, dissect lateral pedicle in the site of its fixation to a clavicle by keeping axial vascularization, form a skin fragment being 3-4 cm above the line of muscular dissection at its bottom being on a nodding muscle, which corresponds to postoperational defect by its area, apply a skin-muscular fragment into the tunnel developed in oral bottom, fold the dissected edge of a nodding muscle as a duplicature to be sutured up to the stump of glossal root, cover postoperational wound with a skin fragment, fix a nodding muscle to surrounding tissues, apply sutures onto subcutaneous-fatty fiber and skin. The method enables to improve functions of swallowing and nutrition and restore patient's distinct speech.

EFFECT: higher efficiency.

1 ex

 

The invention relates to medicine, more specifically to surgery, and can be used in operations for removal of malignant lesions of the tongue and floor of mouth lesion with retromolar area and lymph nodes of the neck and the need for closure postoperative defect.

There is a method of closing defects formed after the removal of malignant tumors ENT stem Filatova ("Reconstructive surgery of the soft tissues of the maxillofacial area", Ed. by Aigaraeva. M.: Medicine, 1997). However, in the shelter of defects after removal of tumors localized in the region of the root of the tongue and floor of mouth, difficulties arise in the use of stem Filatov. This is a huge defect that needs to stalk the big sizes. The need for multiple migration of the stem leads to the fact that often the last step in the migration is disrupted blood supply to his legs and as a consequence there is a complete or partial necrosis and rejection of the stem. The primary drawback of the known method of closure of the defect is the duration of the migration of the stem and therefore a significant time lag, restore the integrity of the maxillofacial region.

There is a method of closure of the defect after removal of tumors of the base of the tongue, skin and muscle gloss is that with the inclusion of the sternocleidomastoid, subcutaneous and trapezius muscles ("Reconstructive surgery of the soft tissues of the maxillofacial area", Ed. by Aigaraeva. M.: Medicine, 1997).

The offered method of recovering the formed postoperative defect allows you to fill in the oral cavity, the side wall of the pharynx. However, a remote part of the language is not filled and the patient loses the ability to take normal food, breaks the function of swallowing and articulate speech.

The aim of the invention is the possibility of simultaneous closure of postoperative defect and restoration of the resected part of the root of the tongue.

This objective is achieved in that an incision of the skin from the submandibular region to the upper edge of the clavicle ahead of the sternocleidomastoid muscle, left medial leg and part of the muscle covering the neurovascular bundle, lateral leg cut off in the place of its attachment to the clavicle, while maintaining axial vascularization, simultaneously, 3-4 cm above the line of dissection of the muscles that form the skin island flap with the base in the sternocleidomastoid muscle, the area corresponding postoperative defect; educated in the tunnel in the floor of the mouth hold the skin-muscle flap, cut off the edge of the sternocleidomastoid muscle is folded in the form of duplicatory and stitched to the cult the root of the tongue, skin flap cover the postoperative wound, the sternocleidomastoid muscle is fixed to the surrounding tissue, suture in the subcutaneous fat, the skin.

The invention "Method of operation for cancer of the tongue and floor of mouth" is new, because it is not known from the level of medicine in the field of surgical treatment of malignant tumors of the tongue and floor of mouth with filling resected part of the root of the tongue.

The novelty of the proposed method is that you can fill in the resected part of the root of the tongue by duplicatory of the selected part of the sternocleidomastoid muscle and shelter postoperative defect with a skin flap based on the sternocleidomastoid muscle.

In open sources information of Russia, CIS and foreign countries similar to the proposed method not found.

The claimed "Method of operation for cancer of the tongue and floor of mouth" industrially applicable. It can be reproduced and repeated many times in the specialty of otolaryngology and Oncology clinics surgical profile.

The method is as follows.

Perform overlay tracheostomy according to the standard technique. Then in the submandibular region produce skin incision, the upper fasciale-casing excision of tissue neck with ligation of the external carotid artery, removal of tumors of the tongue root and posterolateral departments of the bottom of the cavity is the same. Make a skin incision from the submandibular region to the upper edge of the clavicle ahead of the sternocleidomastoid muscle, left medial leg and part of the muscle covering the neurovascular bundle, lateral leg cut off in the place of its attachment to the clavicle, then pick her up, keeping the axial vascularization. Simultaneously above the line dissection of the muscles of 3-4 cm form a skin flap with the base on it, the area corresponding postoperative defect. In the formed tunnel in the floor of the mouth hold the skin-muscle flap, the sternocleidomastoid muscle is fixed to the surrounding tissues. Cut off the edge of the sternocleidomastoid muscle is folded in the form of duplicatory and stitched to the stump of the root of the tongue. The flap cover of postoperative wound suture in the subcutaneous fat, the skin.

An example of a specific implementation of the method can serve as a summary of the history of the disease. Patient R., born in 1936, No. East. bol. 13064/R, was admitted to the Department of head and neck tumors, RNII 27.08.03, with complaints of pain when swallowing. Medical history: considers himself ill 1.5 months when I first noticed the pain when swallowing. Has addressed to therapist at the place of residence and was sent to the hospital, RNII. In the clinic the doctor on reception was discovered tumor ulcer at the root of the tongue produced a biopsy of the tumor. Cytologic conclusion No. 70110-1 "Detecting the wives of a group of cells squamous cell cancer." Local status: during examination of the oral cavity at the root of the tongue to the left is determined infiltrate with ulceration extending into the floor of mouth and anterior palatal bow. The neck on the left, in the upper third, is determined by a single, relatively movable, solid elastic consistency, not associated with skin lymph node with a diameter up to 2.0, see the Diagnosis: cancer of the tongue with metastases in the lymph nodes of the neck to the left, T4N1M0, Art. IV And CL gr. The operation completed 1.09.03. as follows: the skin incision from the submandibular region to the upper edge of the clavicle ahead of the sternocleidomastoid muscle, left medial leg and part of the sternocleidomastoid muscle, covering the neurovascular bundle, cut off the lateral leg in the place of its attachment to the clavicle, saved axial vascularization, simultaneously, 3-4 cm above the line of dissection muscles formed a skin flap based on the sternocleidomastoid muscle, the area corresponding postoperative defect in the oral cavity; educated in the tunnel in the floor of the mouth held skin-muscle flap; cut off the edge of the sternocleidomastoid muscle complex in the form of duplicatory and filed to the stump of the root of the tongue; the flap is covered with a postoperative wound; the sternocleidomastoid muscle is fixed to surrounding tissues; superimposed seams on the subcutaneous fat, the skin.

1 day - the patient's condition meets tegest the surgery. The transplanted skin-muscle flap pale pink viable. Breathing through tracheotomies tube. Power over ecopedagogy probe. 2 and 3 a day for the patient's condition is satisfactory, the flap viable. 4 day - patient no complaints. Removed tracheotomies tube, breathing through the natural way free. Power over ecopedagogy probe. Flap bluish tint. The histological conclusion No. 706714-18 "Squamous cell carcinoma with keratinization; lymph nodes - metastasis of cancer. day 7 - power over ecopedagogy probe. Flap pale pink color. 10 day - flap pale pink color. Stitches on the skin and in the mouth. Removed ecopedagogy probe, power is supplied through the mouth. In the mouth the skin-muscle flap completely covered postoperative defect. The patient was discharged 11 days after surgery. Healing by primary intention. Further recommended chemo treatment.

1.10.03, - the patient feels well, no complaints. Tracheostomy is completely closed. The function of swallowing is not broken, restored articulate speech.

3.12.03, when the next inspection revealed: feels OK, swallowing and breathing normal. It becomes clearer. The neck lymph nodes not palpable signs of tumor recurrence in strips and mouth is not detected. The patient is monitored for 9 months. In good condition, no complaints.

Technical and economic efficiency of the method lies in the possibility to carry out the recovery phase of the operation simultaneously with the surgical removal of the lesion malignant lesions; to preserve the natural function of swallowing and feeding a variety of solid food; restore articulate speech, to improve the quality of life.

The method of operation for cancer of the tongue and floor of mouth, including tracheotomy, fasciale-casing excision of tissue neck with ligation of the external carotid artery, removal of tumors of the tongue root and posterolateral departments of the bottom of the mouth, characterized in that an incision of the skin from the submandibular region to the upper edge of the clavicle ahead of the sternocleidomastoid muscle, left medial leg and part of the muscle covering the neurovascular bundle, cut lateral foot into the place of its attachment to the clavicle, while maintaining axial vascularization, simultaneously, 3-4 cm above the line of dissection muscles form a skin flap based on the sternocleidomastoid muscle the total area of the corresponding postoperative defect; educated in the tunnel in the floor of the mouth hold the skin-muscle flap; cut off the edge of the sternocleidomastoid muscle is folded in the form of duplicatory and stitched to the cult of the Orcestra language; the flap cover postoperative wound, the sternocleidomastoid muscle is fixed to the surrounding tissues; suture in the subcutaneous fat, the skin.



 

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