Method for treating cancer of the lower lip

FIELD: medicine, oncology.

SUBSTANCE: one should cut a skin-muscular flap from buccal external side being 1.0 cm larger against the half of defect's length, moreover, at the side with intact mouth angle one should form a stump of red border of the lower lip due to through incision. For covering internal defect's side one should cut horizontal rectangular mucous-muscular flaps from buccal internal side with foundation facing the mouth of excretory duct of parotid salivary gland. Flaps should be mobilized at the level of surface muscular fibers of buccal muscle being adjacent to mucous membrane. Then it is necessary to dissect a triangular skin-fatty flap in mental area at foundation being equal to defect's length and the top being about 1.5-2.0 cm below mandibular edge. Defect's covering should be started from coinciding mucous-muscular flaps and then - skin- muscular ones. Then red border of lips should be formed. For this purpose, one should fulfill a through incision in intact mouth angle's area towards the upper lip by leaving 0.5 cm against the edge of red border. Prepared parts of the red border of lips should be replaced with their tops towards each other to be sutured together and layer-by-layer sutured up to replaced flaps. The innovation enables to increase flaps' mobility, develop the stump of red border of lips, create anatomical integrity of the lower lip, form angles of the mouth, prevent deformation in area of donor's channel and decrease post-operational complications.

EFFECT: improved cosmetic effect of operation.

3 dwg, 1 ex

 

The invention relates to medicine, in particular to the section of dentistry.

The incidence of lip cancer in the past decades, remains fairly stable among all malignant tumors of the human takes 8-9 place (1,6%), and among tumors of the head and neck, its share is 26%. However, the treatment results prove the feasibility of improving the traditional and the development of new therapies (Aeacs, 2000).

There is a method of recovery of the lower lip using the skin-muscle flaps on vascular legs for outdoor fabrics. The inner lining of the lips create by cutting out the vertical rectangular Muco-muscle flaps with vertices on the upper transition 5-7 fold molar and grounds at the bottom of the transition folds, and the external tissue of the lips restores the skin-muscle flaps, cut with a common lower base with Muco-muscle flaps and the tops of the wings of the nose.

(Patent No. 2163098, And 61 In the 17/24 "Method of recovery of the lower lip", B. I. No. 5 30.11.1999).

The disadvantages of the method are:

1. The need to move the vertical rectangular skin and muscle and mucous-muscle flaps in a horizontal position for closure of soft tissue defects of the lower lip, which reduces the length taken loskota, as a consequence, his tension.

2. Total base flaps at the lower transition folds may be an important factor in creating the lack of mobility roaming flaps.

3. The possibility of deformation of the wings of the nose and the upper lip during closure of the donor bed after taking a skin-muscle flap with the tops of the wings of the nose.

Known methods of reconstructive repair of defects of the lower lip after cancer operations. After a trapezoidal resection of the lower lip in the area of the nasolabial folds and cheeks outlined the borders of the future of the flap corresponding to the size of the defect of the lower lip. Dissected tissue and is formed skin and musculo-mucosal flap, and then in the thickness of the remaining part of the lower lip and angle of the mouth forming a tunnel through which the defect appears medial end of the flap, pre-decapitalized the skin of the lateral end of the flap in accordance with the length of the tunnel. Then proceed to the substitution of the defect formed skin-muscle-slimy flap by layer stitching. Donor place in layers sutured tightly. The sutures are removed 8-10 days.

(Attachsound, Woodenman, Maggiorato. New opportunities reconstructive repair of defects of the lower lip after cancer operations // Dentistry. 1998. No. 3. str).

The disadvantages of this method are:

1. The possibility of developing scar deformation in the area of the preserved part of the lower lip and adjacent to the defect of the soft tissues, after the formation of the tunnel.

2. The technique does not allow for recovery of the red portion of the lower lip as an integral anatomical parts.

3. The method does not reveal the possibilities of forming the vestibule of the oral cavity in the lower jaw.

Closest to the claimed method is a method of treatment of cancer of the lower lip by adequate access and resection of the lower lip organ lymphadenectomies and plasticity of the resulting defect of the lower lip. Form a skin-muscle-mucous patches on the cheeks with the release of the facial artery and vein, with continued cuts from the base of the lower lip, cheeks to the submandibular region, retreating from the edge of the lower jaw by 1.5-2.0 cm to the inner edge of the sternocleidomastoid muscle, the dissection of the superficial fascia, subcutaneous muscle, fascial compartment of the case from the lower jaw. Assign a cut skin-muscular-mucosal flap on the vascular pedicle outwards and remove verhneomrinskiy surface submandibular case in the wound. Determine organ lymph nodes excised and their surrounding tissue in a single block with repetiremos part of the lower lip and vaaraniemi lymphatic vessels connect the shining lower lip with regional lymph nodes. Produce plastic formed of a defect of the lower lip and cheeks are pre-cut flap on the vascular pedicle of the facial artery and vein.

(Patent No. 2164782, And 61 In the 17/24 "Method of treatment of cancer of the lower lip", B. I. No. 10 10.04.2001).

The disadvantages of the method are:

1. A lot of stages of treatment, which increases the risk of postoperative complications arise.

2. The presence of through-cuts in the cheeks, when cutting out skin-muscular-mucosal flaps, contributes to a longer postoperative wound healing.

3. Does not fully utilize the capacities of reconstructive treatment for anatomical integrity of the lower lip.

The objective of the invention is to improve the results of plastic closure formed of postoperative defect of the lower lip, a more complete restoration of its anatomical and functional characteristics and satisfactory cosmetic effect on the stage of surgical treatment of cancer of the lower lip.

This object is achieved by performing cuts from the side cheeks and the base of the lower lip to the submandibular region, retreating from the edge of the lower jaw of 1.5-2.0 cm, adequate resection of the lower lip and plasticity of the resulting defect. By cutting out the skin-muscle flaps on the outside of the cheeks to 1.0 cm more than half of the length of the s formed of a defect, for closing the outer side of the defect. However, on the stored angle of the mouth through the incision to form a stump red border of the lower lip. For closing the inner side of the defect is cut out horizontal rectangular Muco-muscle flaps from the inner side of the cheeks with the base facing the mouth of the excretory duct of the parotid salivary gland, patches immobilized at the level of the surface of muscle fibers buccal muscles adjacent to the mucosa. Excised triangular dermal-fat flap chin area with base equal to the length of the defect, and the top, located 1.5-2.0 cm below the edge of the lower jaw. Closure of the defect start with connection Muco-muscle flaps, then skin-muscle flaps. Then form a red border of the lips. Why performed through an incision in the region of abutment of the upper lip on the side of the defect angle of the mouth and a second incision saved from the corner of his mouth to the side of the upper lip, receding at 0.5 cm from the edge of the red border. Prepared by the red border of lips move vertices towards each other, sew between the layers and stitched to displaced flaps.

The novelty of the method:

1. Viravaidya skin-muscle flaps from the cheek to 1.0 cm more than half the length of the resulting defect to close the outer side of the defect, while on the side with the conservation of the military angle of the mouth through the incision to form a stump red border of the lower lip, increase mobility.

2. For closing the inner side of the defect is cut out horizontal rectangular Muco-muscle flaps from the inner side of the cheeks with the base facing the mouth of the excretory duct of the parotid salivary gland, patches immobilized at the level of the surface of muscle fibers buccal muscles adjacent to the mucous membrane, which helps to form the anatomical integrity of the lower lip and the height of the vestibule of the mouth.

3. Excised triangular dermal-fat flap chin area with base equal to the length of the defect, and the top, located 1.5-2.0 cm below the edge of the lower jaw, thus achieved the most comprehensive convergence of skin and muscle flaps without the formation of skin folds around the chin.

4. Through the incision in the area of the stump of the upper lip on the side of the defect angle of the mouth and a second incision saved from the corner of his mouth to the side of the upper lip, receding at 0.5 cm from the red portion, to make the corners of the mouth and to maintain continuity of the circular muscle of the mouth, the red border of the lower lip.

The essential features of the invention allows to obtain a new technical result: a cut of 1.0 cm, more than half of the resulting defect skin-muscle flaps on the outside of the cheeks increase their mobility when closing the outer side of the flaw. quesnoy incision on the side of the defect to the stored angle of the mouth allows to generate the stump of the red border of the lower lip. Rectangular horizontally positioned Muco-muscle flaps from the inner side of the cheek and turned its base towards the mouth of the excretory duct of the parotid salivary glands contribute to the creation of the anatomical integrity of the lower lip and form the height of the vestibule of the oral cavity of the lower jaw. Deformed triangular dermal-fat flap chin area with base equal to the length of the defect, and the top, below 1.5-2.0 cm below the edge of the lower jaw, allows the best to bring the skin-muscle flaps without the formation of skin folds. Through the incision in the area of the stump of the upper lip on the side of the defect angle of the mouth and a second incision saved from the corner of his mouth to the side of the upper lip, receding 0.5 cm from the edge of the red portion can form the corners of the mouth and to maintain continuity of the circular muscle of the mouth, the red border of the lower lip. The absence of through slits in the cheeks positive effect on postoperative wound healing and prevents the development of deformation in the area of donor couch cheeks.

The invention is illustrated by drawings and photographs, where figure 1. Scheme operation, figure 2. A photograph of the patient before the operation, figure 3. A photograph of the patient after surgery in 15 days.

Figure 1.

1 - postoperative defect of the lower lip.

2 - the lower lip.

3 - skin-muscle flap on the side is calitatii primary focus.

4 - skin-muscle flap on the opposite side of the defect.

5 is formed stump the red border of the lower lip.

6 - excised triangular dermal-fat flap at the chin.

7 - Muco-muscle flap from the inner side of the cheek-side localization of primary tumor.

8 - Muco-muscle flap on the inside of the cheek on the opposite side of the defect.

9 - through the incision in the area of the stump of the upper lip on the side of the dissected corner of his mouth.

10 - through the slit of the upper lip in the corner of his mouth.

11 is formed stump the red border of the upper lip.

The method consists in the following. The localization of malignant tumors (squamous cell cancer) in the area of the lower lip up to 4 cm and spread it on one of the corners of the mouth, under endotracheal anesthesia, after pre-applied markings, end-to-end slits, retreating to 1.5 cm from the edge of the tumor, is trapezoidal resection of the lower lip with excision of the corner of the mouth on the side of the infiltrate. From the vestibule of the oral cavity through the section line passes above the mucous membrane of the transition fold lower jaw 0.5 see with the formation of defect 1. For external closure formed of postoperative defect 1 lower lip 2 according to the prearranged boundaries in the cheeks form the I skin-muscle flaps, the total length of 2.0 cm exceeds the size of a tissue defect of the lower lip. Incisions are within the skin, subcutaneous fat and mimic muscles of the cheeks to the fascia covering the buccal fat lump.

On the side of the localization of primary tumor dissection of soft tissues is performed from the corner of the mouth towards the front edge actually chewing muscles at an obtuse angle to the edge of the defect 1 and 1.0 cm, more than half of its length. Then continue to cut at a sharp angle downward and parallel to the actual chewing muscle below the top of the body of the mandible by 1.5-2.0 see with the formation of skin-muscle flap 3.

The formation of a skin-muscle flap 4 on the opposite side of the defect with the corner of mouth starts with a cross-section of the stump of the lower lip 2, retreating 0.5 cm below the red portion to the corner of the mouth, with cut leather, circular muscle of the mouth, mucous membrane of the lips forming the stump 5 red border of the lower lip 2, further dissection of the soft tissues of the cheeks is the above-described method.

The purpose of the free movement of the skin-muscle flaps should make their immobilization on the whole area to the fascia covering the buccal fat lump, and to produce the excision of a triangular flap 6 of the skin, subcutaneous fat in the chin area with the base of the defect dims the second lip and the top, ending below the edge of the lower jaw by 1.5-2.0 see

The next step is the formation of Muco-muscle flaps from his cheeks to create the inner lining of the lower lip, 2 side vestibule of the oral cavity. To this end is cut horizontal rectangular flaps 7,8, tops facing in the direction of the defect and the base at the mouth of the excretory duct of the parotid salivary gland.

Horizontal incisions on both sides retreating 0.5 cm from the bottom of the transition folds vestibule of the oral cavity, cut through the mucous membrane of cheeks, her submucosal layer and partially muscular half the length of postoperative defect of the lower lip. Subsequent incision is made parallel to the first, and its height corresponds to the specified depth of the vestibule of the mouth. The flaps 7, 8 immobilized at the level of the surface of muscle fibers buccal muscles adjacent to the mucous membrane.

Substitution of postoperative defect of the lower lip 1 should start with move Muco-muscle flaps 7, 8 peaks towards each other, placing the mucous membrane to mucous transition folds of the lower jaw and mucous cheeks suture material, not having the properties of fitelnet. Muscles moved flaps 7, 8 sewn with catgut. Then, freely moving in the horizontal plane of the skin is about muscle flaps 3, 4 from his cheeks, the layers are sewn together the muscles and mucous skin flaps interconnected by a catgut, thereby forming all anatomically important layers of the lower lip. The skin is superimposed suture material does not have pitilessly. The donor site is sutured in layers tightly.

To complete the formation of the anatomic integrity and create the corners of the mouth, must be made through the section 9 (skin, circular muscle of the mouth, mucous membranes) in the area of the stump of the upper lip on the side of the previously dissected corner of the mouth, receding at 0.5 cm from the edge of the red border. The length of the incision depends on the size of defect 1 and sufficiency of the mobilization of previously formed stump the red portion 5 of the lower lip. When her lack of end-to-end length section 10 saved from the corner of his mouth extended in the direction of the upper lip, also departing at 0.5 cm from the red border and corner of the mouth. Prepared fragments of the red portion of the lips 5, 11 are moved peaks towards each other. Layers sewn together and layered filed to the previously displaced flaps (mucosa to mucosa, muscle circular muscle of the mouth, skin to skin). This uses the same suture material, as before.

Seams with skin removed on the 8th day, and with the mucous membranes in 10 days. Preventive excision of regional lymph nodes and fatty tissue submandibular, submental areas Khujand is realized via 3-4 weeks after treatment of the primary lesion.

Example: the Patient With. 57 years old (case history No. 1277) were hospitalized in the clinic of oral and maxillofacial surgery with 08.02.2003 on 25.02.2003 diagnosed with cancer of the lower lip. The clinical-morphological examination the patient was exposed: well-differentiated squamous cell cancer with the expression T2N0M0 (histological study No. 1161). The tumor is localized in the right third of the lower lip and extends to the corner of the mouth to the right size in most parts of the infiltrate to 4 (figure 2). Clinically and after ultrasound enlarged regional lymph nodes is not defined.

Under endotracheal anesthesia produced trapezoidal resection of the right half of the lower lip, the corner of mouth with the formation of skin and muscle, mucous-muscle flaps from the cheek, the excision of a triangular flap at the chin and simultaneous closure of postoperative defect preserving the height of the vestibule of the oral cavity of the lower jaw. Following formation of the corners of the mouth, restoring the continuity of the circular muscles of the mouth and mucous red border of the lower lip (preservation of anatomical and functional characteristics of the lips and a fairly good cosmetic results). The postoperative course without features and complications. After 8 days the stitches removed from the skin of the cheeks, lower lip, and after 10 days from the mucous membrane of the lips and cheeks. the patient was discharged in good condition on further clinical examination (figure 3). After 3 weeks conducted the standard surgery to remove the upper cervical regional lymph nodes and tissue.

Thus was achieved the positive effect produced simultaneously closing the resulting postoperative defect of the lower lip skin and muscle, mucous-muscle flaps, which include all anatomical components. The subsequent formation of the corners of the mouth, restoring the continuity of the circular muscles of the mouth and the red border of the lower lip, allows you to fully restore the anatomical integrity of the lower lip and keep it functional features. This technique helps to preserve the diction of the patients in the postoperative period, capture, retention and formation of food bolus, as one of the stages of the digestive process. Restore the height of the vestibule of the oral cavity of the lower jaw allows tight enough to close the lips, which is also an important factor for the preservation of normal diction and eating. The absence of through slits in the cheeks, when cutting out flaps, positive effect on postoperative wound healing and prevents the development of deformation in the area of donor bed. Excision of a triangular dermal-fat flap chin area and free movement of the skin-muscle flaps provides substitution the effect of the tension-free tissue flap, that has a fairly large value for the initial healing displaced flaps. The combination of the above factors makes it possible to achieve good cosmetic results and to improve the quality of life in this group of patients.

Using this technology in the clinic of maxillofacial surgery, 18 patients operated, next the results showed the reliability and efficiency of the proposed method. This technique allows to fully restore the anatomical and functional features of the lower lip and to achieve good cosmetic results.

The method of treatment of cancer of the lower lip, comprising performing cuts from his cheeks and the base of the lower lip to the submandibular region, retreating from the edge of the lower jaw of 1.5-2.0 cm, adequate resection of the lower lip and the plasticity of the resulting defect, characterized in that the cut skin and muscle flaps on the outside of the cheeks to 1.0 cm more than half the length of the resulting defect to close the outer side of the defect, while on the side with the stored angle of the mouth through the incision to form a stump red border of the lower lip, and for closing the inner side of the defect is cut out horizontal rectangular Muco-muscle flaps from the inner side cheeks with the base facing the mouth of the excretory duct of the parotid salivary gland, the gloss is s immobilized at the level of the surface of muscle fibers buccal muscles, the adjacent mucosa excised triangular dermal-fat flap chin area with base equal to the length of the defect, and the top, located 1.5-2.0 cm below the edge of the mandible, closing the defect start with connection Muco-muscle flaps, then skin-muscle flaps, and then form a red border of the lips, which performed through an incision in the region of abutment of the upper lip, on the side of the defect angle of the mouth and a second incision saved from the corner of his mouth to the side of the upper lip, some distance 0.5 cm from the edge of the red border, the red border of lips move peaks towards each other, sew between the layers and stitched to displaced flaps.



 

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