RU2391923C1 - Method of surgical treatment of tongue and oral cavity floor - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention relates to field of medicine, namely to surgery and can be used during operational invasions caused by locally spread tongue cancer. Essence of method lies in the following: after ablation of tumours of tongue, oral cavity floor and neck metastases in submaxillary area skin, subcutaneous fat are dissected and skin flap of tongue-like form, corresponding in area to formed defect, is formed. Near flap base 10-15 mm wide deepidermalisation is performed, on upper edge additionally separated is epidermis with upper layer of derma parallel to epidermis on 8-10 mm. Diaphragm of oral cavity floor is dissected vertically to the base of formed skin flap. Through formed cut skin flap is passed, covering lower part of oral cavity. Free edge of flap is sewn to tongue stump, with remaining part of lower jaw alveoli and oral cavity floor. Drainages are installed, skin frame in submaxillary area is sewn tightly. ^ EFFECT: application of claimed invention allows to preserve tongue function (feeding with natural food and speech), preserve intactness of lower jaw, avoid cutting cheek and neck, improve patients' life quality. ^ 1 ex

Description

The invention relates to medicine, more specifically to surgery, and can be used during surgical interventions in the presence of locally advanced cancer of the tongue.

A known method of surgical treatment of cancer of the tongue due to the partial removal of tissues of the bottom of the oral cavity and root of the tongue. For better access to the tongue, the skin, subcutaneous tissue, muscle and mucous membrane of the cheek are cut in the vertical direction from the corner of the mouth to the alveolar edge of the lower jaw, and then horizontally along the lower jaw to the retro-molar region (Paches A.I. Tumors of the head and neck. M .: Medicine, 1983).

The method of wide access to the areas of the oral cavity affected by the tumor, proposed by the author, facilitates the surgical intervention. However, to achieve this, the author proposes to dissect not only the tissues of the neck, but also the cheeks and even the periosteum. This leads to additional sections of the skin and muscles, which very often ends with ugly scars on the patient's face.

A known method of surgery to remove cancer of the tongue, giving wide access to the tongue - operation P.M. Krasin. The author proposes to perform incisions in the lateral parts of the anterior surface of the neck, then from the medial zone of one submandibular triangle to another, an incision is made in the form of an arc through the lower part of the chin area. Then, after making a soft tissue incision and exposing the tops of the lower central incisors, a triangular shape of the chin of the jaw is cut with the chin spine on the inner surface (Clinical Operative Maxillofacial Surgery. Ed. By N.M. Aleksandrov, L .: Medicine, 1985 )

The implementation of all the proposed sections opens up wide and free access to the tongue tumor and the tumor-affected areas of the oral cavity. However, after removal of the tumor, replenishment of the resulting defect is difficult, since it requires restoration of the integrity of the lower jaw, plasty of the lower part of the bottom of the oral cavity and oral surface in the chin. This creates additional difficulties for both the operating surgeon and the patient. The method of P.M. Krasin does not provide for the preservation of the function of the language.

The aim of the invention is to preserve the function of the language.

The goal is achieved by the fact that after removal of the tumor of the tongue, the bottom of the oral cavity and local metastases in the submandibular region, the skin, subcutaneous fatty tissue are dissected and a skin-shaped flap of tongue shape is formed, the area corresponding to the defect formed. At the base of the skin flap, epidermis is carried out with a width of 10-15 mm, the epidermis is additionally separated along the upper edge with the upper dermis 8-10 mm parallel to the epidermis. The diaphragm of the bottom of the oral cavity is cut vertically to the base of the formed skin flap, a skin flap is passed through the formed incision and the lower part of the oral cavity is lined with it. The free edge of the flap is sutured to the tongue stump, remnants of the alveolar mucosa of the lower jaw and the bottom of the oral cavity, drainage is established, and the skin wound in the submaxillary region is sutured tightly.

A comparative analysis of the known methods of surgical treatment of cancer of the tongue, spread to surrounding tissues, and the claimed allows us to state the presence of novelty and significant differences of the latter.

The novelty of the “Method for the surgical treatment of cancer of the tongue and the bottom of the oral cavity” lies in the possibility of radical removal of the tumor without cutting the cheek and filling up the resulting defect in the bottom of the oral cavity with a tongue-like flap cut out in the submandibular region. Hemming the free edge of the flap to the cult of the tongue makes it possible to maintain the function of the tongue, eliminating its deformation and retreat.

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

The developed method is industrially applicable, as it can be reproduced and repeated many times in surgical clinics of the general medical network, specialized oncological institutions.

The method is as follows.

After removal of the tumors of the tongue, the bottom of the oral cavity and cervical metastases, the skin and subcutaneous fatty tissue are dissected in the submandibular region, forming a tongue-like skin flap, the area corresponding to the defect formed. At the base of the skin flap, epidermis is carried out with a width of 10-15 mm, the epidermis is additionally separated along the upper edge with the upper dermis 8-10 mm parallel to the epidermis. The diaphragm of the bottom of the oral cavity is cut vertically to the base of the formed skin flap. Through the incision, a skin flap is carried out and the lower part of the oral cavity is lined with it. The free edge of the flap is sutured to the tongue stump, remnants of the alveolar mucosa of the lower jaw and the bottom of the oral cavity, drainage is established, and the skin wound in the submaxillary region is sutured tightly.

The proposed method was carried out the treatment of 7 patients with a malignant tumor of the tongue with a transition to the bottom of the oral cavity.

An example of a specific implementation of the method can serve as an extract from the medical history.

1. Patient A ... medical history No. C15484 / 1, was admitted to the Department of Head and Neck Tumors of the RNII on 10/17/2008 with a diagnosis of:

relapse of common cancer of the mucous membrane of the bottom of the mouth and tongue. Condition after radiation therapy in the total focal dose - 40 Gy.

Local status: at the bottom of the anterior section, with a transition to the left half of the bottom of the oral cavity, a tumor ulcer with a diameter of up to 1.5-2.0 cm.

Tumor infiltration extends to the entire front part of the bottom of the oral cavity and the lower surface of the movable part of the tongue. The tongue is inactive. Cervical nodes are not palpable.

10/20/2008 tracheostomy and resection of the bottom of the oral cavity and partially the tongue with plastic skin flap. Tracheostomy is carried out according to the generally accepted technique. After removal of the tumors of the tongue, the bottom of the oral cavity and cervical metastases in the submandibular region, the skin and subcutaneous fat were dissected and a skin-shaped flap of a tongue-like shape was formed, the area corresponding to the defect formed. At the base of the flap, epidermization was carried out with a width of 10-15 mm, an epidermis with an upper layer of the dermis 8-10 mm parallel to the epidermis was further separated along the upper edge. The diaphragm of the bottom of the oral cavity is dissected vertically to the base of the formed skin flap, a skin flap is made through the incision, with which the lower part of the oral cavity is lined, the free edge of the flap is sutured to the tongue stump, the remnants of the lower jaw alveoli and the bottom of the oral cavity, drainages are installed, the skin wound is in submandibular region sutured tightly.

The postoperative period is without complications. Sutures were removed on the seventh day. The patient is in satisfactory condition.

November 3, 2008 the patient was discharged at the place of residence under the supervision of an oncologist. Appearance for inspection in a month.

December 05, 2008 - the patient is in satisfactory condition, eats a variety of natural foods, swallowing function - without difficulty. Appearance for the next inspection - in February 2009.

The technical and economic efficiency of the developed "Method for the surgical treatment of cancer of the tongue and the bottom of the oral cavity" lies in the possibility of:

- preserve the function of the tongue, providing nutrition with natural food, and speech;

- maintain the integrity of the lower jaw;

- Avoid crippling incision of the cheek and neck;

- improve the quality of life of patients.

Claims (1)

A method for the surgical treatment of cancer of the tongue and the bottom of the oral cavity, including the removal of tumors of the tongue, the bottom of the mouth and cervical metastases, characterized in that after removal of the tumors of the tongue, the bottom of the mouth and cervical metastases in the submandibular region, the skin, subcutaneous fatty tissue are cut and a skin flap is formed linguistic form, the area corresponding to the resulting defect; at the base of the flap, epidermisation is carried out with a width of 10-15 mm, the epidermis is additionally separated along the upper edge with the upper layer of the dermis 8-10 mm parallel to the epidermis; the diaphragm of the bottom of the oral cavity is cut vertically to the base of the formed skin flap; a skin flap is passed through the formed incision, the lower part of the oral cavity is lined with it; hem the free edge of the flap to the stump of the tongue, the remains of the mucosa of the alveoli of the lower jaw and the bottom of the oral cavity, drainages are installed, the skin wound in the submandibular region is sutured tightly.