MD1145Z - Method for treating cancer of the tongue and floor of the mouth - Google Patents
Method for treating cancer of the tongue and floor of the mouth Download PDFInfo
- Publication number
- MD1145Z MD1145Z MDS20160133A MDS20160133A MD1145Z MD 1145 Z MD1145 Z MD 1145Z MD S20160133 A MDS20160133 A MD S20160133A MD S20160133 A MDS20160133 A MD S20160133A MD 1145 Z MD1145 Z MD 1145Z
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- tongue
- muscle
- wound
- region
- oral cavity
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- 238000000034 method Methods 0.000 title claims abstract description 12
- 206010062129 Tongue neoplasm Diseases 0.000 title claims abstract description 7
- 210000003205 muscle Anatomy 0.000 claims abstract description 22
- 210000000214 mouth Anatomy 0.000 claims abstract description 20
- 206010052428 Wound Diseases 0.000 claims abstract description 14
- 208000027418 Wounds and injury Diseases 0.000 claims abstract description 14
- 230000007547 defect Effects 0.000 claims abstract description 13
- 238000002512 chemotherapy Methods 0.000 claims abstract description 9
- 206010028980 Neoplasm Diseases 0.000 claims abstract description 7
- 210000003823 hyoid bone Anatomy 0.000 claims abstract description 7
- DQLATGHUWYMOKM-UHFFFAOYSA-L cisplatin Chemical compound N[Pt](N)(Cl)Cl DQLATGHUWYMOKM-UHFFFAOYSA-L 0.000 claims abstract description 5
- 229960004316 cisplatin Drugs 0.000 claims abstract description 5
- 210000001165 lymph node Anatomy 0.000 claims abstract description 5
- 210000000062 pectoralis major Anatomy 0.000 claims abstract description 5
- 238000001959 radiotherapy Methods 0.000 claims abstract description 5
- 238000007920 subcutaneous administration Methods 0.000 claims abstract description 5
- 210000004304 subcutaneous tissue Anatomy 0.000 claims abstract description 5
- 230000002792 vascular Effects 0.000 claims abstract description 5
- 210000003462 vein Anatomy 0.000 claims abstract description 5
- 208000002847 Surgical Wound Diseases 0.000 claims abstract description 4
- 210000000115 thoracic cavity Anatomy 0.000 claims abstract description 4
- 210000004373 mandible Anatomy 0.000 claims description 15
- 210000001367 artery Anatomy 0.000 claims description 4
- 230000001815 facial effect Effects 0.000 claims description 4
- 239000003814 drug Substances 0.000 abstract description 2
- 230000002980 postoperative effect Effects 0.000 description 5
- 230000035876 healing Effects 0.000 description 3
- 201000006134 tongue cancer Diseases 0.000 description 3
- 230000000472 traumatic effect Effects 0.000 description 3
- 206010061523 Lip and/or oral cavity cancer Diseases 0.000 description 2
- 208000003445 Mouth Neoplasms Diseases 0.000 description 2
- 230000004075 alteration Effects 0.000 description 2
- 230000008929 regeneration Effects 0.000 description 2
- 238000011069 regeneration method Methods 0.000 description 2
- 238000004904 shortening Methods 0.000 description 2
- 210000001519 tissue Anatomy 0.000 description 2
- 206010027476 Metastases Diseases 0.000 description 1
- 208000025865 Ulcer Diseases 0.000 description 1
- 230000003115 biocidal effect Effects 0.000 description 1
- 210000000269 carotid artery external Anatomy 0.000 description 1
- 230000001413 cellular effect Effects 0.000 description 1
- 230000006003 cornification Effects 0.000 description 1
- 238000002316 cosmetic surgery Methods 0.000 description 1
- 238000003745 diagnosis Methods 0.000 description 1
- 230000002500 effect on skin Effects 0.000 description 1
- 210000002409 epiglottis Anatomy 0.000 description 1
- 210000000609 ganglia Anatomy 0.000 description 1
- 210000004877 mucosa Anatomy 0.000 description 1
- 210000004400 mucous membrane Anatomy 0.000 description 1
- 238000004321 preservation Methods 0.000 description 1
- 230000001681 protective effect Effects 0.000 description 1
- 238000011012 sanitization Methods 0.000 description 1
- 238000000926 separation method Methods 0.000 description 1
- 206010041823 squamous cell carcinoma Diseases 0.000 description 1
- 238000001356 surgical procedure Methods 0.000 description 1
- 238000002560 therapeutic procedure Methods 0.000 description 1
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- Surgical Instruments (AREA)
Abstract
Изобретение относится к медицине, в частности к онкологии и может быть использовано для лечения рака языка и дна полости рта с пластикой дефекта.Метод, согласно изобретению, состоит в том, что проводят радиотерапию по 2 Гр на один сеанс, суммарный курс составляет 40 Гр, затем выполняют разрез кожи в подчелюстной области от медиальной линии и до внутреннего края грудино-ключично-сосцевидной мышцы, на расстоянии 1,5...2,0 см от нижнего края нижней челюсти, разрез поверхностной фасции и подкожной мышцы, мобилизуют лицевую артерию и вену на уровне нижнего края нижней челюсти, затем в сонном треугольнике определяют лимфатические узлы, которые мобилизуют от ложи раны с сохранением связи в блоке с поврежденной частью языка, выполняют эксцизию мышц дна полости рта и языка от подъязычной кости и нижней челюсти пораженной стороны, со стороны полости рта выполняют разрезы, часть языка для удаления выводят в рану из области шеи и удаляют всю опухоль, после чего из грудной области секционируют кожно-мышечный лоскут на сосудистой ножке из большой грудной мышцы, который вращают под углом 180° с его прохождением через хирургическую рану и его расположением в области дефекта, затем раны ушивают послойно, после чего выполняют химиотерапию раствором цисплатина, в разовой дозе 100 мг/м2, один раз в 3...4 недели, курс лечения химиотерапией повторяют 3...4 раза.The invention relates to medicine, in particular to oncology and can be used to treat cancer of the tongue and the bottom of the oral cavity with plastic defect. The method according to the invention consists in the fact that they carry out radiotherapy at 2 Gy for one session, the total course is 40 Gy, Then, a skin incision is made in the submandibular region from the medial line to the inner edge of the sternocleidomastoid muscle, at a distance of 1.5 ... 2.0 cm from the lower edge of the lower jaw, a section of the superficial fascia and subcutaneous muscle is mobilized and no vein the lower margin of the lower jaw, then lymph nodes are determined in the carotid triangle, which mobilize from the bed of the wound while maintaining communication in the block with the damaged part of the tongue, excise the muscles of the bottom of the oral cavity and tongue from the hyoid bone and lower jaw of the affected side, from the side of the oral cavity sections, part of the tongue for removal is removed into the wound from the neck and the entire tumor is removed, after which a skin-muscle flap on the vascular pedicle from the pectoralis major muscle is sectioned from the thoracic region, which is rotated at an angle of 180 ° c about passing through a surgical wound and its location in the area of the defect, then the wounds are sutured in layers, after which chemotherapy is performed with cisplatin solution, in a single dose of 100 mg / m2, once every 3 ... 4 weeks, the course of chemotherapy is repeated 3 ... 4 times.
Description
Invenţia se referă la medicină, în special la oncologie şi poate fi utilizată pentru tratamentul cancerului de limbă şi de planşeu bucal cu plastia defectului. The invention relates to medicine, in particular to oncology and can be used for the treatment of tongue and floor of mouth cancer with defect plasty.
Este cunoscută metoda de tratament al cancerului de limbă, care include înlăturarea porţiunii de limbă afectată până la nivelul osului hioid în bloc cu conţinutul triunghiului submandibular al gâtului. Se efectuează incizia prin metoda cunoscută a tegumentelor obrazului şi buzei inferioare cu separarea lamboului din tegumente şi mucoasă ce asigură un abord combinat. Apoi se înlătură conţinutul triunghiului submandibular al gâtului. În cazul prezenţei metastazelor se efectuează o etapă radicală pe gât pentru înlăturarea lor până la picioruşul osului hioid. Intervenţia se prelungeşte în cavitatea bucală. Se efectuează incizia limbii cu rădăcina ei pe linia mediană până la epiglotă cu înlăturarea la acest nivel. Se efectuează rezecţia mandibulei în cazul implicării în proces sau afectării planşeului oral. Apoi intervenţia se prelungeşte în regiunea submandibulară. După ligaturarea preliminară a arterei carotide externe se secţionează muşchii limbii şi planşeului bucal. În acest mod se înlătură în bloc ţesuturile menţionate cu tumoarea şi cu conţinutul triunghiului submandibular şi ţesutul celular al părţii corespunzătoare a gâtului. Defectul este apoi suplinit cu un lambou dermal sau cu un lambou ce include tegumente şi muşchi care au fost preparate de pe gât [1]. The method of treatment of tongue cancer is known, which includes the removal of the affected portion of the tongue up to the level of the hyoid bone en bloc with the contents of the submandibular triangle of the neck. The incision is performed by the known method of the integuments of the cheek and lower lip with the separation of the flap from the integuments and mucosa, which ensures a combined approach. Then the contents of the submandibular triangle of the neck are removed. In the case of the presence of metastases, a radical stage is performed on the neck to remove them up to the foot of the hyoid bone. The intervention is extended into the oral cavity. The tongue is incised with its root on the midline up to the epiglottis with removal at this level. The mandible is resected in case of involvement in the process or damage to the floor of the mouth. Then the intervention is extended into the submandibular region. After preliminary ligation of the external carotid artery, the muscles of the tongue and floor of the mouth are sectioned. In this way, the aforementioned tissues with the tumor and the contents of the submandibular triangle and the cellular tissue of the corresponding part of the neck are removed en bloc. The defect is then replaced with a dermal flap or a flap that includes skin and muscles that have been prepared from the neck [1].
Este cunoscută metoda de tratament al cancerului limbii care include efectuarea inciziei tegumentelor în regiunea submandibulară de la linia mediană până la marginea internă a muşchiului sternocleidomastoidian, la o distanţă de 1,5…2,0 cm de la marginea inferioară a mandibulei, incizia fasciei superficiale, muşchiului subcutanat, mobilizarea arterei faciale şi venei la nivelul marginii inferioare a mandibulei, modelarea unui lambou musculodermal sau musculo-mucos, care se prepară din obraz după dimensiunile defectului planificat. Lamboul se deplasează spre exterior, teaca fascială se delimitează de mandibulă, în ea şi în triunghiul carotid se determină ganglionii, care se delimitează de la loja plăgii, dar cu păstrarea legăturii în bloc cu partea de limbă afectată. Se excizează muşchii planşeului bucal şi limbii de la osul hioid şi mandibulă de partea afectată. Din partea cavităţii bucale se efectuează inciziile, partea din limbă pentru înlăturare se exteriorizează în plaga din regiunea gâtului, se delimitează hotarele tumorii în întregime şi se înlătură blocul complet. În defectul format în cavitatea bucală pe sub marginea inferioară a mandibulei se deplasează lamboul format pe picioruş, care se suturează de partea restantă a limbii şi de mucoasa planşeului bucal. Tegumentele se suturează pe straturi [2]. The method of treatment of tongue cancer is known, which includes performing an incision of the skin in the submandibular region from the midline to the inner edge of the sternocleidomastoid muscle, at a distance of 1.5…2.0 cm from the lower edge of the mandible, incision of the superficial fascia, subcutaneous muscle, mobilization of the facial artery and vein at the level of the lower edge of the mandible, modeling of a musculodermal or musculo-mucous flap, which is prepared from the cheek according to the dimensions of the planned defect. The flap is moved outwards, the fascial sheath is delimited from the mandible, in it and in the carotid triangle the ganglia are determined, which are delimited from the wound bed, but with the preservation of the block connection with the affected part of the tongue. The muscles of the floor of the mouth and the tongue are excised from the hyoid bone and mandible on the affected side. From the oral cavity, incisions are made, the part of the tongue to be removed is externalized in the wound in the neck region, the tumor boundaries are delimited in full and the complete block is removed. In the defect formed in the oral cavity under the lower edge of the mandible, the flap formed on the pedicle is moved, which is sutured to the remaining part of the tongue and to the mucous membrane of the floor of the mouth. The skin is sutured in layers [2].
Dezavantajele metodelor cunoscute constau în aceea că sunt traumatizante, după prelevarea lamboului pentru plastie de pe gât rămân defecte nedorite din punct de vedere estetic, în perioada postoperatorie apar recidive şi durata de vindecare este îndelungată. The disadvantages of known methods are that they are traumatic, after the flap for neck plastic surgery is removed, aesthetically undesirable defects remain, relapses occur in the postoperative period, and the healing period is long.
Problema pe care o rezolvă invenţia constă în elaborarea unei metode de tratament al cancerului de limbă şi de planşeu bucal, care ar fi mai puţin traumatizantă, fără defecte în regiunea donatoare, ar oferi o posibilitate de manevrare mai eficientă cu lamboul format, care după regenerarea lui ar da o libertate mai mare de mişcare a limbii şi o alterare mai mică a vorbirii, precum şi ar preîntâmpina apariţia recidivelor cu micşorarea perioadei de vindecare. The problem solved by the invention consists in developing a method for treating tongue and floor of mouth cancer, which would be less traumatic, without defects in the donor region, would offer a more efficient possibility of handling the formed flap, which after its regeneration would give greater freedom of movement of the tongue and less speech alteration, as well as prevent the occurrence of relapses by shortening the healing period.
Metoda, conform invenţiei, constă în aceea că se efectuează radioterapia câte 2 Gy la o şedinţă, seria sumară fiind de 40 Gy, apoi se efectuează incizia tegumentelor în regiunea submandibulară de la linia mediană până la marginea internă a muşchiului sternocleidomastoidian, la o distanţă de 1,5...2,0 cm de la marginea inferioară a mandibulei, incizia fasciei superficiale şi a muşchiului subcutanat, se mobilizează artera facială şi vena la nivelul marginii inferioare a mandibulei, apoi în triunghiul carotid se determină ganglionii limfatici, care se mobilizează de la loja plăgii cu păstrarea legăturii în bloc cu partea de limbă afectată, se excizează muşchii planşeului bucal şi limbii de la osul hioid şi mandibulă de partea afectată, din partea cavităţii bucale se efectuează inciziile, partea din limbă pentru înlăturare se exteriorizează în plaga din regiunea gâtului şi se înlătură tumoarea în întregime, după care din regiunea toracică se secţionează un lambou musculocutanat pe picioruş vascular din muşchiul pectoral mare, care se roteşte sub un unghi de 180° cu trecerea lui prin plaga operatorie şi amplasarea în regiunea defectului, apoi plăgile se suturează pe straturi, după care se efectuează chimioterapie cu soluţie de cisplatină în doză unică de 100 mg/m2, o dată la 3...4 săptămâni, seria de tratament chimioterapic se repetă de 3...4 ori. The method, according to the invention, consists in performing radiotherapy of 2 Gy per session, the total series being 40 Gy, then the skin incision is performed in the submandibular region from the midline to the internal edge of the sternocleidomastoid muscle, at a distance of 1.5...2.0 cm from the lower edge of the mandible, the incision of the superficial fascia and the subcutaneous muscle, the facial artery and vein are mobilized at the level of the lower edge of the mandible, then in the carotid triangle the lymph nodes are determined, which are mobilized from the wound bed while maintaining the block connection with the affected part of the tongue, the muscles of the floor of the mouth and the tongue are excised from the hyoid bone and mandible on the affected side, incisions are performed from the oral cavity, the part of the tongue for removal is exteriorized in the wound in the neck region and the tumor is removed in its entirety, after which from the region In the thoracic region, a musculocutaneous flap is dissected on the vascular pedicle from the pectoralis major muscle, which is rotated at an angle of 180° with its passage through the surgical wound and placement in the defect region, then the wounds are sutured in layers, after which chemotherapy is performed with cisplatin solution in a single dose of 100 mg/m2, once every 3...4 weeks, the chemotherapy treatment series is repeated 3...4 times.
Rezultatul invenţiei constă în aceea că intervenţia este mai puţin traumatizantă, fără defecte în regiunea donatoare, ar oferi o posibilitate de manevrare mai eficientă cu lamboul format, care după regenerarea lui ar da o libertate mai mare de mişcare a limbii şi o alterare mai mică a vorbirii, precum şi preîntâmpinarea apariţiei recidivelor cât şi micşorarea perioadei de vindecare. The result of the invention is that the intervention is less traumatic, without defects in the donor region, would offer a possibility of more efficient maneuvering with the formed flap, which after its regeneration would give greater freedom of movement of the tongue and less alteration of speech, as well as preventing the occurrence of relapses and shortening the healing period.
Metoda se realizează în modul următor. The method is carried out in the following way.
Se efectuează în perioada preoperatorie radioterapia câte 2 Gy la o şedinţă, seria sumară fiind de 40 Gy, apoi se efectuează incizia tegumentelor în regiunea submandibulară de la linia mediană până la marginea internă a muşchiului sternocleidomastoidian, la o distanţă de 1,5...2,0 cm de la marginea inferioară a mandibulei, incizia fasciei superficiale şi a muşchiului subcutanat, se mobilizează artera facială şi vena la nivelul marginii inferioare a mandibulei, apoi în triunghiul carotid se determină ganglionii limfatici, care se mobilizează de la loja plăgii cu păstrarea legăturii în bloc cu partea de limbă afectată, se excizează muşchii planşeului bucal şi limbii de la osul hioid şi mandibulă de partea afectată, din partea cavităţii bucale se efectuează inciziile, partea din limbă pentru înlăturare se exteriorizează în plaga din regiunea gâtului şi se înlătură tumoarea în întregime, după care din regiunea toracică se secţionează un lambou musculocutanat pe picioruş vascular din muşchiul pectoral mare, care se roteşte sub un unghi de 180° cu trecerea lui prin plaga operatorie şi amplasarea în regiunea defectului, apoi plăgile se suturează pe straturi, după care se efectuează chimioterapie cu soluţie de cisplatină în doză unică de 100 mg/m2, o dată la 3...4 săptămâni, seria de tratament chimioterapic se repetă de 3...4 ori. În primele 48...72 ore pacientul se alimentează prin sonda nazogastrală, permanent se igienizează cavitatea bucală. Totodată în perioada postoperatorie se efectuează terapia protectoare cu antibiotice. Metoda a fost aplicată la 14 pacienţi cu cancer de limbă sau al planşeului bucal. During the preoperative period, radiotherapy is performed at 2 Gy per session, the total series being 40 Gy, then the skin incision is performed in the submandibular region from the midline to the internal edge of the sternocleidomastoid muscle, at a distance of 1.5...2.0 cm from the lower edge of the mandible, the incision of the superficial fascia and the subcutaneous muscle, the facial artery and vein are mobilized at the level of the lower edge of the mandible, then in the carotid triangle the lymph nodes are determined, which are mobilized from the wound bed while maintaining the connection en bloc with the affected part of the tongue, the muscles of the floor of the mouth and the tongue are excised from the hyoid bone and mandible on the affected side, incisions are made from the oral cavity, the part of the tongue to be removed is exteriorized in the wound in the neck region and the tumor is removed in its entirety, after which the thoracic region is sectioned a musculocutaneous flap on the vascular pedicle of the pectoralis major muscle, which is rotated at an angle of 180° with its passage through the surgical wound and placement in the defect region, then the wounds are sutured in layers, after which chemotherapy is performed with cisplatin solution in a single dose of 100 mg/m2, once every 3...4 weeks, the chemotherapy treatment series is repeated 3...4 times. In the first 48...72 hours, the patient is fed through a nasogastric tube, the oral cavity is constantly sanitized. At the same time, protective antibiotic therapy is performed in the postoperative period. The method was applied to 14 patients with cancer of the tongue or floor of the mouth.
Exemplu Example
Pacientul K., 62 ani, a fost internat cu diagnosticul de cancer de limbă T3NxM0. Forma histologică de cancer pavimentos cu cornificare. Obiectiv tumoarea de formă infiltrativ-ulceroasă pe partea laterală stângă în treimea medie a limbii. Ganglionii limfatici regionali nu se palpează. A fost efectuată radioterapia, câte 2 Gy la o şedinţă, cura de tratament fiind de 40 Gy, apoi intervenţia chirurgicală cu înlăturarea limbii şi planşeului bucal şi plastia defectului cu ajutorul lamboului musculo-cutanat, şi anume din muschiul pectoral mare cu pedicul vascular preluat din regiunea sternală. În perioada postoperatorie precoce s-a efectuat chimioterapia cu soluţie de cisplatină în doză unică de 100 mg/m2 suprafaţă corporală, o dată la 4 săptămâni, cura de tratament s-a repetat de 4 ori. Perioada postoperatorie fără complicaţii. La controlul postoperator peste 6 luni şi peste 12 luni fără recidive. Patient K., 62 years old, was hospitalized with the diagnosis of tongue cancer T3NxM0. Histological form of squamous cell carcinoma with cornification. Objectively, the tumor was infiltrative-ulcerative on the left lateral side in the middle third of the tongue. Regional lymph nodes were not palpable. Radiotherapy was performed, 2 Gy per session, the treatment course being 40 Gy, then surgery with removal of the tongue and floor of the mouth and plasty of the defect using a musculocutaneous flap, namely from the pectoralis major muscle with a vascular pedicle taken from the sternal region. In the early postoperative period, chemotherapy was performed with cisplatin solution in a single dose of 100 mg/m2 body surface, once every 4 weeks, the treatment course was repeated 4 times. The postoperative period was without complications. At the postoperative control after 6 months and after 12 months, no relapses.
1. SU 1113929 A1 1985.12.23 1. SU 1113929 A1 1985.12.23
2. RU 2190975 C2 2002.10.20 2. RU 2190975 C2 2002.10.20
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| MDS20160133A MD1145Z (en) | 2016-11-22 | 2016-11-22 | Method for treating cancer of the tongue and floor of the mouth |
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| MDS20160133A MD1145Z (en) | 2016-11-22 | 2016-11-22 | Method for treating cancer of the tongue and floor of the mouth |
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| MD1145Z true MD1145Z (en) | 2017-12-31 |
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Citations (6)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| SU888957A1 (en) * | 1980-03-11 | 1981-12-15 | Свердловский Ордена Трудового Красного Знамени Государственный Медицинский Институт | Method of surgical treatment of tongue root goiter |
| SU1113929A1 (en) * | 1983-04-08 | 1985-12-23 | Всесоюзный онкологический научный центр АМН СССР | Method of treating locally distributed cancer of tongue side areas and oral cavity bottom |
| SU1113930A1 (en) * | 1983-04-08 | 1985-12-23 | Всесоюзный онкологический научный центр АМН СССР | Method of treating tongue root cancer |
| SU1717112A1 (en) * | 1989-04-04 | 1992-03-07 | Научно-исследовательский институт онкологии и медицинской радиологии | Method of exposure and catheterization of the lingual artery in patients with tumors of the tongue and oral cavity |
| RU2190975C2 (en) * | 2000-09-27 | 2002-10-20 | Бакиров Рим Талгатович | Method for treating glossal cancer |
| MD958Y (en) * | 2015-02-06 | 2015-10-31 | Andrei Doruc | Method for treating tongue cancer with defect replacement by nasobuccal flap |
-
2016
- 2016-11-22 MD MDS20160133A patent/MD1145Z/en not_active IP Right Cessation
Patent Citations (6)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| SU888957A1 (en) * | 1980-03-11 | 1981-12-15 | Свердловский Ордена Трудового Красного Знамени Государственный Медицинский Институт | Method of surgical treatment of tongue root goiter |
| SU1113929A1 (en) * | 1983-04-08 | 1985-12-23 | Всесоюзный онкологический научный центр АМН СССР | Method of treating locally distributed cancer of tongue side areas and oral cavity bottom |
| SU1113930A1 (en) * | 1983-04-08 | 1985-12-23 | Всесоюзный онкологический научный центр АМН СССР | Method of treating tongue root cancer |
| SU1717112A1 (en) * | 1989-04-04 | 1992-03-07 | Научно-исследовательский институт онкологии и медицинской радиологии | Method of exposure and catheterization of the lingual artery in patients with tumors of the tongue and oral cavity |
| RU2190975C2 (en) * | 2000-09-27 | 2002-10-20 | Бакиров Рим Талгатович | Method for treating glossal cancer |
| MD958Y (en) * | 2015-02-06 | 2015-10-31 | Andrei Doruc | Method for treating tongue cancer with defect replacement by nasobuccal flap |
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| Publication number | Publication date |
|---|---|
| MD1145Y (en) | 2017-05-31 |
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