RU1790924C - Method for correction of a defect of the parotid gland duct - Google Patents

Abstract

Usage: in medicine, namely in maxillofacial surgery. The purpose of the invention is to prevent violations of the salivary function. SUMMARY OF THE INVENTION that the defect plastic is performed by the reverse section of the small saphenous vein of the lower third of the leg, the ends of the graft are sutured with the fibrous membrane of the duct, after which a second row of adventitio-adventitious veno-ductal sutures is applied. An advantage of the invention is in improving functional results.

Description

The invention relates to medicine and can be used in maxillofacial surgery as an organoplastic surgery for complete extra-glandular salivary fistulas, strictures and dilatations of the duct, salivary stones and foreign bodys of the duct with a defect length of more than 1 cm.

A method is known for plastic restoration of the parotid duct with a complete external fistula of its extra-iron part, in which, after isolation of the remaining proximal part of the duct from the scar tissue, the latter is sutured to a tongue-like flap cut out on the mucous membrane of the cheek. those. external fistula translates into internal.

The known method has the following disadvantages - when creating an artificial mouth of the excretory duct, the anatomical relationship between the salivary gland and the oral cavity changes - the path of the physiological saliva flow is reduced | which contributes to retrograde infection of the salivary gland, as well as the impracticability of this operation with a relatively small (up to

1 cm) the length of the duct in its proximal part, ......

A known method of plastic restoration of the missing part of the duct by suturing between the proximal and distal parts of a tubular hollow graft formed from the mucous membrane of the cheek or skin, end-to-end, in which, after matching the anastomosed ends of the duct and graft, separate knotted sutures are applied across the entire thickness of structures.

The known method, although it restores the path of physiological outflow of the secretion of the salivary gland, however, it is difficult to create a tubular transplant with an internal diameter of 1.5-2.0 mm, it is prone to deformation and scarring, since the sutures are not only across the newly created duct, but and along it, which inevitably leads to stenosis and stricture with impaired salivary function. In addition, the application of knotted seams across the entire thickness of the structures does not provide

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The tightness of the anastomosis requires full matching of the diameters of the stitched fragments.

It is an object of the invention to prevent violations of the salivary function of the main excretory duct of the peritoneal salivary gland.

The fasting of the military circuit is achieved by the fact that in the method of repairing the defect of the main duct of the parotid salivary gland by using a tube autograft, a reversed section of the small saphenous vein of the lower third of the leg is used, the ends of which are sutured with the fibrous membrane of the duct, after which a second series of adventitio-adventitious ducts are applied seams.

The method is as follows.::

After access to the duct is established, a polyethylene catheter is inserted through the mouth of the excretory duct, and a resected portion of the small saphenous vein of the leg is placed between the dietary and proximal parts of the duct. An autograft is taken in the region of the lower third of the leg, where the inner diameter of the saphenous vein of the leg coincides with the diameter of the excretory duct of the parotid salivary gland. The venous autograft is instilled with physiological saline and sutured into the duct defect in a reversed state (so that the vein valves do not interfere with the free flow of saliva). Dissected movable parts of the duct adventitia exfoliate from the fibrous membrane of the duct and displace the parts in the proximal direction of the submaximal region and in the distal direction of the inferior duct in the distal region. Parts of adventitia are fixed with shvemi-holders. A revision of Shchotok is performed, and the edges are refreshed if necessary. The anastomosis of the vein and the fibrous membrane of the duct is performed by the end-to-end type with a manual twisted suture for the purpose of less tramatization of the anastomotic zone. Then adventitious cuffs are unscrewed: proximal - in the dystal direction, distal - in the proximal direction and for fixation a second row of adventitious-adventitial vein-duct U-shaped sutures is laid so that a part of the suture line is hidden in the transverse direction. The catheter remains in the lumen of the newly created excretory duct for 5-7 days and is sutured to the mucous membrane of the cheek for temporary stability.

For example Dog, male, weight 15.5 kg.

Subthiopental anesthesia performed a linear incision 7 cm long parallel to the edge of the lower jaw along the line connecting the lower edge of the external auditory meatus and the angle of the mouth. Dissected skin, subcutaneous tissue, superficial fascia. Dull and sharp paths highlighted the main excretory duct of the parotid salivary gland. A duct defect of 3.5 cm in length is formed. Through

the mouth of the excretory duct introduced a polyethylene catheter. In the area of the outer surface of the lower third of the tibia, a 10 cm long incision was made, a small saphenous vein was bluntly and sharply distinguished. A section 3.5 cm long was resected. Vienna was instilled with physiological saline and placed in a catheter in a reversed state. The wound on the lower leg protection in layers. The free portion of the catheter is inserted into

proximal part of the duct. The adventitious membrane of the ends of the dissected duct is peeled off from the fibrous part and turns away by 0.5 cm, is fixed by holders. Continuous stitching

an anastomosis is applied to the wall of the vein and the fibrous membrane of the duct. The adventitious membrane returns to the correct position and U-shaped adventitious-adventitious vein-ductal sutures are laid so that the hidden line of sutures is located in the transverse direction. Sialography for 21 days showed the patency of the duct, while massage the gland from the mouth of the duct, it was clear

saliva. The catheter was removed on day 5.

In total, 27 operations were performed using the proposed method.

The proposed method allows to eliminate some difference in the diameters of the stitched veins and duct, ensures the tightness of the anastomosis and optimal conditions for reparative regeneration in the anastomotic zone, the method allows to remove the catheter from the early (3-5 days)

duct, does not require subsequent bougienage of the duct.

Claims (1)

SUMMARY OF THE INVENTION A method for repairing a defect in the duct of the parotid salivary gland using a graft, wherein, in order to prevent disturbances in the salivary function, the defect is plastic with a reverse section of the small saphenous vein of the lower third of the leg, the ends of the graft are sutured with the fibrous membrane of the duct, after which a second row of adventitio-adventitious venous ductal sutures is applied.