RU1792663C - Method of tongue resection in initial stages of malignant tumors of its middle third - Google Patents

Abstract

Usage: in medicine, namely in maxillofacial surgery. The purpose of the invention is to reduce postoperative complications and ensure radical operation. The essence of the proposal is that before performing an incision in the tongue, the mucous membrane of the hyoid is cut from the frenum of the tongue to the anterior palatine arch, the mucous membrane along with the duct of the submandibular salivary gland they are pulled to the inner surface of the lower jaw, then the ligamentous artery or its main branches are ligated, the hyoid - lingual muscle and chin muscles are crossed and make longitudinal and transverse sections on the tongue. The advantage of the proposal is to improve functional results.

Description

The invention relates to medicine, namely to maxillofacial surgery, and can be used in the treatment of malignant tumors of the tongue.

Known methods for resecting the tongue using the oral cavity with flashing of the distal portion of the tongue before resection to reduce blood loss.

However, when performing an operative measure according to the indicated methods, it is not sufficient to observe ablasticity and excessively draining the surgical floor.

A tongue resection method is also known in which, using a sharp needle, a loop stitch is inserted through the entire thickness of the root tissue or previously bind to the external carotid artery to reduce bleeding. Beginning from the tip, cut the tongue along the middle line to the root. Blood-sharpening vessels are stitched with catgut. Cross cutting of tissues starts from the middle towards the lateral surface of the tongue. After half the removal of the language, the final hemostasis is performed, the edges of the mucous membrane of the upper and lower surfaces of the remaining half of the language bring together and, if possible, stitch together.

The method is not sufficiently flexible and radical because the operation does not take into account the possibility of the tumor spreading in the direction of the skeletal muscle fibers of the tongue.

Suturing in the region of the root tongue does not provide sufficient bleeding of the surgical floor, since vessels accompanying the skeletal muscle of the tongue remain outside the ligature.

The purpose of the invention is to ensure the radicalism of the operation and the reduction of postoperative complications is achieved by the fact that along with the site of the tongue, a part of its skeletal muscles is excised within the necessary limits, along the fibers of which the tumor can spread, and the rocks by operation

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the lingual artery or its main branches are ligated in the language.

The essence of the method is as follows.

Lay the patient on his back. Open your mouth. Sew the language. From the bridle of the tongue to the anterior palatine arch on the side of the operation, the mucous membrane of the sublingual region is dissected. The mucous membrane along with the duct of the submandibular salivary gland is pulled towards the inner surface of the body of the lower jaw. The tongue is pulled as far as possible from the mouth of the mouth. In the lower part of the wound, the fibers of the hyoid muscle cross. Tie the trunk of the lingual artery or its main branches, going to the resected section of the lingual. The fibers of the hymenoid muscle are crossed according to the resected section of the tongue. A gauze napkin is placed in the wound. The required portion of the tongue is resected above the napkin.

Example. Sick 3-core A.T., 75 years old, received 02.04.90. g, with gutters for the presence of an ulcer on the lateral surface of the tongue on the right, soreness when eating, talking .... ..: .- ..;

He considers himself to be a patient since May 1989, when an ulcer appeared in the language. Histological examination No. 12780 of 21. g, squamous keratinizing cancer. In November 1989, in Donetsk, the oncology dispensary received a course of radiation therapy in the amount of 40 Gy.

When entering the tongue on the lateral surface, an ulcer of about 4 cm in size is identified on the right, with the edges turned upright and the base infiltrated. Language is mobile. The mucous membrane of the hyoid region is unremarkable. On palpation of the sublingual region, no pathological changes are detected.

Enlarged lymph nodes are determined in the right submandibular triangle, one of which is limitedly mobile.

04.03.90, the operation was performed half resection of the language.

Under anesthesia with a scalpel, the mucous membrane of the hyoid region to the right of the frenulum of the tongue to the anterior palatine arch is dissected. The mucous membrane of the hyoid region, together with the excretory duct of the submandibular salivary gland, is chickpea to the inner surface of the lower body

the jaw. The sublingual muscle is crossed by an electric knife. The arteries are recalled. The chin-muscle is crossed. An electric knife is dissected from its tip to the root, approaching to the left of the midline by 0.7-1 cm. An electric knife is used to cut off part of the tongue along with the tumor by a transverse incision, and an indent 3 cm backward from its border.

the lining of the stump of the tongue is stitched with the mucous membrane of the bottom of the oral cavity. In the end section, the mucosa is sewn together with the membrane of the upper and lower surfaces of the tongue.

The postoperative wound healed partially by primary tension, partially by granulation. 11.04.90, was discharged under outpatient supervision.

04.0b 90 g hospitalized for lymphadenectomy. The cult of the language is soft, mobile. Sublingual area without features

On 05.06.90, Crail's operation was performed on the right. The operation and the postoperative period were uneventful. On the 10th day the seams were removed, 06/19/90 was discharged under outpatient supervision. . Examined at the end of August 1990 - there are no signs of tumor recurrence.

The advantages of the claimed method are that the radicalism of the operation is increased in connection with the inclusion in the reserved section of the skeletal muscle of the tongue, along the fibers of which

malignant tumors spread.

Prior surgical intervention on the ligation of the ligation of the lingual artery or its main branches leading to

the resected section of the language, it bleeds the surgical field well, reduces blood loss during surgery, provides constant visual control over the course of the operation,

The introduction of a gauze napkin into the wound channel under the resected section of the tongue prevents tissue damage during incisions in the tongue.

The method of resection of the language at the initial

stages of malignant tumors of its middle third can be used to localize the tumor on the lateral surface or back of the tongue and the degree of spread of the Ti tumor, i.e. no more than 2 cm in the most voltam measurement.

Claims (1)

SUMMARY OF THE INVENTION A method for resecting a tongue in the initial stages of malignant tumors of the middle third by means of intraoral access, a longitudinal and transverse incision, and resection, characterized in that, in order to reduce postoperative complications and ensure radical surgery, the mucous membrane is cut before the incision is made in the tongue the hyoid region from the frenulum of the tongue to the anterior palatine arch, the mucous membrane along with the duct of the submandibular salivary gland is pulled to the inner surface of the lower jaw; then they cross the hyoid muscle, bandage the hyoid artery or its main branches and the chin muscle and make longitudinal and transverse incisions in the tongue.