RU2100970C1 - Method to dissect hard and soft palate - Google Patents

Abstract

FIELD: medicine, otorhinolaryngology, oncology. SUBSTANCE: after longitudinal cut of soft palate a T-shaped dissection of hard palate is performed along both longitudinal and cross-sectional sutures, horizontal platelets of palatine bones are mobilized at the place of fixation to perpendicular ones and upon mucous-periosteal fragment together with a half of soft palate are taken aside. After resection of posterior department of nasal septum all nasopharynx parts become available. On removing neoplasms mobilized palatal fragments are placed into initial position and fixed with sutures. EFFECT: higher efficiency to keep normal anatomic structures and physiological functions of a palate, avoid operational hemorrhages and trophic dysfunctions of soft tissues at postoperative period. 2 dwg

Description

 The invention relates to medicine, namely to oncology and otorhinolaryngology and can be used for surgical treatment of nasopharyngeal neoplasms.

 A known method of dissection (prototype) of the palate by longitudinal section of the soft palate along the midline, prolongation of the midline section of the mucous membrane of the palate in the direction of the alveolar process and resection of the horizontal plates of the palatine bones. With this dissection method, good access is created in all parts of the lower jaw.

The disadvantages of this method are:
normal anatomical structures are destroyed;
neurovascular bundles passing in large palatine channels and vascular anastomoses of the hard palate with soft are damaged;
heavy surgical bleeding;
violation of the physiological functions of the sky.

 There is also a method of dissecting the sky by longitudinal section of the soft sky in the midline.

 The disadvantage of this method is that it does not create optimal conditions for effective intervention from the dome of the nasopharynx, since the upper anterior parts of the nasopharynx are practically inaccessible.

 There is also a method of dissection of the sky by cross-section at the border of hard and soft palate with the removal of horizontal plates of the palatine bones. After pulling the soft palate behind, access to the nasopharynx is created.

The disadvantages of this method are:
normal anatomical structures are destroyed:
damage to the neurovascular bundles passing in large channels and vascular anastomoses of the hard palate with soft:
heavy surgical bleeding;
physiological functions of the sky are disturbed;
lack of access to the posterior nasopharynx.

 The disadvantages of these methods are: the destruction of normal anatomical structures; damage to the neurovascular bundles; heavy bleeding during surgery; violation of the physiological functions of the palate in the postoperative period when creating optimal conditions for intervention in the area of the dome of the nasopharynx, or insufficient access to all parts of the nasopharynx while maintaining normal sky structures.

 Thus, the above methods for dissecting the palate lead to the destruction of normal anatomical structures, the occurrence of surgical bleeding and the violation of the normal physiological functions of the palate and do not allow normal access to all sections of the nasopharynx without these disorders (Fig. 1).

 It is proposed with the aim of excluding resection of the palatine bones, preventing surgical bleeding and preserving the normal physiological functions of the palate, a new method for dissecting the palate.

 This goal is achieved by the fact that they produce a T-shaped dissection of the hard palate along the longitudinal and transverse sutures, mobilize the horizontal plates of the palatine bones at the attachment point to the perpendicular and mucoperiosteal flap, along with half of the soft palate, to the side (Fig. 2).

The method is as follows:
A longitudinal midline incision is made of the soft palate, then a T-shaped dissection of the hard palate along the longitudinal and transverse seams. From the back of the nasal cavity, the nasal septum is cut off at the point of attachment to the palatine bones. The horizontal plates of the palatine bones thus selected are mobilized by breaking in the place of attachment to the perpendicular and on the mucoperiosteal flap along with half of the soft palate. At the same time, the neurovascular bundle that passes in the large palatine canal and the vascular anastomoses between the hard and soft palate are preserved. The posterior nasal septum is resected. Thus, sufficient conditions are created for access to all departments of the nasopharynx. After removal of nasal formation, the mobilized horizontal plates of the palatine bones, together with the halves of the soft palate, are put into place and fixed with sutures between themselves and to the hard palate.

 Clinical example 1.

 Patient L. 19 years old, was admitted to the clinic 06/09/92. Clinical diagnosis: juvenile nasopharyngeal angiofibroma.

 Upon receipt, the condition is satisfactory, complaints of difficulty in nasal breathing and periodic nosebleeds.

 Objectively: the lymph nodes of the neck are not enlarged. With posterior rhinoscopy: in the dome of the nasopharynx a tuberous, profusely bleeding tumor of a dark red color is visible, covering 2/3 of the lumen of the choan. Tumor biopsy juvenile angiofibroma.

 06/25/92 operation removal of a tumor of the nasopharynx.

 General anesthesia. A through median longitudinal section of the soft palate was made until it was connected to the hard palate. Then, with a scalpel, a T-section of the mucoperioste of the hard palate was made along the longitudinal and transverse palatine sutures. Using boron, horizontal plates of the palatine bones were extracted along the longitudinal and transverse palatine suture. From the back of the nasal cavity, the nasal septum is cut off at the site of attachment to the palatine bones. The horizontal plates of the palatine bones are broken at the place of attachment to the perpendicular and on the mucoperiosteal flap along with the attached halves of the soft palate laid aside. Resection of the posterior nasal septum. Tumor removal The nasopharynx cavity is plugged. On the tampon are laid horizontal plates of the palatine bones along with half the soft palate. Layered seams on the soft palate and on the mucoperioste of the hard palate. At the seams - an iodine swab. Operating bleeding is moderate.

 On the fourth day after the operation, the tampon was removed from the nasopharynx, and on the seventh iodine-shaped tampon. Healing of the sky by primary intention. The phonation and the act of swallowing are not disturbed. The patient was discharged on the 20th day after surgery in satisfactory condition.

 Clinical example 2.

 Patient M., 36 years old, was admitted on September 21, 93. Clinical diagnosis: nasopharyngeal fibroma.

 Upon receipt complained of difficulty in nasal breathing, separated from the left half of the nose. Posterior rhinoscopy: a dense, smooth tumor of pink color, without ulceration, occupies the left choana. Nasal breathing on the left is absent. The histological conclusion of fibroma.

 10/14/93 tumor removal operation.

 General anesthesia. A through median longitudinal section of the soft palate was made until it was connected to the hard palate. Then, with a scalpel, a T-section of the mucoperioste of the hard palate was made along the longitudinal and transverse palatine sutures. Using boron, horizontal plates of the palatine bones were extracted along the longitudinal and transverse palatine suture. From the back of the nasal cavity, the nasal septum is cut off at the site of attachment to the palatine bones. The horizontal plates of the palatine bones are broken at the place of attachment to the perpendicular and on the mucoperiosteal flap along with the attached halves of the soft palate laid aside. Resection of the posterior nasal septum. Tumor removal The nasopharynx cavity is plugged. On the tampon are laid horizontal plates of the palatine bones along with half the soft palate. Layered seams on the soft palate and on the mucoperioste of the palate. On the seams iodine swab. The bleeding on the operation is moderate. On the 5th day, the tampon was removed from the nasopharynx, on the 7th iodoform tampon. Healing sutures in the palate by primary intention. The patient was discharged on the 12th day after surgery in satisfactory condition. The act of swallowing and phonation are not broken.

 Thus, it can be seen from the examples that the technique of dissecting the palate by the proposed method eliminates the resection of the palatine bones, the occurrence of heavy bleeding during surgery and allows you to maintain normal physiological functions of the palate.

Claims (1)

 A method for dissecting soft and hard palate by conducting a longitudinal section along the midline, characterized in that, in order to exclude resection of the palatine bones, prevent surgical bleeding and maintain normal physiological functions of the palate, a T-shaped dissection of the palate is performed along the longitudinal and transverse sutures, mobilized horizontal plates of the palatine bones at the point of attachment to the perpendicular and on the mucosal-periosteal flap along with half of the soft palate are removed to the sides.

Images