RU2110968C1 - Method for surgical treatment of benign tumors and chronic productive inflammatory processes in a lower lobe of submandibular salivary gland - Google Patents

Abstract

FIELD: medicine, surgery. SUBSTANCE: at traditional treating benign tumors and chronic productive inflammatory processes in submandibular salivary gland the latter should be totally removed. Such a procedure leads to defected function of removed organ and other disadvantages, so the given method deals with making a cut parallel to a large hornlet of hyoid bone, the own capsule of submandibular salivary gland is opened and only its lower lobe is removed, fascial case for the rest of two lobes of submandibular salivary gland is formed from the upper and lower leaves of a cut main cervical fascia. EFFECT: higher efficiency to keep function of submandibular salivary gland, to exclude possibility for the damage of marginal branch of facial arteries and vein, to decrease traumaticity of operation and improve cosmetic results.

Description

 The invention relates to medicine, namely to maxillofacial surgery, and can be used in the treatment of benign tumors and chronic productive inflammatory processes that affect the lower share of the submandibular salivary gland.

 Known methods for the treatment of benign tumors of the submandibular salivary gland and its chronic productive inflammatory processes, affecting, among other things, its lower lobe [1]. Total removal of the submandibular salivary gland is performed.

 However, during surgery by these methods, the function of one of the two submandibular salivary glands, which produce 70% of saliva, is lost.

 There is also a method of removing the submandibular salivary gland, which we selected as a prototype [2]. According to the prototype method, under local anesthesia, a 5-6 cm long incision is made in the submandibular region parallel to the lower edge of the lower jaw, 2 cm away from it. The skin, subcutaneous tissue, superficial fascia with subcutaneous muscle are dissected. Carefully open the second fascia. The gland is fixed with a thick silk ligature and carefully secreted using a curved hemostatic clamp, Cooper scissors and tweezers.

 When submandibular salivary gland is isolated, two silk ligatures are placed on the initial section of the excretory duct, between which the duct is crossed. Without leaving closed cavities, impose immersion seams with catgut. For 2 to 3 days, the wound is drained.

The disadvantages of this method are:
1. Loss of function of the removed gland producing 35% of the secreted saliva.

 2. The inevitability of damage to the facial arteries and veins, the danger of damage to the hyoid, lingual and regional branches of the facial nerves.

 3. Significant invasiveness of surgical intervention.

 The aim of the invention is to maintain the function of the submandibular salivary gland, eliminating the risk of damage to the marginal branch of the facial and lingual nerves, reducing the risk of damage to the facial arteries and veins and the invasiveness of surgical intervention.

 This goal is achieved by removing only the lower lobe of the submandibular salivary gland that is affected by a benign tumor or chronic productive inflammatory process, leaving its other two lobes functioning. This reduces the volume of surgical intervention, and the surgical field is located away from the lingual and marginal branches of the facial nerves and is removed from the facial vessels.

 The invention consists in the following.

 Under infiltration anesthesia, an incision is made above the tumor at the level of the large horn of the hyoid bone. Cut the skin, subcutaneous tissue, subcutaneous muscle of the neck, the main cervical fascia. Open their own capsule of the submandibular salivary gland and remove its lower lobe.

 The upper leaf of the dissected main cervical fascia is sutured to the remaining two lobes of the submandibular salivary gland, the interstitial tendon and the posterior abdomen of the biceal muscle, and its lower leaflet is lapped to the upper.

 An example of a specific implementation of the method. Sick V-na, 15 years old, East. Hospital No. 434, was admitted to the maxillofacial department No. 1 of the first clinical hospital in Donetsk on March 22, 1995, with complaints of a tumor-like formation in the right submandibular triangle.

 I noticed a tumor-like formation in January 1995. It gradually increased, never hurt. In the right submandibular triangle, a dense, enlarged, tuberous, painless salivary gland is palpated. The skin above it is mobile, painless. Transparent saliva is released from the excretory duct. At the mouth of the excretory duct of the left submandibular salivary gland, a round calculus with a diameter of 2-3 mm is determined.

 Diagnosis: mixed tumor of the right submandibular salivary gland, salivary stone disease of the left submandibular salivary gland.

 March 23, 1995 (protocol No. 148), a lobectomy was performed on the lower lobe of the right submandibular salivary gland, and a stone was removed from the left duct.

 Under infiltration anesthesia (Sol. Novocaini 0.5% - 40.0 ml), an incision was made above the tumor parallel to the large horn of the hyoid bone in the right submandibular triangle about 4 cm long.

 Dissected skin, subcutaneous tissue and muscle of the neck, the main cervical fascia. The lower lobe of the submandibular salivary gland with the tumor is resected. The stump of the gland after hemostasis is covered with the main fascia of the neck by suturing its upper edge to the intermediate tendon of the biliary network, and the lower one - with an overlap to the upper.

 The wound is sutured in layers. Aseptic dressing. The stone was removed from the duct of the left submandibular salivary gland.

 The result of a histological examination of the removed lobe of the right submandibular salivary gland N 6369-70 dated 04/05/95: chronic inflammation with a powerful growth of fibrous hyalinated connective tissue in places with preservation of small sections of the salivary gland along the periphery and individual glands among the scar tissue. Hyperplasia of the lymphoid tissue located in the tissue of the lymph node. No evidence of a tumor.

 The postoperative course is smooth. The wound healed by primary intention. 30.3.95, was discharged under outpatient supervision.

 Examined a month after the operation. There are no complaints. The function of the salivary glands is not impaired. There are no signs of an inflammatory process in the area of the submandibular salivary glands.

 The advantages of the proposed method are that only one, affected by a benign tumor or a chronic productive inflammatory process, is removed, the share of the submandibular salivary gland and the function of the two remaining parts is preserved.

 Significantly reduced operational trauma by reducing the volume of surgery. Reliably prevented damage to the lingual and marginal branches of the facial nerves due to the fact that the surgical field is outside these formations.

 The cosmetic advantages of the proposed method are that the skin scar is smaller than with the total removal of the submandibular salivary gland, is localized in the skin fold of the neck and there is no retraction of tissues in the localization of the salivary gland.

Literature
1. Paches A.I. Tumors of the head and neck M., Medicine, 1983, p. 231.

 2. Alexandrov N.M. /under. Ed. / Clinical operative maxillofacial surgery. M., 1985, p. 342 - 343 - prototype

Claims (1)

 A method for the surgical treatment of benign tumors and chronic productive inflammatory processes of the lower lobe of the submandibular salivary gland, including performing a submandibular approach, characterized in that they cut their own capsule of the gland, remove the lobe affected by the tumor, the upper leaf of the dissected main cervical fascia is sutured to the remaining two lobes of the submandibular with the intermediate tendon and the posterior abdomen of the double-abdominal muscle, and its lower leaf is lapped to the upper.