RU2411009C1 - Method of jawline repair - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to oncology, and aims at jawline repair in chin oncotomy surgeries. A lower edge of a jaw is incised at 1-1.5 cm downwards from a right to left angle. Subcutaneous fat and lymph nodes of left, right mandibular, mental and tracheal triangles and submandibular glands are removed en bloc by blunt and sharp techniques. Then the tumour is excised within healthy tissues. A formed skin defect of a chin is repaired with a counterlateral pedicle cellulocutaneous flap of the width 2.5-3 cm of a mental-submaxillary area which is anchored by a mucous membrane of a vestibule of mouth. Skin is separated along a lower edge of the incision of the cellulocutaneous flap. The defect is coated by pulling separated skin up to the lower edge of the cellulocutaneous flap. An internal lining is formed of a buccal mucosa. Skin is sutured and dressed.

EFFECT: method allows one-stage radical oncotomy, to repair an anatomically correct chin, to reduce hospital stay of a patient, to save the patient from multiple surgeries.

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Description

The invention relates to medicine, in particular to oncology, and can be used in surgical interventions to remove malignant tumors of the chin and lower lip.

There is a method of restoring the integrity of the chin, its correct anatomical appearance using the Filatov stem for the outer surface and a cut neck flap to create the inner surface of the chin ("Plastic surgery on the face", A.E. Rauer and N.M. Michelson, M .: Medgiz , 1954).

The method proposed by the authors can significantly improve the appearance of the patient and restore the functional value of the organ. However, the preparation of the Filatovsky stem requires 2.5-3 weeks, which does not allow to begin treatment of the main disease - a malignant tumor, and creates the conditions for the further spread of the process. In addition, surgery must be performed on three or more parts of the patient’s body, which also negatively affects the latter.

A known method of restoring the integrity and shape of the chin from a cut quadrangular flap on the neck, and the outer layer of the chin is formed from a flap cut from the scalp ("Plastic surgery on the face", A.E. Rauer and N.M. Mikhelson, M .: Medgiz, 1954).

The described method has obvious advantages, as it can be used for timely surgical removal of the tumor. However, the need to remove the legs of the head flap, expanding it and suturing it into the previously formed skin pocket, force us to perform repeated surgical interventions after the main removal of the malignant tumor.

All this prompts surgeons to look for more advanced methods of surgical removal of a malignant tumor with simultaneous restoration of the chin.

The aim of the invention is the formation of the chin and its full blood supply.

The goal is achieved by the fact that along the lower edge of the jaw, stepping down 1-1.5 cm, an incision is made from the right to the left corner. Dull and sharp paths in a single block remove the fiber and lymph nodes of the left, right submandibular, chin and carotid triangles and submandibular salivary glands. The tumor is then removed within the healthy tissue. The resulting skin defect of the chin is restored with a 2.5-3 cm wide skin-fat flap on the contralateral feeding legs of the chin-submandibular region, which hem the mucosa of the vestibule of the oral cavity. Separate the skin along the lower edge of the incision of the skin-fat flap, cover the defect by pulling the separated skin to the lower edge of the skin-fat flap, the inner lining is formed from the mucous membrane of the cheeks.

A comparative analysis of the known methods of restoring the chin and the proposed allows us to state the presence of novelty and significant differences of the latter.

The novelty of the developed “Method for restoration of the lower part of the face” lies in the possibility of simultaneous removal of a malignant tumor and restoration of the natural anatomical state of the patient’s chin. Surgical intervention to remove the malignant tumor and restore the integrity of the face is carried out without additional incisions, since the skin-fat flap of the chin-submandibular region is pulled up, and the inner lining is formed from the mucous membrane of the cheeks.

In open sources of information in Russia, the CIS countries and abroad, a similar method could not be found.

The claimed "method of restoration of the lower part of the face" is industrially applicable. It can be reproduced and repeated many times in specialized ENT clinics of healthcare institutions.

The method is as follows.

In the operating room, after the necessary anesthesia is performed on the operating table, the patient undergoes a skin incision parallel to the lower jaw from the right to the left corner, stepping down 1-1.5 cm. Dull and sharp paths remove the cellulose and lymph nodes of the left, right submandibular, chin and carotid triangles and submandibular salivary glands. The tumor is then removed within the healthy tissue. The resulting skin defect of the chin is restored with a 2.5-3 cm wide skin-fat flap on the contralateral feeding legs of the chin-submandibular region, which hem the mucosa of the vestibule of the oral cavity. Separate the skin along the lower edge of the incision of the skin-fat flap, cover the defect by pulling the separated skin to the lower edge of the skin-fat flap, the inner lining is formed from the mucous membrane of the cheeks.

An example of a specific implementation of the method can serve as an extract from the medical history.

Patient I., medical history No. 1923 / t, born in 1949, was admitted to the head and neck tumor department of RNII with a diagnosis of lower lip cancer with spread to the skin of the chin, St IVA, T4N0M0, Cl. column 2.

On 2.02.04, an operation was performed: bilateral upper fascial-sheath excision of the fiber and lymph nodes of the left, right submandibular, chin and carotid triangles and submandibular salivary glands, subtotal resection of the lower lip with skin and soft tissues of the chin. Under intravenous anesthesia with mechanical ventilation, a skin incision was made parallel to the lower jaw from the right to the left corner, stepping down 1-1.5 cm. Dull and sharp paths removed the fiber and lymph nodes of the left, right submandibular, chin and carotid triangles and submandibular salivary organs in a single block. glands. The tumor is removed within healthy tissues. The resulting skin defect was restored by a 2.5-3 cm wide skin-fat flap on the contralateral feeding legs of the chin-submandibular region, which is hemmed to the mucosa of the vestibule of the oral cavity. Next, the skin is separated along the lower edge of the cutaneous-fatty flap incision and pulled to the lower edge of the skin-fatty flap, stitches are applied. The inner lining and the red border of the lip are formed from the mucosa of both cheeks. The skin is stitched, a bandage.

02.17.04 the patient was discharged in satisfactory condition. Breathing through the natural paths is free. Nutrition through natural routes on the 7th day after surgery.

The patient is under medical observation.

March 6, 2008 - the patient is in satisfactory condition, the natural chin formed, elastic.

According to the developed “Method for restoration of the lower part of the face”, surgical interventions were performed for 7 patients who had malignant tumors of the lower lip with spread to the chin. In no case was a relapse of the disease noted. Patients are in satisfactory condition and lead an active lifestyle.

The technical and economic effectiveness of the “Method of restoration of the lower part of the face” allows you to:

- make a simultaneous radical removal of the malignant tumor and restore the anatomically correct chin;

- reduce the patient’s hospital stay;

- save the patient from multiple surgical interventions;

- improve the quality of life and social rehabilitation of patients.

Claims (1)

The method of restoration of the lower part of the face, including surgical removal of the tumor by blunt and sharp paths in a single block with cellulose and lymph nodes of the left, right submandibular and chin triangles, sanitation of the sleepy triangles of the neck, characterized in that a cut of the skin is made in the submandibular region parallel to the lower jaw, stepping down 1-1.5 cm; the resulting skin defect is filled with a 2.5-3 cm wide skin-fat flap on the contralateral feeding legs of the chin-submandibular region, which is sutured to the mucosa of the vestibule of the oral cavity; skin is separated along the lower edge of the cutaneous-fatty flap incision, sutured, the inner lining is formed from the mucosa of both cheeks; Stitches are applied to the skin, a bandage.