RU2590862C1 - Method for reconstruction of tongue after half-resection thereof - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to maxillofacial surgery and oncology. Method includes forming within jugular notch a skin flap on neck muscles. Introduction thereof into oral cavity, flap is anchored to bottom of oral cavity and tongue. Suturing donor zone vertically with interrupted sutures. Flap is cut out of oval shape of size 8×5 cm, which is separated on two pairs of sternum-sublingual and thyrohyoid muscles, including top poles and front parts of thyroid gland underlying said muscles with upper thyroid arteries and veins on both sides. Flap is displaced by 90° along horizontal line, is introduced after side pharyngotomy in submandibular area between hyoid bone and body of mandible. Fixing skin rear part of flap to base of epiglottis, front part of flap to top of tongue, remaining soft edge flap is distributed and sutured along perimeter to half tongue and bottom of oral cavity.

EFFECT: method enables to reconstruct tongue after its half-resection with adequate blood supply of tissues and early recovery of patient in postoperative period.

1 cl, 1 ex

Description

The invention relates to medicine, namely to maxillofacial surgery and oncology, and can be used for reconstruction of the tongue after its half resection.

A known method of reconstruction of the tongue using a musculocutaneous flap on the cervical muscles (1).

The disadvantages of this method is that the flap has acute angles, insufficient size for the reconstruction of half of the tongue, has no axial blood supply, and has only minor branches of the upper thyroid artery.

A known method of reconstruction of the tongue in the surgical treatment of malignant tumors of the tongue according to Pismenny V.I. by forming an islet skin flap on the anterior muscles of the neck and introducing it into the oral cavity into the defect zone, characterized in that the islet skin flap is formed in the 5 × 6 cm jugular notch area, the sternum-hyoid and sternum-thyroid muscles are cut from both sides to the place of attachment to the sternum, the islet skin flap on the anterior muscles of the neck is inserted into the oral cavity into the defect area above the biceps muscle, the lower edge of the flap is sutured to the mucosa of the bottom of the oral cavity, the upper edge of the flap is placed to the root of the tongue, and the maternal soil is sutured at the skin graft, vertically with single-node sutures, and a tracheostomy is applied in the lower part (2). This method is taken by us as a prototype.

The disadvantages of this method is that the flap is formed on three pairs of muscles - sternum-hyoid, sternum-thyroid and thyroid muscles, does not have sufficient mobility, given its massiveness; there is insufficient trophic flap due to the lack of pronounced arterial blood supply. It is not advisable to use the sterno-thyroid muscles as part of the flap, since the blood supply to these muscles is through the branches of the lower thyroid artery, which leads to marginal or total necrosis of the flap, and therefore to inconsistency of the sutures, secondary healing and an increase in the postoperative period.

The aim of the present invention is to provide a method for reconstructing the tongue after half resection with sufficient blood supply to the tissues used for plastic surgery and early recovery of the patient in the postoperative period.

This goal is achieved by cutting out an oval-shaped flap measuring 8 cm × 5 cm, which is secreted on two pairs of sternum-hyoid and thyroid-hyoid muscles, including the upper poles and the anterior thyroid gland, which are subordinate to the above muscles with superior thyroid arteries and veins on both sides; the flap is shifted 90 ° horizontally, it is inserted after the lateral pharyngotomy into the submandibular region between the hyoid bone and the body of the lower jaw, the skin posterior part of the flap is fixed to the base of the epiglottis, the front part of the flap is placed to the top of the tongue, the remaining non-fixed edges of the flap are distributed without tension and hem along the perimeter to half the tongue and the bottom of the oral cavity, the donor area is sutured vertically with interrupted sutures.

The technical result of the application of the method is that in the next postoperative period up to 14 days the patient's natural nutrition is restored due to improved trophic flap due to the inclusion of the front parts, the upper poles of the thyroid gland, an adequate and anatomically correct location of the flap in the oral cavity, which allows function the rest of the language. Necrotic changes in the flap do not occur, as the blood supply to the tissues used for plastic surgery improves, their regenerative potential increases, axial blood supply appears due to the formation and inclusion of the anterior parts and upper poles of the thyroid gland with the upper thyroid arteries and veins. During the formation of the flap, the muscles are cut off from the place of their attachment to the sternum, thereby supplying blood through anastomoses that connect to the upper thyroid artery.

The method is as follows. After performing half-resection of the tongue according to the classical method (3), an oval-shaped flap of 8 cm × 5 cm in size is cut out, which is secreted on two pairs of sternum-hyoid and thyroid-hyoid muscles, including the upper poles and the anterior thyroid glands, which are to the above muscles with the upper thyroid arteries and veins on both sides; the flap is shifted 90 ° horizontally, it is inserted after the lateral pharyngotomy into the submandibular region between the hyoid bone and the body of the lower jaw, the skin posterior part of the flap is fixed to the base of the epiglottis, the front part of the flap is placed to the top of the tongue, the remaining non-fixed edges of the flap are distributed without tension and hem along the perimeter to half the tongue and the bottom of the oral cavity, the donor area is sutured vertically with interrupted sutures.

The method is illustrated by a clinical example.

Patient V., 56 years old, was admitted to the head and neck tumors department of the GBUZ SOKOD with a diagnosis of Cancer of the right half of the tongue with T2N0M0 II art. The tumor was removed in a single block from the right half of the tongue according to the classical technique (3). An oval-shaped flap 8 cm × 5 cm in size was selected, isolated on two pairs of sternum-hyoid and thyroid-hyoid muscles with the upper poles and anterior thyroid glands with upper thyroid arteries and veins on both sides; the flap was moved horizontally, performed lateral pharyngotomy in the submandibular region, the flap was moved to the oral cavity between the hyoid bone and the lower jaw, the skin posterior part of the flap was fixed to the base of the epiglottis, the front part of the flap was to the top of the tongue, the remaining unstretched edges of the flap were not spread and hemmed around the perimeter to half the tongue and the bottom of the oral cavity, the donor area was sutured vertically with interrupted sutures. The wounds healed by primary intention. No necrotic flap changes in the postoperative period were observed. The patient’s natural nutrition was restored and the naso-gastric tube was removed on the 14th day.

The proposed method can be successfully applied in patients for reconstruction of the tongue after its half resection both in oncology hospitals and in the departments of maxillofacial surgery.

Information sources

1. Nerobeev A.I., Plotnikov N.A. Restorative surgery of the soft tissues of the maxillofacial region. M., 1997 .-- 185 s.

2. Application for the invention of the Russian Federation “Method for the reconstruction of the tongue in the surgical treatment of malignant tumors of the tongue according to Pismennoy V.I.” No. 201152746 dated 10.11.2013, Bulletin No. 35.

3. Patent SU No. 1113929, authors V. P. Lyubaev A.I. Paches, N.A. Abdullin "A method for the treatment of locally advanced cancer of the lateral parts of the tongue and the bottom of the oral cavity."

Claims (1)

A method for reconstructing the tongue after half resection, including forming a skin flap on the neck muscles in the jugular notch, introducing it into the oral cavity, suturing the flap to the bottom of the oral cavity and tongue, suturing the donor area vertically with interrupted sutures, characterized in that the oval flap is cut out 8 cm × 5 cm in size, which is secreted on two pairs of sternum-hyoid and thyroid muscles, including the upper poles and the anterior thyroid gland, which are subject to the above muscles with the upper thyroid arteries and veins on both sides; the flap is moved 90 ° horizontally, it is inserted after the lateral pharyngotomy into the submandibular region between the hyoid bone and the body of the lower jaw, the skin posterior part of the flap is fixed to the base of the epiglottis, the front part of the flap is to the top of the tongue, the remaining non-fixed edges of the flap are distributed without tension and hemmed along the perimeter to half the tongue and the bottom of the oral cavity.