RU2820963C1 - Method of treating tongue cancer by intraoral tongue hemiresection - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to oncology and maxillofacial surgery. At the first stage, skin incision is performed under intubation anaesthesia along the upper cervical fold from the angle of the lower jaw to the inner edge of the nodding muscle at 2.0 cm from the edge of the lower jaw. Submandibular sheath is exposed. Accessory zone, submandibular zone, neck fat is excised in a single block with submandibular salivary gland, regional lymph nodes. Wound is drained and closed in layers. At the second stage, the intraoral approach involves a single-stage radical removal of the tumour of the posterior and middle one-third of the tongue with a figured L-shaped incision with preserving the end portion of the movable free part of the tongue. Formed defect is repaired by a posteriorly displaced fragment of the tongue, soft tissues, an oropharyngeal mucosa and an oral floor.

EFFECT: method enables improving treatment results, reducing the length of treatment and rehabilitation of tongue cancer, preserving speech function.

1 cl, 4 dwg, 1 ex

Description

The invention relates to medicine, namely to oncology, and can be used in the surgical treatment of tongue cancer.

There is a known method of tongue resection using external access, in which the red border of the lower lip is cut at a distance of 0.5-1 cm from the corner of the mouth, the cut is continued along the border of the red border and skin to the corner of the mouth, then down along the border of the lower lip and cheek to level 1, 5 cm below the edge of the lower jaw. The incision is continued parallel to the lower edge of the jaw to the anterior edge of the sternocleidomastoid muscle. In the oral cavity, an incision in the mucous membrane of the lower lip is carried out vertically to the alveolar process, and then along it the incision is continued to the retromolar region. Using a sharp needle, a loop suture is applied through the entire thickness of the root of the tongue. The tongue is dissected along the midline from the anterior section to the root. Bleeding vessels are sutured with catgut. Transverse cutting of tissue begins from the middle towards the lateral surface of the tongue. After final hemostasis, the wound surface of the tongue is sutured to the wound surface of the mucous membrane of the floor of the mouth.

However, after such an operation, a visible scar remains on the skin, the function of the lower lip is impaired, and swallowing and speech functions suffer, which leads to permanent disability and disability.

There is also a known method of tongue resection using intraoral access with suturing of the distal portion of the tongue before resection to reduce bleeding. The tongue is dissected along the midline from tip to root. Bleeding vessels are sutured with catgut. Transverse cutting of tissue begins from the middle towards the lateral surface of the tongue. After final hemostasis, the wound surface of the tongue is sutured to the wound surface of the mucous membrane of the floor of the mouth.

The known method does not involve preserving the clinically unaffected part of the tip of the tongue. Therefore, when surgical intervention is performed using this method, swallowing and speech functions also suffer, which leads to long-term disability.

The objective of the proposed method is to improve results and reduce treatment and rehabilitation time for tongue cancer with maximum preservation of speech function. The problem is solved by the proposed method, by intraoral subtotal hemiresection of the tongue in the middle and posterior third to the level of the hyoid bone, preserving the free part of the end of the tongue and simultaneous plastic surgery of the resulting defect of the tongue and floor of the mouth with a posteriorly displaced preserved fragment of the tongue, pharyngeal mucosa and floor of the mouth. The method is radical, organ-preserving, functionally sparing, allows maximum preservation of speech function, improves results and reduces the time of treatment and rehabilitation, which is very important for young patients and those associated with active professional speech load.

The method is carried out as follows.

Under intubation anesthesia, at the first stage, a skin incision is made along the upper cervical fold from the angle of the lower jaw to the inner edge of the sternocleidomastoid muscle, departing from the edge of the lower jaw by 2.0 cm, the submandibular sheath is exposed, the tissue of the accessory zone is isolated, the tissue of the submandibular zone and the lymph nodes are excised in in a single block with the submandibular salivary gland and regional lymph nodes, the wound is drained and sutured layer by layer.

At the second stage, intraoral access provides one-stage radical removal of the tumor of the posterior and middle third of the tongue using a shaped L-shaped incision, preserving the end section of the movable free part of the tongue, plastic surgery with a posteriorly displaced preserved fragment of the tongue, soft tissues and the mucous membrane of the oropharynx and the floor of the mouth.

Brief description of the drawings. Fig. 1. Scheme of the tongue section. Fig. 2. Scheme of tongue resection with preservation of the tip section. Fig. 3. Patient B-n. Photo. Scar on the neck after lymphadenectomy along the upper cervical fold. Fig. 4. Patient B-n. Photo. Full tongue movements after surgery. Speech is completely preserved.

Example.

Full name: B-na N. Age: 22 years,

Address: Arkhangelsk

Date of admission: 05/24/2016

Date of operation: 05/25/2016

Diagnosis: cancer of the root of the tongue on the right Tl NlxM0, condition after non-radical surgery and preoperative course of radiation therapy SOD 46 gray

Surgery: organ-preserving upper cervical fascial-sheath lymphadenectomy on the right, subtotal resection of the right half of the tongue with simultaneous plastic surgery with local tissues.

Anesthesia: TVVA+IV L

Operation protocol

A skin incision was made along the upper cervical fold to the right from the chin to the earlobe, layer-by-layer tissue dissection, and hemostasis by coagulation. The skin-fat flaps are mobilized, spread to the sides to the edge of the lower jaw, the lower third of the neck and the midline. The fascia and platysma were dissected, the external jugular vein was isolated and preserved. The sheath of the sternocleidomastoid muscle is opened, the muscle is mobilized and retracted laterally. The cellular spaces of the posterior triangle under the sternocleidomastoid muscle and the accessory zone are isolated and mobilized bluntly and sharply, preserving the accessory nerve and branches of the cervical plexus. The lower pole of the parotid salivary gland is resected, the stump is sutured and bandaged. The internal jugular vein is isolated and preserved, the tissue along the neurovascular cervical bundle is mobilized from the hyoid-scapular muscle to the base of the skull, and excised, preserving the latter. Fiber of the lateral, anterior, triangle, and accessory zone of the neck was removed in a single block with the lower pole of the parotid salivary gland, lymph nodes of the neck and surrounding fiber. Considering the stage and localization of the process in the root of the tongue, the gender and age of the patient, it was decided not to perform submandibular lymphadenectomy. Toilet the wound with antiseptic solutions, control for hemostasis and foreign bodies. Layer-by-layer suturing of the wound, covering the neurovascular bundle with a muscle flap, vicryl No. 3/0, atraumatic. A vacuum drainage system is installed and fixed to the skin. Intradermal suture with prolene No. 4/0, atraumatic. The seam line was treated with a 5% aqueous solution of potassium permanganate. Aseptic dressing.

A shaped L-shaped incision was made from the blind opening of the root of the tongue along the midline, preserving the end section, bordering the lateral surface of the tongue along the mucous membrane of the floor of the mouth to the root of the tongue with a longitudinal dissection of the maxillary-lingual fold with a Surgitron radio wave knife. The tissues of the tongue are cut through their entire thickness to the point of attachment to the hyoid bone. The lingual artery on the right is stitched and bandaged in the wound. The tumor was removed within healthy tissue. Hemostasis by coagulation and stitching. The tongue root defect is replaced by preserved and displaced tissues of the anterior third of the tongue, floor of the mouth and pharynx. Interrupted sutures on the muscles and mucous membrane of the tongue using vicryl No. 3/0, atraumatic. The defect has been corrected. The tongue is mobile and pink. Toilet wound. Treatment of the seam line with an aqueous solution of brilliant green.

Preparations: 1) tissue of the lateral, anterior triangle of the neck, accessory zone with the lower pole of the parotid salivary gland, lymph nodes of the neck and surrounding tissue, enlarged lymph node in the middle third of the neck in the area of the anterior surface of the internal jugular vein. 2) the right half of the tongue, on the section there is no tumor, a retracted postoperative scar with tissue compaction at the base.

Claims (1)

A method of treating tongue cancer by means of fascial-sheath cervical lymphadenectomy and subtotal hemiresection of the tongue using intraoral access with preservation of the end section and simultaneous reconstruction of the resulting defect in the tongue and floor of the mouth, which consists of performing a skin incision under intubation anesthesia at the first stage along the upper cervical fold from the angle of the lower jaw to the inner edge of the sternocleidomastoid muscle, retreating from the edge of the lower jaw by 2.0 cm, exposing the submandibular sheath, isolating the tissue of the accessory zone, submandibular zone, neck, excising it in a single block with the submandibular salivary gland, regional lymph nodes, draining and suturing the wound in layers ; and performing, at the second stage, through an intraoral approach, a simultaneous radical removal of the tumor of the posterior and middle third of the tongue using a shaped L-shaped incision, preserving the end section of the movable free part of the tongue, reconstructing the resulting defect with a posteriorly displaced preserved fragment of the tongue, soft tissues, the mucous membrane of the oropharynx and the floor of the mouth.