UA134920U - METHOD OF TREATMENT OF PATIENTS WITH TEMPERATURAL PIT TUMORS WITH DISTRIBUTION IN THE NOSE CAVITY, Pterygopalatine fossa, ROTO AND NOSE - Google Patents

Abstract

A method of treating patients with tumors of the temporal fossa with spread to the nasal cavity, pterygopalatine fossa, oropharynx and nasopharynx includes surgical access to the anatomical spaces for further removal of tumors. To remove large tumors from the above areas, remove the maxillofacial ridge, upper jaw tubercle, posterior wall of the maxillary cavity, lower parts of the pterygopalatine process, after which the soft tissues of the subtemporal and pterygopalatine fossa are repositioned and fixed for example a tampon or a plastic grid. The cheekbone-alveolar ridge is then restored with fragments of previously removed bone, and the wound is sutured.

Description

The useful model belongs to medicine and surgery, medical surgical technique, in particular to operative approaches to the pterygopalatine and subtemporal fossae, which are used in maxillofacial surgery, otorhinolaryngology, neurosurgery, skull base surgery.

There is a well-known surgical approach to the pterygoid fossa, which is used during the dissection of inflammatory processes of this localization, and which includes dissection of the mucous membrane along the transitional fold at the level of 5-8 teeth of the upper jaw, blunt exfoliation of soft tissues from the bone, passing the instrument into the subtemporal and pterygoid pits, getting exudate and draining the wound (according to Denker).

But this approach does not provide enough space to remove the tumor from the subtemporal fossa.

There is a known method of operative access to the pterygopalatine and subtemporal fossae (H. Obwegeser, 1975), which includes coronal access, osteotomy of the facial arch in two places and its downward displacement, osteotomy of the coronal process of the lower jaw and its upward displacement, after which these anatomical spaces

This approach also has disadvantages - it is traumatic and rather narrow, which does not ensure the removal of even small tumors, especially if they spread not only to the subtemporal fossa, but also to the nasal cavity, nasopharynx and pterygoid fossa.

The useful model is based on the task of eliminating the indicated shortcomings of existing methods of access to the subtemporal fossa, improving the results of surgical treatment of patients with large tumors of the subtemporal fossa with spread to the nasal cavity, pterygopalatine fossa, oropharynx and nasopharynx.

The task is solved by the fact that in the method of treatment of patients with tumors of the subtemporal fossa with spread to the nasal cavity, pterygopalatine fossa, oropharynx, which includes operative access to anatomical spaces for further removal of tumors, according to a useful model, for removal of large tumors from of the places of distribution that are indicated above, the facial-alveolar ridge, the tubercle of the upper jaw, the back wall of the maxillary cavity, the lower parts of the pterygoid process are removed, after which the soft tissues of the subtemporal and pterygoid fossa are repositioned and fixed, for example with a tampon or a plastic mesh, after which they are restored the facial-alveolar ridge with fragments of the previously removed bone, and the wound is sutured.

The result of using the method is to ensure the possibility of removing large tumors that are located in the subtemporal and pterygopalatine pits with spread to the nasal cavity, oro- and nasopharynx in a minimally traumatic way.

The proposed method is performed as follows: under anesthesia, the maxillary sinus is opened through a mucous membrane dissection, the buccal-alveolar crest, the maxillary tuberosity, the back wall of the maxillary cavity, and, if necessary, the lower parts of the pterygoid process are removed, thereby opening access to the subtemporal and pterygopalatine spaces, then if necessary, Bish's fat body is removed, after which access to the specified spaces is wide. The tumor and foreign body are removed. After that, the facial-alveolar crest is restored with bone plastic, and the wound is sutured.

An example of using the proposed method.

Patient Ya., 16 years old, disabled since childhood, hospitalized at the Institute of Otolaryngology of the National Academy of Medical Sciences

of Ukraine (medical history No. 1182 dated September 25, 2018) regarding the recurrence of juvenile angiofibroma, which occupied the left pterygoid, subtemporal area, nasal cavity, nasopharynx, and disturbed breathing, eating, and speech. Previously, with the aim of removing the tumor, he underwent operations that were ineffective, because known operative approaches were used, and the tumor is located close to the stony part of the internal carotid artery. Objectively: the tumor spreads to the base of the skull, occupies the pterygoid and subtemporal fossa, the left half of the nasal cavity, nasopharynx and oropharynx. On October 10, 2018, an operation was performed to remove the tumor. Under anesthesia, through the dissection of the mucous membrane along the transitional fold, a hygrotomy was performed, the buccal-alveolar crest, the tubercle of the upper jaw, the back wall of the maxillary cavity, the lower parts of the pterygoid process were removed, which opened access to the subtemporal and pterygoid spaces, then the tumor was removed in fragments. its size is 577710 cm. The autopsy was sewn up.

Blood loss - 700 ml.

Postoperative period without special features.

Indications for the proposed method are wide spread of the tumor in the nasal cavity, nasopharynx and oropharynx with germination in the pterygopalatine and subtemporal fossa.

The advantages of the proposed method are that it provides a wide and reliable opening of the subtemporal and pterygopalatine spaces with the possibility of extending the operative field into the oropharynx, cheek, pterygoid-mandibular space.

Claims (1)

USEFUL MODEL FORMULA The method of treatment of patients with tumors of the subtemporal fossa with spread into the nasal cavity, pterygo-palatine fossa, oro- and nasopharynx, which includes operative access to anatomical spaces for further removal of tumors, which is distinguished by the fact that for the removal of large tumors from the sites of spread, which are indicated above, the buccal-alveolar crest, maxillary tuberosity, posterior wall are removed the maxillary cavity, the lower parts of the pterygium-palatine process, after which the soft tissues of the subtemporal and pterygium-palatine fossa are repositioned and fixed, for example with a tampon or plastic mesh, after which the buccal-alveolar ridge is restored with fragments of the previously removed bone, and the wound is sutured.