Biller surgery

Treatment of diseases: meningioma Indication This procedure can well reveal the middle part of the middle skull from the styloid process to the lower part of the rock bone near the midline, the infraorbital fossa, the top of the parapharyngeal space, the base of the sphenoid bone and the upper neck. This technique can be used to remove benign or malignant tumors in these areas, such as fibroangiomas that invade the pterygopalatine, infraorbital fossa, and sphenoid sinus, small malignant tumors of the parotid gland, Schwannoma, residual squamous cell carcinoma, and meninges. Tumor, neuroma, mixed tumor, osteoma, etc. that invade the parapharyngeal space. Contraindications The lesion has a high position, close to or invades the tumor of the skull base, and the above separation lacks direct vision conditions, which may leave residual lesions and important structures of damage. Preoperative preparation 1. Systemic and specialist examinations, including blood biochemistry, blood type, heart, lung, liver, kidney function, chest X-ray and paranasal sinus CT, MRI examination, if necessary, please consult the relevant departments, including neurosurgery, ophthalmology, etc. 2. Antibiotics were given 1 to 2 days before surgery and administered as required for general anesthesia. 3. Head preparation skin. Surgical procedure 1. The skin incision and the neck reveal the incision line from the lower lip, stepped down to the underarm, to the posterior margin of the hyoid bone to the posterior margin of the sternocleidomastoid, up to the mastoid. The lower lip is cut in all layers and the lower lip artery is ligated. The neck is cut through the platysma, and the second abdominal muscle and the mandibular ligament muscle are separated and cut, and the submandibular gland is turned upside down. The arteriovenous and vagus nerves of the arterial sheath were separated and the sublingual and accessory nerves were exposed at the upper side. 2. Cut the mandible and the bottom of the mouth, and further dissect the neck structure to cut the mandible in the midline step. The open bottom mucosa was cut between the jaws of the submandibular gland, and the anterior arch of the tonsil was passed through the lateral side of the tongue. The blunt dissection separates the lingual and hypoglossal nerves and protects them. The submandibular gland is kept on the outside. The mandible is pulled outward and the external carotid artery is ligated. Cut the ligament of the styloid ligament, the genital ligament, the pharyngeal muscle, free the internal carotid artery to the arterial tube hole, separate the internal jugular vein, and the 10th, 11th, and 12th pairs of cranial nerves to the skull base. The intraoral incision was 1 cm forward to the midline along the maxillary nodules in the gums. 3. Further to the skull base to separate the mucosal periosteal flap, cut the collateral vessels of the ipsilateral iliac crest, bite the hard iliac bone, and separate the nasal mucosa of the pterygopalatine. The tongue nerve is separated into the foramen ovale, the wing inner muscle is separated by the outer wing plate, enters the infraorbital fossa and the anterior intervertebral space, the soft tissue of the pharynx is retracted, the eustachian tube and its attached muscle are exposed, and the anterior side is pulled. , the slope and cervical area can be revealed. The wing flap, the posterior wall of the maxillary sinus and the side wall can be removed to enter the maxillary space of the wing. If the lesion invades the anterior nasal cavity and the anterior cranial fossa, it should be combined with the nasal incision. 4. After the tumor is removed, the pharyngeal muscles are restored to the base of the skull, and the posterior nostrils are filled. The periosteal flap of the ankle was repositioned, the ankle and the incision were sutured, the mandible was fixed by ligation, and the lower lip, ankle and neck incision were sutured in layers. complication Surgery or intracranial infection, exudative otitis media, neck leakage, etc., timely treatment. Those with more cranial nerve damage, have aspiration and difficulty swallowing, may need a gastrostomy, and a few cases may also consider laryngectomy.

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