Combined cheek, jaw and neck radical mastectomy

Buccal, maxillary and cervical combined radical surgery for buccal mucosal cancer has a wide range of primary lesions, involving the buccal (or skin) or mandibular gingiva and jaw, accompanied by submandibular or cervical lymphadenopathy, suspected or There has been a cervical lymph node metastasis, and there may be a complete resection. Treatment of diseases: buccal infection Indication The range of primary lesions suitable for buccal cancer is wider. Contraindications 1. The range of primary or metastatic lesions is too wide, and it has been difficult to surgically cut. 2. There are already distant transferers. 3, advanced cancer has appeared cachexia or heart, lung, liver, kidney, important organs have serious dysfunction, difficult to undergo radical resection surgery. Preoperative preparation 1, systemic examination including blood, urine, fecal routine examination, cardiopulmonary conditions, liver and kidney function. If there is hypertension, anemia or heart, lung, liver, kidney dysfunction, etc., the necessary treatment should be done before surgery, try to correct and improve to reduce intraoperative and postoperative complications. 2, face, neck, chest skin preparation. 3, preoperative medication according to general anesthesia before the anesthesia medication, and blood transfusion, infusion preparation. 4, clean teeth. 5. Prefabricated intermaxillary fixation devices or prefabricated bevel guides on the upper and lower jaw teeth for postoperative application to prevent mandibular dislocation. 6, the need for surgery in the surgery, should be designed before surgery to repair the flap or myocutaneous flap. Surgical procedure 1. Cervical lymphadenectomy First full neck dissection. When the operation proceeds to the submandibular area, the tissue at the lower edge of the lower jaw is not cut off. 2, the lower lip, the middle of the incision In the lower lip midline, the lower lip and the soft tissue of the ankle are cut open to the bone surface and continuous with the upper neck incision. 3, flip the lip and cheek tissue flap The lip and cheek tissue flap was peeled from the bone surface to the corner of the mouth to reveal the buccal lesion. 4. Separation of the soft tissue inside the mandible The periosteum was cut at the lower edge of the buccal mandibular bone, and the periosteal stripper was inserted into the mandibular body (lingual) side, and the soft tissue attached to the mandible of the mandible was separated from the bone surface and up to the gingival margin of the lingual side. 5, saw off the mandible A mandibular tooth was removed 1.5 cm from the leading edge of the buccal cancer. Use a wire saw to cut the mandible at the extraction site. Stop bleeding at the end of the bleeding with bone wax to stop bleeding. 6, remove the original cheek cancer An incision was made at the border of the cancer at 1,0 cm to remove the buccal mucosa, submucosal tissue, buccal muscle and subcutaneous tissue. If the cancer has spread to the skin of the cheeks, the skin should be removed together to form a hole-filled defect. 7, free mandibular ascending branch Peel off the inner and outer sides of the mandibular ascending branch, cut off the muscle iliac and the inferior alveolar nerve vascular bundle, and ligation. 8, removal of buccal and neck combined resection specimens Finally, the tissues of the buccal cancer, part of the mandible, the parotid gland and the neck dissection were completely removed. 9, defect repair Buccal mucosal defects can be freely transplanted with medium-thickness skin flaps. Sutures that are sutured and ligated should be left long and used for wrapping. If there are more soft tissue defects in the cheeks, it can also be repaired with regional flaps such as frontal flaps. If the buccal skin is also removed at the same time, the repair of the piercing defect should take into account the double-layer repair of the lining and facial covering. Two pedicled area flaps can be used to repair the skin flaps, or skin grafts can be performed on a transferred pedicle flap to complete the double layer repair. 10, close the wound The inner and outer muscles and soft tissues of the mandibular resection are first sutured to eliminate the ineffective cavity. Then sew the lower lip flap back to the original position. Layered sutures, closure of the submandibular and cervical incisions. A vacuum tube for vacuum drainage is placed in each of the lower jaw and the lower neck. complication 1. Skin flap necrosis. 2, vagus nerve damage. 3, chest tube injury. 4, large blood vessel damage.

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