Виртуальное хирургическое планирование для реконструкции мягких тканей при раке полости рта

Introduction. Reconstruction of soft tissue defects after radical surgeries in cancer patients is important for early surgical rehabilitation and improving quality of life. Our study presents technologies for virtual surgical planning (VSP) of soft tissue defect reconstruction in patients with squamous cell carcinoma of the oral cavity.Case presentation. We described VSP in a report of a 54-year-old patient with locally advanced buccal mucosa cancer after extensive radical resection and reported the results. VSP was used to construct a 3D model from CT images, which was used to accurately assess the margin of radical surgical resection, as well as to develop individually based reconstruction of soft tissue defects. Next, we reported a series of cases of patients with oral cancer of various locations, who, after radical surgery, underwent reconstruction with using of VSP (n=7) or conventional reconstruction (n=10). A comparative analysis of intra and postoperative results was carried out.Results. In a patient with locally advanced left buccal mucosa cancer, reconstruction of the postoperative defect was successful without local complications after reconstruction. Good functional and aesthetic results were obtained. The patient was observed for 2 years without signs of disease. A comparative assessment of the results of the main and control groups showed that patients in the VSP group had a shorter operation time and postoperative hospital stay, as well as fewer and milder postoperative local complications in comparison with the control group.Conclusion. Our results showed the effectiveness of using 3D technology in reconstructive surgery of soft tissue defects after radical surgery for oral SCC. This technology has significantly reduced operative time, hospital stay, and improved flap utilization. This method has great potential for wider application and provides greater benefits with further improvement of technology.Введение. Реконструкция дефектов мягких тканей после радикальных операций у онкологических больных важна для ранней хирургической реабилитации и улучшения качества жизни. В нашем исследовании представлены технологии виртуального хирургического планирования (ВХП) реконструкции дефектов мягких тканей у больных с плоскоклеточным раком полости рта.Описание клинического случая. Представляем результаты применения методики ВХП при обширной радикальной резекции по поводу местнораспространенного рака слизистой оболочки щеки у пациента 54 лет. С помощью ВХП на основе КТ-изображений построена 3D-модель, которая использовалась для точной оценки границ радикальной резекции, а также для индивидуальной реконструкции дефектов мягких тканей. Далее мы сообщили о серии случаев больных раком полости рта, которым после радикальной операции проведена реконструкция с использованием ВХП-технологии (n=7) или традиционными методами (n=10). Проведен сравнительный анализ интра- и послеоперационных результатов.Результаты. У больного местнораспространенным раком слизистой оболочки левой щеки c реконструкцией образовавшегося дефекта послеоперационный период протекал без осложнений, получены хорошие функциональные и эстетические результаты. Больной наблюдался в течение 2 лет без признаков заболевания. Сравнительная оценка результатов показала, что у пациентов с ВХП были короче продолжительность операции и сроки послеоперационного пребывания в стационаре, а также меньшее количество и более легкие послеоперационные осложнения по сравнению с контрольной группой.Заключение. Наши результаты показали эффективность использования 3D-технологии в реконструктивной хирургии дефектов мягких тканей после радикальных операций по поводу плоскоклеточного рака полости рта. Эта технология позволила значительно сократить время операции и пребывания в больнице, а также улучшить использование лоскута. Этот метод имеет большой потенциал для более широкого применения и дает большие преимущества при дальнейшем совершенствовании технологии

Reconstruction of full-thickness chick defects formed after tumor removal using a modified technique for submental flap dissection

Reconstruction of vast penetrating defects after radical resection of advanced tumors of the head and neck is a complex problem of reconstructive oral and maxillofacial surgery. In case of a vast full-thickness defect of the chick, it is necessary to create isolated walls both inside and outside the oral cavity, i.e. to perform two-layer reconstruction. In most articles, use of 2 distant flaps or a double folded free revascularized autologous transplant are described. However, performance of such large-scale and long surgical interventions can be limited by patient’s age or functional status, as well as other objective factors.In reconstruction of full-thickness chick defects, a submental flap is an adequate alternative to a free revascularized autologous transplant. This surgery is technically much easier and produces a better esthetic effect compared to the use of a combination of temporal myofacial and cervicofacial flaps, as well as a double cervicopectoral flap. The proposed modification of the method–sialoadenectomy at the stage prior to harvesting of the pedicle flap – not only makes dissection easier but allows to determine tumor advancement. Temporal ligation of the facial artery above the branching site of the submental artery reduces blood loss during removal of a primary tumor of the chick

Treatment of extensive tumors of the jaws by hemimandibuloectomy with simultaniouse reconstruction of the mandible, arthroplasty of temporomandibular joint, orthopedic rehabilitation supported by dental implants

Background. Reconstruction of subtotal and total defects of maxillofacial region after ablative tumor surgery is a challenging task of reconstructive surgery. The “golden rule” is maintaining of radicalism of ablative surgery as well as appropriate surgical reconstruction and prosthodontic rehabilitation, that allows patient return to normal life. Wherein reconstructive procedure is focusing on restoring of mandibular continuity by the means of different flaps and grafts, while prosthodontic rehabilitation is performing after some period of time (usually around year) by the means of removable and non-removable prosthodontic devices. Non-removable device requiring dental implants insertion into grafted material followed by period of osteointegration, that is requiring some time as well. However, within this period of time one could observe significant soft tissue deformity.The objective is to improve the outcomes of surgical reconstruction of extensive defects of the mandible and to carry out rapid prosthodontic rehabilitation supported by dental implants by application of 3D preoperative planning and navigation devices.Clinical case. Forty-nine years-old female patient with recurrent ameloblastoma, that affects vertical and horizontal ramus of the mandible. Within virtual preoperative planning one performed: resection of the mandible associated with exarticulation of condylar head, virtual plate bending according to contours of the mandible (that were determined by application of “mirror” function of virtual planning software), arthroplasty of temporomandibular joint, determination of donor site on fibula bone, osteotomy of fibula free flap, positioning of dental implants, transferring of composite flap and it’s fixation by reconstructive plate. According to acquiring data one performed fabrication of patient specific navigation guides for both fibula flap segmentation and dental implants positioning. Surgical procedure included single-step tumor ablation and exarticulation of condylar head, reconstruction of defect by the means of osseo-myo-cutaneous fibula free flap, that was pre-implanted by dental implants, total joint reconstruction by titanium condylar head and polypropylene fossa, fixation of the flap and condylar head in recipient site by the means of prebended reconstructive plate, as well as insertion of non-removable bridge prosthodontic device. Postoperative result was asses clinically and radiologically. No significant postoperative complications occurred. Restoration of facial contours, mouth opening, I class occlusion, as well as adequate meal and speech were detected. Postoperative radiological investigation revealed adequate positioning of dental implants within neo-mandible, as well as positioning of artificial joint.Conclusion. In cases of extensive tumors of the jaws single-step ablative surgical procedure, reconstruction of missing anatomical structures of the jaws and simultaneous prosthodontic rehabilitation allows to prevent possible deformities of the soft tissues and due to rapid restoration of vital functions has great impact to quality of patient’s life. Adequacy of performing procedures could be reached by implementation of virtual preoperative planning and fabrication of patient-specific surgical guides

Management of the total glossectomy defect with latissimus dorsi free flap

Radical surgical management of tongue cancer results in sever speech and swallowing disruption, impaired airway protection and life-threatening aspiration. Surgical objective of total glossectomy defect management is an adequate restoration of lingual mass and affected tissues   of the floor of the mouth. Range of flaps are known to provide the adequate outcome, i. e. pediculed pectoralis major flap, anterolateral free thigh flap, rectus abdominis flap, radial free forearm flap and latissimus dorsi flap.In the current report, we present a case of glossectomy defect reconstruction with pediculed latissimus dorsi flap.Postoperative assessment of the transplant was made according to clinical criteria and viability of the flap was assessed via laser Doppler flowmetry. Signs of microcirculation improved starting from day 5 postoperatively, and were almost equal with donor site microcirculation signs on day 14. A sufficiently large mass of the transplant allowed to create a thickening over the epiglottis, as well as to close the defect   in the oral cavity. The latissimus dorsi flap in the tongue reconstruction has a high potential: its use provides a relatively good quality of articulation, recovery of deglutition