Некоторые аспекты комплексной реабилитации пациентов с приобретенными дефектами и деформациями орофарингеальной зоны

The aim of this study was to assess the features of disturbed food intake and find ways to optimize rehabilitation and resocialization processes for patients with acquired defects and deformities of the oropharyngeal zone.Materials and methods. The study included 86 patients of a surgical hospital with defects and deformities of the oropharyngeal zone: 59 men and 27 women. The degree of dysphagia was assessed using clinical scales: volumeviscosity swallow test (V-VST) and swallowing disability scale (SDS). Rehabilitation measures to normalize swallowing were performed in the experimental group (I), which consisted of 42 patients. The control group (II) consisted of 40 patients and was not included in the restorative effect. The groups were balanced according to the severity of the disorder, sex and age. Comparative analysis of the severity of impaired swallowing before and after rehabilitation and evaluation of its effectiveness were conducted.Results. Data from the study of the dysphagia degree on the SDS scale for the whole sample (n = 82) suggest that the degree of disorder manifestation depends on the location and extent of anatomical defect. Moreover, comparative analysis suggests that the presence of a combined defect exacerbates the severity of dysphagia. Step-by-step speech therapy in the control group aimed at overcoming swallowing disorders included adaptive, compensatory and restorative strategies used in various combinations depending on the location of the defect and the severity of dysphagia. The comparison of the repeated assessment data on dysphagia severity in two groups of patients (I and II) showed that the rehabilitation measures had a positive impact.Conclusion. Thus, we can state that speech therapy, which is a non-drug and non-invasive rehabilitation method, allows patients to successfully normalize eating process, helps in preventing cachexia-anorexia and dehydration, which is important for a successful postoperative period, as well as for improving the life quality of patients.Цель: оценка особенностей нарушений процесса приема пищи и поиск путей оптимизации процесса реабилитации пациентов с приобретенными дефектами и деформациями орофарингеальной зоны.Материалы и методы. В исследование были включены 86 пациентов хирургического стационара с дефектами и деформациями орофарингеальной зоны: 59 мужчин и 27 женщин. Степень дисфагии оценивалась с помощью клинических шкал: Volume Viscosity Swallow Test (V-VST), Swallowing Disability Scale (SDS). Реабилитационные мероприятия по нормализации глотания проводились в экспериментальной группе (I), которую составили 42 пациента. Группа контроля (II), не включенная в восстановительное воздействие, состояла из 40 пациентов. Группы были уравновешены по тяжести дефекта, полу и возрасту. Проведен сравнительный анализ выраженности нарушений акта глотания до и после восстановительного воздействия и оценка его эффективности.Результаты. Данные исследования степени дисфагии по шкале SDS по выборке в целом (n = 82) позволяют говорить о наличии зависимости степени проявления нарушения от места и объема анатомического дефекта. Причем сопоставительный анализ позволяет  утверждать, что именно наличие комбинированного дефекта усугубляет тяжесть  дисфагии. Поэтапно проводимое в контрольной группе логопедическое воздействие, нацеленное на преодоление расстройств глотания, включало в себя адаптивные, компенсаторные и восстановительные стратегии, применяемые в различных комбинациях в зависимости от локализации дефекта и тяжести дисфагии. Результаты сопоставления данных повторной оценки тяжести дисфагии у двух групп пациентов (I и II) показали, что проведенные реабилитационные мероприятия оказали положительное влияние.Заключение. Таким образом, можно утверждать, что логопедическое воздействие, которое относится к немедикаментозным, неинвазивным методам реабилитации, позволяет успешно нормализовать процесс приема пищи, способствует профилактике кахексии-анорексии и дегидратации, что важно для успешного течения послеоперационного периода, а также улучшения качества жизни пациентов.

Microsurgical head and neck tissue repair by visceral mini-autografting

Objective. To minimize surgical trauma in patients with head and neck tumors during microsurgical plasty with visceral autografts.Subjects and methods. Clinical experience has been gained in the treatment of 53 patients with locally advanced craniofascial (n = 27) and oropharyngeal (n = 36) cancers. Abdominal organs were used for plastic closure of extensive defects after surgical resection. Paraumbilical incision allowing for an adequate approach into the abdominal cavity with minimal external trauma in the anterior abdominal wall was chosen as an access procedure. Video-assisted techniques were used to excise the midline aponeurosis. Donor organs, such as the omentum, greater curvature of the stomach, transverse colon, small intestine) were taken through a mini-laparotomic incision to the anterior abdominal wall, then the vascular pedicle was exposed and a visceral autograft was made. After forming and cutting off the autograft, organ anastomoses were created extracorporeally.Results. Mini-access surgery could be completed in 50 of the 53 cases (4 patients had previously undergone abdominal interventions). Omental (n = 26), colo-omental (n = 15), gastro-omental (n = 7), and entero-omental (n = 5) flaps were made and prepared for autografting. No intra- or postoperative abdominal complications were found.Conclusion. Minimally invasive technologies used to create visceral authografts for head and neck tissue repair can minimize surgical trauma and reduce treatment duration. The indications for this access are the debilitating state of a cancer patient or the young age of a patient who does not wish to have an additional scar in the donor region

[Surgery of skull base tumors extending into the orbit, paranasal sinuses, nasal cavity, pterygopalatine and infratemporal fossas: treatment principles in certain types of tumors]

Following the paper focused on surgery of skull base tumors invading the orbit, paranasal sinuses, nasal cavities, pterygopalatine and infratemporal fossae, the authors discuss particular issues of surgical treatment of the most common craniofacial mass lesions, including meningiomas, juvenile angiofibromas, trigeminal nerve tumors, chondroid tumors, and others