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

СОВРЕМЕННЫЕ КРИТЕРИИ ОТБОРА ПАЦИЕНТОВ ДЛЯ РЕКОНСТРУКЦИИ ВИСЦЕРАЛЬНЫМИ АУТОТРАНСПЛАНТАТАМИ ВЕРХНИХ ОТДЕЛОВ АЭРОДИГЕСТИВНОГО ТРАКТА ПРИ ЛЕЧЕНИИ ЗЛОКАЧЕСТВЕННЫХ ОПУХОЛЕЙ ГОЛОВЫ И ШЕИ

Introduction. The high incidence of cancer of the upper aerodigestive tract, impairment of breathing, speech, and swallowing functions accompanied by prolonged and often persistent disability put the rehabilitation and the quality of life of patients among the most important social problems.Material and methods. We have gained experience in reconstructing the pharynx and esophagus with various fragments of the gastrointestinal tract in 121 cancer patients. Based on our own clinical experience, the most important criteria of selecting patients after laryngectomy for reconstruction of the upper aerodigestive tract with visceral flaps were identified. Visceral autografts formed from different parts of the patient’s gastrointestinal tract were full-layer fragments of the abdominal organs, which included the mucous membrane of the stomach, small intestine, or large intestine. In some patients, the choice of flap was limited by a large omentum.Results. In 9.9 % of cases, flap necrosis was observed. Oral nutrition was restored in 93.9 % of patients. In 90.5 % of cases, speech function was restored after the installation of avoice prosthesis. The method of autologous transplantation of the ileo-colonic flap made it possible not only to remove the organs affected by the tumor, but also to simultaneously restore the lost nutrition and vocal functions without resorting to artificial prostheses, but using only their own tissues. The 5-year survival rates were 36.4 % and 67.3 % in patients with simultaneous reconstruction and in patients with delayed reconstruction, respectively.Conclusion. The use of visceral flaps in the reconstruction of the upper aerodigestive tract allows patients to restore both the nutrition and voice functions after laryngectomy.Введение. Значительная распространенность опухолей верхних отделов аэродигестивного тракта, сложность и стойкость нарушения функций дыхания, речи, глотания, сопровождающиеся длительной и нередко стойкой утратой трудоспособности, ставят проблему реабилитации и качества жизни больных в ряд важнейших социальных задач.Материал и методы. нами накоплен опыт реконструкции глотки и пищевода различными фрагментами желудочно-кишечного тракта у 121 пациента со злокачественными опухолями. на основе собственного клинического опыта нами были сформированы основные критерии отбора пациентов после ларингэктомии для реконструкции верхних отделов аэродигестивного тракта висцеральными аутотрансплантатами. Это были полнослойные фрагменты органов брюшной полости, которые включали в себя слизистую оболочку желудка, тонкой или толстой кишки. У ряда больных выбор аутотрансплантата ограничивался большим сальником.Результаты. В 9,9 % наблюдений был отмечен некроз аутотрансплантата. Питание через рот было восстановлено у 93,9 % оперированных больных. В 90,5 % случаев после установки голосового протеза была восстановлена речевая функция. Способ аутотрансплантации подвздошно-толстокишечного лоскута позволил в один хирургический этап выполнить не только удаление пораженных опухолью органов, но и одномоментно восстановить утраченные пищепроводную и голосовую функции, не прибегая к помощи искусственных протезов, а используя только собственные ткани. Показатели 5-летней выживаемости в группе больных при одномоментной реконструкции составили 36,4 %, в группе с отсроченной реконструкцией – 67,3 %.Заключение. использование висцеральных аутотрансплантатов при реконструкции верхних отделов аэродигестивного тракта после ларингэктомии позволяет восстановить пациентам как пищепроводную, так и голосовую функции

Компьютерно-томографическая семиотика лейомиосаркомы забрюшинной локализации исходящей из мышечной стенки селезеночной вены (клиническое наблюдение)

Background. Diagnostic imaging of retroperitoneal neoplasms that arise within the retroperitoneal space but outside the major organs in this space is challenging due to the presence of large spaces filled with fatty tissue that allows the tumor to develop asymptomatically for a long time. In addition, these tumors are rare, and radiological semiotics and clinical manifestations can be nonspecific.Case presentation. We present the rare clinical case of a 53-year-old patient with a large retroperitoneal mass detected by contrast-enhanced computed tomography. Additional imaging diagnostic procedures as well as histological findings helped to make a definitive diagnosis: extraorganic retroperitoneal leiomyosarcoma arising from the muscular wall of the splenic vein.Conclusion. The retrospective analysis of CT data showed that the tumor-induced marginal defect in the contrasted splenic vein may indicate the tumor arising from the muscular wall of the vessel. The final diagnosis was made on the basis of a morphological study.Актуальность проблемы объясняется сложностью диагностики внеорганных образований ретропе-ритонеума по данным лучевых методов исследования. Это обусловлено большими пространствами, заполненными рыхлой жировой клетчаткой, которые позволяют образованию длительное время развиваться бессимптомно. Кроме того, этот вид патологии является достаточно редким, а рентгенологическая семиотика и клиническая картина могут быть неспецифичными.Описание. Представлено редкое клиническое наблюдение 53-летней пациентки, у которой по данным мультиспиральной компьютерной томографии (МСКТ) с рентгенконтрастным усилением было выявлено объемное образование забрюшин-ного пространства. Ряд дополнительных диагностических процедур, а также данные морфологического исследования позволили установить окончательный диагноз - внеорганная забрюшинная лейомиосар-кома, исходящая из мышечной стенки селезеночной вены.Заключение. Как показал ретроспективный анализ данных КТ, краевой дефект контрастированной селезеночной вены, обусловленный опухолью, может являться вероятностным признаком происхождения данного новообразования из мышечной стенки сосуда. Окончательный диагноз ставится на основании морфологического исследования

Реконструкция гортаноглотки с использованием аутологичных тканеинженерных эпителизированных лоскутов

After removal of metastatic malignant tumors of the hypopharynx and larynx, hypopharyngeal defects are formed. To restore the hypopharynx, a mucosa and a muscular component are needed.The objective of this study is to develop a hypopharyngeal reconstruction technique using prelaminated pectoralis major flap with mucosal epithelium analogue from autologous epithelial layers.Materials and methods. Nine patients underwent reconstruction of the hypopharynx using bioengineered prelaminated pectoralis major flaps. The mucosa was restored by tissue-engineered autologous epithelial cell layers that were obtained by culturing in vitro cells isolated from skin biopsies that were previously obtained from patients.Results. Oral nutrition was restored in all cases. Pharyngeal stenosis was detected in one (11%) patient. A stratified squamous epithelium on the pectoral fascia was revealed in 67% of cases at week 2 after prelamination, in 89% of cases at week 4 after reconstruction and in 100% of cases at month 3, 6, 12 and 24 after reconstruction.Conclusion. Reconstruction using prelaminated bioengineered flaps allows recreating the anatomical integrity and function of the hypopharynx.После удаления распространенных злокачественных опухолей гортаноглотки и гортани образуются дефекты верхних пищеварительных путей, для устранения которых необходимы слизистая оболочка и мышечный компонент.Целью данного исследования является разработка методики реконструкции гортаноглотки с использованием преламинированных пекторальных лоскутов с аналогом эпителия слизистой оболочки из аутологичных эпителиальных пластов.Материалы и методы. Девяти пациентам выполнена реконструкция гортаноглотки биоинженерными преламинированными пекторальными лоскутами с восстановлением слизистой оболочки тканеинженерными аутологичными эпителиальными клеточными пластами, которые были получены путем культивирования in vitro клеток, выделенных из предварительно полученных у пациентов биоптатов кожи.Результаты. Во всех случаях было восстановлено пероральное питание. У одного (11%) пациента был выявлен стеноз глотки. Многослойный плоский эпителий на фасции пекторального лоскута выявлен в 67% случаев через 2 недели после преламинации, в 89% случаев – через 4 недели после реконструкции и в 100% случаев – через 3, 6, 12, 24 месяца после реконструкции.Заключение. Реконструкция с использованием преламинированных биоинженерных лоскутов позволяет воссоздать анатомическую целостность и функцию гортаноглотки

Modern oncological classification of maxillary and mandibular defects, combined defects of the oral and maxillofacial region

After radical removal of regional tumors of the middle third of the face, defects of facial skeleton and adjacent anatomical structures in the maxillofacial region develop, including defects of the floor of the mouth, tongue, oropharynx, base of the skull, orbital tissues. Surgeons have proposed several classifications aimed at categorization of complexity and volume of the defects and promoting easier selection of the type of reconstruction. This article describes the main classifications of maxillary and mandibular defects. All classifications consider the problem from the point of view of a different practical approach, but most of them haven’t received wide acceptance. The available classifications do not fully take into account all components of the defects forming after surgical treatment of regional tumors. The authors propose a modification of the classification of maxillary defects by J. S. Brown and R. J. Shaw (2010). The modified classification should include not only bone defects but also other parts of the maxilla: epithelium, oropharynx, base of the skull, dura mater.The authors present a classification of mandibular defects based on the classification by M. L. Urken et al. (1991). The new classification includes notations of mandibular regions as well as extraskeletal components of defects of the lower third of the face. The authors distinguish anatomo-functional regions of the maxilla and mandibula and 3 complexity categories of defects of the facial skeleton. This allows to determine the necessity of single flap or complex reconstruction and its staging. The article also describes a classification developed at the P. A. Hertzen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Center, Ministry of Health of Russia, which considers combined defects of the maxilla and mandibula and takes into account adjacent resected anatomical structures.The proposed classifications allow to categorize defects after resection of the maxillofacial area of any volume including removal of regional tumors, and promote optimal selection of the tactics of surgical reconstruction

VIRTUAL MULTISLICE-CT-BRONCHOSCOPY AS A DIAGNOSTIC TOOL IN PATIENTS WITH BRONCHIAL TUMORS

Purpose: to study the role of virtual multislice-CT-bronchoscopy in the detection of bronchial tumors and assessment of bronchial tumor extension. Material and methods. Findings of the virtual multislice-CTbronchoscopy were analyzed in 61 patients with primary and secondary bronchial tumors. Virtual multislice-CTbronchoscopy was performed using the AquilionONE (320-slice) CT scanner. Results. Virtual bronchoscopy revealed 3 types of bronchial involvement: peribronchial, intrabronchial and mixed tumor infiltrations. The virtual fly through bronchoscopy was used to assess the macrostructure and tumor margins in patients with intrabronchial tumor growth. Broad-based polypoid masses causing the obstructing narrowing of the bronchus were visualized inside the bronchial lumen. The narrowing of the bronchial lumen and no visualization of the cartilaginous structures (the bronchus turned into the deformed tubular structure) were the signs of infiltration of the main bronchi and the trachea. In patients with lung and hilar lymph node metastases, infiltration of segmental and lobar bronchi led to the impaired ventilation of the affected segments or lobes of the lungs, thus resulting in the development of atelectasis. In patients with benign tumors, the lesion was characterized by the regular shape, smooth surface and homogeneous internal structure, as well as the absence of infiltration of the bronchial wall. Conclusion. Virtual multislice-CT-bronchoscopy with multiplanar and three dimensional reconstruction is a reliable noninvasive method for accurate diagnosis of bronchial involvement and the differential diagnosis between extrinsic pressure on the bronchial tree and bronchial tumor

Aggressive inflammatory myofibroblastic tumor of the tongue (clinical case)

The study objective is to present a rare clinical case of an aggressive myofibroblastic tumor of the tongue.Clinical case. A 24-year-old patient was revealed a 44 × 25 × 50 mm volumetric formation of the left side of the tongue spreading to the contralateral side and bottom of the oral cavity. The patient denied injuries or chronic autoimmune diseases. Additional studies did not reveal failure of other organs or systems. Histological conclusion: malignant spindle-polymorphic cell neoplasm with myxomatosis, perineal growth, muscle fiber infiltration and their death. An immunohistochemistry revealed expression of vimentin, CD34, S100; Ki-67 – 30 % in tumor cells. He was diagnosed with T3N0M0 fibrosarcoma of the tongue. Subtotal resection of the tongue with simultaneous microsurgical plasty via re-activated radiation autograft was performed. According to morphological study of the removed tissues, he was finally diagnosed with an aggressive inflammatory myofibroblastic tumor of the tongue. Observation period at the time of writing was 15 months. The patient eats solid food, sound pronunciation is restored in full. There are no signs of relapse or metastasis.Conclusion. Diagnostics of an inflammatory myofibroblastic tumor of the oral cavity is complex and depends on clinical and morphological features of a particular tumor. We need reliable criteria to differentiate aggressive forms of inflammatory myofibroblastic tumor of the tongue from non-aggressive ones to choose treatment. The main difficulties arise in determining the resection volume and predicting relapse or metastasis

Removal of a maxillary tumor with simultaneous placement of intraosseous zygomatic implants

The study objective is to report a case of successful placement of intraosseous zygomatic implants for functional and aesthetic rehabilitation of a patient with a maxillary defect resulted from maxillary resection for right-sided stage IIB maxillary sarcoma (сT2N0M0, G3).Materials and methods. A 34-year-old male patient visited a doctor in P.A. Herzen Moscow Oncology Research Institute with complaints of maxillary tumor. During the examination of the oral cavity, we found a dense endophytic tumor in the area of two missing teeth (17 and 18) involving the alveolar process and palatine process of the maxilla. Computed tomography revealed destruction of the alveolar process, lateral, medial, and posterior walls of the maxillary sinus on the right, and tumor invasion into the right iliac fossa, pterygopalatine fossa, and right maxillary sinus. We also observed tumor destruction of the right palatine process of the maxilla. The patient was diagnosed with osteogenic sarcoma.Results. The patient received 4 courses of polychemotherapy with cisplatin and doxorubicin, which resulted in disease stabilization. Then the patient underwent en-block resection of the fragment of the right maxilla with alveolar and palatine processes, fragments of the zygomatic bone, wings of the sphenoid bone on the right side, and adjacent soft tissues. Simultaneously, we placed two zygomatic implants to provide supportfor the maxillary plate denture. To create an additional supporting point, we extracted tooth 11 and installed an implant with external hexagonal connection. Later, we produced and installed a specially designed palatal obturator.Conclusion. Installation of removable dentures supported by implants ensures complete and rapid rehabilitation, allowing a patient to chew, swallow, and speak normally. A palatal obturator on implants supports the soft tissues of the medial face, thus ensuring complete aesthetic rehabilitation

Computer tomographic semiotics of retroperitoneal leiomyosarcoma arising from the muscular wall of the splenic vein: a case report

Background. Diagnostic imaging of retroperitoneal neoplasms that arise within the retroperitoneal space but outside the major organs in this space is challenging due to the presence of large spaces filled with fatty tissue that allows the tumor to develop asymptomatically for a long time. In addition, these tumors are rare, and radiological semiotics and clinical manifestations can be nonspecific.Case presentation. We present the rare clinical case of a 53-year-old patient with a large retroperitoneal mass detected by contrast-enhanced computed tomography. Additional imaging diagnostic procedures as well as histological findings helped to make a definitive diagnosis: extraorganic retroperitoneal leiomyosarcoma arising from the muscular wall of the splenic vein.Conclusion. The retrospective analysis of CT data showed that the tumor-induced marginal defect in the contrasted splenic vein may indicate the tumor arising from the muscular wall of the vessel. The final diagnosis was made on the basis of a morphological study