maxillary enlargement radical surgery

Maxillary resection is the main procedure for the treatment of maxillary tumors. According to the nature of the tumor, the extent and extent of the lesion, partial maxillary resection (removal of alveolar process and condyle), subtotal maxillary resection (retaining the infraorbital margin and the humerus) and the maxilla Total resection. In cases of high malignancy in the maxillary sinus, an enlarged maxillary resection is needed. The extent of resection may include resection of the mandibular condyle, ascending branch leading edge, pterygoid, humerus and partial zygomatic arch. Or remove the contents of the sputum and remove the contents of the ethmoid sinus. Treatment of diseases: maxillary sinus cancer Indication Maxillary radical enlargement is suitable for malignant tumors that have invaded the maxillary sinus, the orbit, the nasal inferior middle turbinate, the ethmoid labyrinth, and the frontal sinus and sphenoid sinus. The scope of extended radical resection should include mandibular condyle and ascending branch leading edge, sphenoid pterygoid, sputum contents and infraorbital plate, humerus and part of zygomatic arch, and ethmoid sinus contents. Contraindications 1. The tumor has been widely transferred to distant organs, and the system has developed cachexia or old and weak, cardiovascular disease can not bear anesthesia. 2. The tumor has spread to the nasopharyngeal cavity, the posterior pharyngeal wall and the deep pterygopalatine fossa. The operation is not easy. 3. The tumor has spread to the contralateral side, the range is large, and the postoperative severe deformity. 4. Clinically, the VIIXXXII cranial nerve symptoms or X-ray films have been found to have destroyed the sphenoid lobes and have invaded the cranial fossa. Preoperative preparation 1. Systematic examination of heart, lung, kidney and liver function should be performed. Blood test. 2. Periodontal scaling. The 1:500 potassium permanganate solution contains hydrazine. 3. Take one side of the oral cavity model and make it into a protective plate. 4. Matching blood 600~900ml, spare. 5. Chloramphenicol eye drops, 3/d. Surgical procedure Incision The entire layer cuts the midline of the upper lip and the lip, and then the base of the nose and the nasal sulcus, up the nasal side and reaches the medial iliac crest, crossing the cleft palate to the lateral malleolus, directly to the posterior side of the temporomandibular joint. 2. Flap the flap to reveal the surgical field After ligation of the labial arteries, the mucosa is cut along the cheek and sulcus, and cut straight to the top of the posterior region of the molar. The periosteum is then used to open the cheek flap upwards and outwards. If the tumor has penetrated the bone wall, the muscle layer on the muscle layer is removed with an electric knife, and the periosteum and part of the normal tissue of the superficial periosteum are removed together with the tumor. The internal iliac artery was ligated, and the iliac crest was opened from the inferior temporal iliac crest to the lateral iliac crest and the iliac artery was ligated. The cleft palate was extended posteriorly and the iliac crest was crossed. surface. Separate up and down and ligature the superior iliac artery. Open the entire cheek flap. At this time, the entire operation area revealed the anterior wall of the maxillary sinus, the eyelids, the condyle, the lower part of the armpit, the chewing muscle, the lower jaw and the temporomandibular joint (Fig. 10.4.3.7.3-2). 3. Dissection of the inferior fossa and ligation of the internal maxillary artery Fully expose the posterior margin of the mandibular ascending branch, and pull forward, revealing the parotid gland tissue and pulling it backwards. In this space, the internal maxillary artery passes through the parotid gland and traverses the posterior border of the condyle. After separation, it is given. Proper ligation can significantly reduce wound bleeding. The muscles of the cheek muscles slightly below the humerus and the diaphragm of the tibia are generally freed from the internal jaw artery after cutting the muscles. At both ends of the humerus, a bone scissors or a bone chisel can be used to break away, but the humerus is not removed, and the stump of the chewing muscle and the diaphragm is attached. The mandibular ascending branch is traversed by a chainsaw or a wire saw, the temporomandibular joint is released in the socket, and the superficial temporal artery is ligated as needed. At this time, the entire specimen of the condyle, the lower end of the diaphragm, the upper end of the chewing muscle, and the upper part of the ascending branch of the mandible are turned to the front, and the extrapteral muscle attached to the condyle is lifted, and the front part of the iliac crest is retained. The part, adjacent to the sphenoidal wing and the side of the pterygoid, this step can fully reveal the lower part of the infraorbital fossa, the lateral aspect of the infraorbital fissure of the eyelid, the subywing fossa and the lateral part of the pterygoid muscle (Fig. 10.4.7.1. 3-4). 4. Cut hard Use a blade or an electric knife to cut the suture directly to the bone surface and reach the edge of the hard palate, and then rotate 90° outward at the junction of the soft and soft palate. The soft tissue is cut into the whole layer until the end of the post-molar area meets the incision of the buccal vestibular groove. At the same time of compression and hemostasis, the aorta can be directly burned by a spherical electric iron at the exit of the aorta at a distance of 1 cm from the third molar. Here, the bleeding is very fierce. Because of the branching of the internal maxillary artery of the aortic artery, it is consistent with the branch of the metacarpal artery of the ascending artery and the posterior lingual artery. The burning can stop the bleeding. Finally, the soft tissue is cut from the base of the same side of the nasal spine to the middle part of the alveolar process with a knife or an electric knife to connect with the incision of the middle part of the ankle. 5. Remove the bone connection and remove the specimen (1) Cut the periosteum of the 1/2 bone wall of the eyelid, expose the upper part of the iliac wall with a separator, and separate the nasal bone and the sinus sinus at the inner side of the nasal cavity, and then use the bone scissors or osteotome to cut the nasal bone vertically. Jaw seam. Fill the gauze to stop bleeding. (2) The osteotome is placed obliquely at the temporomandibular joint, which is kept at the same level as the inferior iliac crest, and the lateral side of the temporomandibular joint and the axillary fossa are drilled to the outside. (3) Remove the central incisor of the affected side, and place the wide-bone chisel or wide-bone knife vertically in the middle part of the alveolar base of the nasal sac, and perform the mediastinum to the hard palate to fracture the hard palate. Finally, the osteotome is placed in the pterygoid portion of the posterior superior edge of the maxillary nodule, and the upper jaw nodule is connected to the pterygoid wing. If the tumor expands posteriorly, it should be removed along with the pterygoids. At the time of excision, it should be removed from the base of the wing, and the intra-wing muscle fibers attached to it are also removed at the same time. (4) Cut off the pedicle and remove the specimen: the whole specimen is moved forward, and the periosteal separator is used to separate the nasal wall from the iliac crest, so that the optic nerve and the vascular pedicle can be seen, and the curved vascular clamp is clamped. After cutting and properly double ligation, the entire specimen can be removed. (5) Wound skin grafting: cut the middle turbinate, the wound is fully rinsed with normal saline, bone wax is used to stop bleeding at the edge of the bone, live bleeding points are ligated with silk thread, and the rest of the bleeding is burned with electric iron. The skin graft on the inner side of the thigh is used for free skin grafting. The skin should be larger than the actual wound surface to prevent postoperative skin contraction. The skin should cover the bottom of the base and the surface of the cheeks, and the edges should be sutured intermittently. (6) suture the wound: reset the lip and cheek flap. Before resetting, cover the surface of the skin with several layers of large iodoform gauze, then insert the impression glue model, or insert the ball plastic model prepared in advance, put on the enamel guard, and then reset the lip and cheek . The flap is divided into two layers of muscle and skin, and the mucous membrane, muscle and skin of the lip are sutured. Finally pressurized dressing. complication Wound infection and secondary bleeding.