Maxillary resection with orbital contents extraction

The maxillary sinus cancer invades the iliac crest tissue and has penetrated the periosteum. In addition to the maxillary radical resection, the sputum content should be completely removed, and the cure can be achieved. Nowadays, the maxillary sinus cancer invades the inferior tibiofibular wall and retains the sputum content. The preoperative radiotherapy is 40-60 Gy, the peripheral tumor is controlled, and the periosteal resection is performed. Treatment of diseases: maxillary sinus cancer Indication Maxillary resection combined with sputum content removal is suitable for maxillary sinus cancer invading the iliac tissue and has worn the periosteum. Contraindications Old, infirm, poor heart and lung function, cancer has distant metastasis. Preoperative preparation 1. At present, maxillary sinus cancer advocates preoperative local radiotherapy (40Gy) to promote the narrowing of cancerous tumors and the closure of lymphatic vessels. After the radiotherapy, rest for 3 to 4 weeks and then surgery. During the radiotherapy, the anterior wall of the maxillary sinus should be made into holes, and a rubber tube should be placed to facilitate the excretion of the secretion of the maxillary sinus. At the end of the radiotherapy, remove the rubber tube. 2. Preoperative administration of antibiotics to control oral and nasal infections. 3. If there are dental caries, remove the surgery first. 4. Biopsy must be performed before surgery to confirm the type of diagnosis and cancer. 5. If there is anemia, preoperative blood is 200 ~ 400ml. During the operation, blood preparation was 800ml. 6. Clean the face, cut the nose hair, and drop the chlorinated mixture into the nasal cavity. 7. Before the operation, the dental tray can be well separated, and the mouth can be separated from the nasal cavity to restore the chewing function as soon as possible. 8. Heart, lung, liver and kidney function tests. 9. General anesthesia surgery, preoperative administration by anesthesiology. Surgical procedure 1. In addition to the Weber-Fergusson incision used in the maxillary radical resection, the incision from the beginning of the first incision of the internal incision, outward and upward along the upper edge of the ankle to the lateral side of the eye, a horizontal incision, incision of the skin and subcutaneous organization. 2. Separating the skin piece The skin piece was separated from the incision from the anterior wall of the maxillary sinus to the lateral edge of the zygomatic arch and the tibia. The soft tissue and periosteum were dissected along the upper iliac crest, the nasal side, the midline of the hard palate and the middle part of the humerus. 3. Separation of sputum content The sacral flap was separated from the incision by scissors, and connected to the buccal flap of the maxillary resection. The upper incision was peeled off from the superior iliac crest along the subcutaneous tissue to the upper edge of the iliac crest, and then peeled off along the gingival margin. The rim is completely exposed. The periosteum was cut along the upper edge of the iliac crest, extended into the stripper, and the periosteum was peeled inward to the vicinity of the optic nerve, and then peeled off to the lateral and medial margins, leaving the inferior temporal margin still connected to the maxilla. The optic nerve and the ophthalmic artery were clamped by a curved hemostat, and the optic nerve was cut off after the ligation. Remove the sputum content and tumor tissue. The wound is coated with hot salt water gauze. 4. Cut the nasal bone, tibia and hard palate to cut the nasal bone to the medial side of the iliac crest along the suture of the nasal bone and the maxillary frontal process, and then cut the bottom of the iliac crest to the middle of the inferior iliac cleft. Cut with a rongeur or wire saw from the middle of the humerus, and then cut the bottom of the eyelid to the middle of the underarm. The mucosa and hard palate are cut along the bottom of the nose from the front nasal spine, and the root of the pterygoid is excavated at the posterior edge of the third molar, and the pterygoid muscle and the pterygoid muscle are cut so that the inner and outer flaps can be removed together with the maxilla. 5. The maxilla is removed. The upper and lower, left and right sides of the maxilla are gently shaken with a occlusal forceps. For example, the humerus, hard palate, and pterygoids are cut at the upper jaw nodules. Remove the maxilla, stop bleeding with hot saline gauze, check the bleeding point for ligation or electrocautery, and carefully check for residual tumor tissue, clean or electrocautery. 6. Wound treatment The eyelid incision can be sutured, or the eyelid can be turned inwardly and close to the inner wall of the ankle to allow for any recurrence in the ankle. The cheek flap can be taken from the inner side of the thigh to cover the wound surface, and the silk thread is sutured along the edge. The wound is filled with iodoform or Vaseline oil gauze, the subcutaneous tissue and the skin are sutured layer by layer, and the wound is wrapped. If the skin of the underarm or cheek has been invaded by the tumor, the skin can be removed and repaired with the pectoralis major myocutaneous flap. complication 1. Intraoperative infection can be controlled by broad-spectrum antibiotics. 2. Cerebrospinal fluid leakage, mostly caused by damage to the sieve plate or the deep skull base of the pterygopalatine fossa. Filling conservative treatment or surgical repair can be used. 3. Hemorrhagic shock, in order to stop bleeding in the operation is not complete, you must reopen the wound, look for bleeding points, completely stop bleeding, and then anti-shock treatment. 4. Aspiration pneumonia, improper filling of the hypopharynx during surgery, blood inhalation into the lungs, should be given a large number of antibiotics, and use a fiber bronchoscope to absorb blood and secretions. 5. Tumor recurrence selection cases are not appropriate, such as more advanced patients, surgery can not completely cut the tumor, generally after surgery to change the drug can be found tumor growth. Therefore, radiotherapy should be given before surgery, but the tumor does not shrink after radiotherapy, local lesions beyond the scope of surgery or extensive metastasis, can be performed under the skull base surgery.