total maxillary resection

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 Full cut-off. 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: maxillofacial bone giant cell tumor, mandibular ameloblastoma Indication Total maxillary resection is suitable for benign tumors that have damaged one side of the maxilla, such as fibrous fibrous osteodystrophy, giant cell tumor or ameloblastoma. Malignant tumors have invaded the maxillary sinus or malignant tumors that originated in the maxillary sinus. Contraindications The old and the weak have developed cachexia, and there are those who have distant metastases, or who have not been able to withstand general anesthesia. Preoperative preparation 1. X-ray film and nasal and sinus ct examination should be done. 2. Systematic examination of heart, lung, kidney and liver function should be performed. Blood test. 3 periodontal scaling. The 1:500 potassium permanganate solution contains hydrazine. 4. Take one side of the oral cavity model and make it into a protective plate. 5. Matching blood 600~900ml, spare. 6. In the case of tumor invasion of the pterygopalatine fossa, which is limited by mouth opening, it is not convenient for anesthesia through oral intubation. The tracheotomy can be performed before operation, and the general anesthesia is applied by intubation at the electric incision. 7. In order to reduce intraoperative bleeding, the ipsilateral external carotid artery can be ligated first. Surgical procedure Incision The incision was designed and made a transverse incision from the medial malleolus along the inferior temporal margin to the lateral ankle 1 cm. During operation, the fingers can be pinched on both sides of the upper lip, and then the skin and part of the muscle layer are cut first, and then the muscle layer is cut through the mucosa. A neat level can be achieved. After releasing the hand, the upper lip artery is clamped to stop bleeding. Followed by the base of the vestibule, bypassing the side of the nose and reaching the internal iliac crest, the whole layer is cut open to the bone surface. First, the internal iliac artery is clamped and fully stopped. 2. Flap Open the upper lip, cut the periosteum of the vestibular groove and extend to the side of the upper jaw nodules. Use the periosteal separator to peel off the upper and outer sides and lift the lip and cheek flap. If the tumor has worn through the anterior wall of the maxillary sinus, the mucous membrane should be opened first, and the electrosurgical knife should be used to sharply separate the flap from the normal subcutaneous tissue layer, so that the normal tissue of the periosteum and superficial periosteum is removed together with the tumor. . When separating to the inferior temporal margin, the infraorbital neurovascular bundle should be released and cut and ligated. Continue to cut the medial iliac crest along the lower edge of the iliac crest to the external iliac crest, subcutaneous tissue and muscle layer to the bone surface, and use the periosteal separator to peel off the lateral side, and then the lip cheek flap on one side is completely opened, revealing the entire operation area. The maxilla, humerus and humerus. 3. Osteotomy Cut off the joint of the bone. (1) Incision of the periosteum of the lower edge of the nasal bone, fully exposing the bone surface of the maxillary frontal process of the lateral margin of the ankle, and then retracting the contents of the tendon, the osteotome or the chainsaw obliquely to the nasal side, cutting the maxillary frontal process and the tear bone, A small gauze strip is inserted into the bone gap to stop bleeding. (2) Retract the contents of the iliac crest and pull out the sacral fissure; at the same time, cut off some of the chewing muscles and attach the long vascular clamp under the root of the humerus to make it fall. Since then, the wire saw has been introduced so that it can be subtalated and protruded under the maxillary protrusion. Then, the upper and lower pulling and swinging can be used to cut the connection between the outer edge of the ankle and the tibia (the jaw joint). If the tumor has expanded to the tibia, the wire saw can be placed outward under the humerus and removed together with the tibia. It is also possible to cut the bone surface directly under the humerus root by cutting the lower edge of the iliac crest, and cut the bone connection with the osteophyte or the chainsaw obliquely to the root of the tibia (Fig. 10.4.7.3.7-3). The section of the bone is also filled with gauze to stop bleeding. (3) Remove the affected central incisor, cut the mucosa of the midline of the hard palate, and expose the alveolar ridge to the humerus. Use a wide bone chisel or a bone knife to place the alveolar ridge in the middle, from front to back. By hitting the mediastinum, you can open the hard seam. Slightly twitching on both sides, it is confirmed that it has been opened, and the gauze strip is filled to stop bleeding. (4) Using a machete to make a transverse full-thickness to open the soft tissue at the junction of the soft and soft palate, and to bypass the maxillary nodule and the buccal cheek (vestibular) groove incision. While pressing the gauze block to stop bleeding, the wide bone chisel is quickly placed at the joint between the maxillary nodules and the sphenoid pterygoids, and the number of hits is broken. Use a rongeur to remove the tumor along with one of the maxilla. The wound is filled with a pre-prepared gauze ball to stop bleeding. If the bony connection has been broken and the maxilla can not be removed smoothly, the following examination should be made: whether the chewing muscle is not completely cut; whether the soft tissue at the trailing edge of the soft palate is not completely broken; or the tumor tissue invades to the underarm Blocking in the nest. After further peeling and cutting off the remaining connected tissue, the upper jaw can be completely removed, and it is forbidden to violently tear and twist and damage the adjacent blood vessels at the base of the skull to cause major bleeding. Cut off the middle turbinate and completely stop the wound. Rinse the wound with saline, remove the residual broken bone pieces, smooth the sharp bone edge, and apply the bone wax to the bone wound. (5) In order to prevent postoperative opening restriction, the mucosa of the condylar process can be cut, and the condyle can be revealed and cut off. It can also cut off the condyle, cut off the sacral muscle attached to it and remove it. Recently, after the maxillary bone removal, the condylar process with the iliac pedicle is used to quickly repair the defect, that is, after the condyle is revealed, a large range of condylar process is performed obliquely forward and downward from the sigmoid incision. Then, the iliac muscle pedicle of sufficient length is released upward, and the condyle with the pedicle is turned to the contralateral side, and the adipose tissue of the submandibular body and the forehead of the contralateral maxillary bone are sutured and fixed. New bottom. (6) Wound skin grafting: Take the thickness of the medial thigh in the same side of the thigh, which should be larger than the actual wound area. The skin was covered on the wound surface of the wound, the face and the cheek, and then the suture was sutured opposite to the wound edge. The buccal side, the midline and the soft suture line were not cut and left as the final compression dressing. The wound edge of the soft palate is sutured at the oral side and the nasal mucosa to eliminate the wound margin. It is also possible to fill the bone cavity with a soft paste of the impression paste and take out a model. Then, the skin piece is implanted, and the skin piece does not need to be excessively sutured, but only a few needles are fixed for four weeks, so as to keep the skin piece from shifting, and then filling the impression paste model to fix the skin grafting time. . (7) Stitching and dressing: The wound is filled with iodoform gauze cloth, and the sputum guard plate is fixed, and then the lip and cheek tissue flap is restored to the original position, and the incision is layered and sutured. The red part of the lip should be sutured first, then the muscle layer and the skin are sutured. The alignment is required to be accurate and the lip is not harmonious. Finally, check whether there is any gap between the iodoform yarn group and the skin piece, and continue to fill with the iodoform gauze piece until the gauze group and the skin piece are in close contact with each other, and the long line heads are ligated to fix the skin piece. If the impression paste model is filled, after filling the iodoform gauze, it is only necessary to apply facial compression wrap. The thigh is supplied to the wound area, covered with several layers of oil gauze, gauze plus cotton pad pressure bandage. complication Wound infection and secondary bleeding.