Tumor resection at the base of tongue with suprahyoid approach

Although the incidence of tumors at the base of the tongue is lower than that of the tongue, it is also common, and both benign and malignant. According to clinical statistics, tumors at the base of the tongue are more common. Therefore, the approach of the benign tumor resection of the tongue base described in this section is also applicable to malignant tumors. The base of the tongue is behind the mouth. The vision is unclear and the operation is inconvenient. Sensitive pharyngeal reflexes cause nausea and even vomiting, which makes it difficult to check and treat. The tongue root tumor is also often involved in the throat, and the edema reaction and hematoma after surgery can cause airway obstruction and even suffocation and death. Therefore, the key to the success of benign tumor resection of the tongue is the surgical approach and surgical safety issues. At present, there are four types of median approach, side approach, pharyngeal advancement and intraoral approach. Clinically, it should be correctly selected according to the systemic and local conditions of the patient, especially the specific location and size of the tumor and the nature of the tumor. After the removal of the tumor at the base of the tongue, there will be some functional effects due to the defect and deformity of the tissue. After the tumor is too large or too deep, there is still a problem of closure and repair of the wound, which should be considered in the design of the operation. This section focuses on issues related to the approach. Related issues related to tumor resection of the base of the tongue have been described in the previous section. Treating diseases: tongue cancer Indication The supracondylar approach of the lingual approach is applied to the case of the tumor at the base of the tongue, which is larger in volume and does not involve the pharyngeal tissue. Surgical procedure Incision An arc-shaped incision is made on the lingual bone parallel to the lower edge of the mandible on both sides, and the ends thereof reach the mandibular angle. 2. Approach and reveal tumor According to the incision, the skin, the subcutaneous tissue, the platysma and the deep fascia of the neck were cut into layers, and the flaps were separated layer by layer. The flaps were separated up and down in the middle of the lingual bone and the second abdominal muscles and stems were cut. Attached to the lingual muscles of the lingual muscles, the anterior abdominal ventral muscles of the affected side are freely turned up, and the mandibular lingual muscles are cut in the direction of the sublingual nerve, which is exposed between the mandibular and lingual muscles and the tongue. The hypoglossal nerve of the superficial lingual muscle is distracted with a rubber band after dissociation, and the hyoid bone is cut to the large angle of the hyoid bone, and the lingual artery is exposed to protect or ligature and cut. Guide the epiglottis in the mouth with your fingers, carefully cut the pharyngeal mucosa between the anatomy and the base of the tongue, determine the length of the incision as needed, and even extend to the pharyngeal wall if necessary, but must pay attention to the depth and prevent injury. Deep important nerve vessels. At this point, the base of the tongue can be fully revealed. 3. Resection of the tumor Depending on the location of the tumor, a method of resection of the tumor through the incision of the lingual bone or intraoral cavity may be employed. After the tumor is behind and close to the epiglottis, the tongue is pulled and turned outwards to remove the tumor under bright vision. The tumor is in front and close to the tongue blind hole. The tongue can be pulled outward through the oral cavity. Because the tissue around the tongue root has been largely broken off, it can be pulled out a lot and is easy. The tumor is also fully exposed and can be completely removed. 4. Stitching After the tumor is resected, the wound is cleaned, the bleeding is completely stopped, the ineffective cavity is eliminated, the root wound of the tongue is sutured, the parapharyngeal incision is sutured with the 3-0 gut, and then the incision of the tongue and the epiglottis are incision, and the oropharynx cavity and the deep incision of the neck are tightly closed. Surgical access between. Rinse the wound again, suture the root muscle of the tongue on the residual muscle of the hyoid bone, and finally stratify the incision on the anterior lingual bone. 5. Set the negative pressure drainage tube. 6. Postoperative tracheostomy as needed. 7. Aseptic dressing to dress the wound.