Partial resection of the upper jaw by intraoral approach

Curing disease: Indication Partial excision of the jaw by intraoral access is applicable to: 1. The odontogenic malignant tumor of the maxilla is limited to the alveolar space of the maxilla, or the fibrous alveolar osteoma of the upper alveolar bone. 2. Confined to the lower end of the maxilla, the maxillary sinus floor or the inner wall, and some hard malignant tumors, such as enamel, cylindrical tumor, epithelioid tumor, mixed tumor. Contraindications 1. The degree of malignancy is high, and the lesion has affected the maxillary sinus wall, anterior wall and external posterior wall. 2. The tumor has violated the ethmoid sinus and sphenoid sinus 3. Hypertension, frail elderly or liver and kidney dysfunction. 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. The incision can be performed in accordance with the expanded Denker procedure. Along the labial sulcus, the incision is made from the affected side to the third molar, and the soft tissue at the hard palate is cut back to the soft palate. Then, after extending the incision to the third molar, it is connected to the incision of the anterior wall of the maxillary sinus. The incision must be more than 1 cm from the tumor. 2. Separate the mucoperiosteum, expose the anterior wall of the maxillary sinus and the piriform hole to separate the mucosa of the nasal floor and the lateral wall of the nasal cavity along the pear-shaped hole. 3. Cut out the teeth, hard palate, anterior wall of the maxillary sinus, outer wall and inner side wall within 1cm of the tumor, cut the mucosa of the outer wall of the nasal cavity, make the maxillary sinus cavity communicate with the nasal cavity, and remove some nasal mucosa if necessary. 4. Remove the bones that have been removed, check the surgical field, and remove the residual tumor tissue or burn it properly to stop the bleeding properly. 5. Install the tray. The iodoform gauze is stuffed. complication 1. Intraoperative infection can be controlled by antibiotics. 2. Bleeding should remove the tooth tray, observe the bleeding of the operation cavity for ligation or electrocautery, and the outer side wall of the nasal cavity should also be checked for the presence or absence of bleeding points. 3. Nasal dry scars can be dripped with mint paraffin oil.