total mandibular resection

Total mandibular resection for surgical treatment of mandibular tumors. Treatment of diseases: temporomandibular joint disease Indication Total mandibular resection is available for: 1. A critical tumor or benign tumor has invaded the entire mandible. 2. Both sides of the mandibular malignant tumor have invaded the bilateral mandibular ascending branch and inferior alveolar vascular bundle. Contraindications Mandibular malignant tumors are extensively invasive to the surrounding tissues that have been unable to be cut or have distant metastases or have been cachectic and have important organ dysfunction. Preoperative preparation 1. Facial X-ray film or CT scan to determine the extent of the lesion. 2. Cardiopulmonary and liver and kidney function tests. 3. Prepare an artificial full mandibular stent for the simultaneous mandibular repair. 4. Do a tracheostomy preparation. 5. Prepare blood. Surgical procedure Incision and flap The submaxillary incision can be made to the mastoid tips on both sides, the lower lip is cut in the median, and the midline of the iliac crest is connected with the submandibular incision. The submandibular skin, the subcutaneous tissue, the deep fascia of the platysma, and the mandibular resection of the same lateral lip and cheek tissue flap were performed. Due to the rich blood vessels in the face, in order to reduce bleeding, a physiological saline containing epinephrine can be injected subcutaneously in the incision line. The operator and the assistant pinch the lower lip sides, cut from the middle of the lower lip, clamp and ligature the bleeding point. Cut the lower jaw skin, subcutaneous tissue, platysma, and deep fascia of the neck. 2. Flap and ligation of the external and external veins of the jaw In the deep surface of the deep layer of the deep fascia of the platysma, it is separated upward to the lower edge of the mandible. The facial nerve mandibular branch is deep in the platysma, and the surface of the intersection of the external maxillary artery and the lower mandible is passed. At the junction of the lower edge of the mandible and the front of the chewing muscle, the external and external veins of the jaw are separated and exposed. In order to avoid damage to the mandibular branch, the artery and vein should be clamped, cut and ligated under the lower or lower inferior margin of the mandible. The mandibular branch of the facial nerve should be examined after separation and ligation of the vessel. 3. Separation of the mandibular medial and total mandibular resection The operation is performed on the same side of the mandible, and after the one side is separated, the other side is performed until the entire mandible is removed. 4. Reveal the mandible If it is a benign tumor, the mandibular outer plate should be removed from the periosteum, that is, the periosteum of the lower mandible should be cut, and the flap should be turned from front to back, such as the bone plate is very thin or penetrated by the tumor, or it should be a malignant tumor. Flap the flap on the periosteum. In benign lesions, the mucosa can be cut at the gums, leaving more mucous membranes. The vascular bundle is separated, clamped, severed, and ligated at the pupil. The chewing muscles are closely attached to the mandibular angle and the ascending branch, and the sharp separation can be used to peel the chewing muscles from the bone surface. 5. Osteotomy The ipsilateral central incisor was removed, and the periosteum was inserted from the lingual subperiosteum and separated from the bone surface. The large curved vascular clamp was used to extend from the medial surface of the lower edge of the mandible at the extraction site, and the lingual margin of the extraction socket was taken out, and the wire saw was introduced. The soft tissue inside and outside the mandible was protected by a periosteal stripper, and the bone was sawn. The angle of the wire saw is larger, and the distance to pull the saw is larger, so as to avoid the wire saw being broken. 6. Remove the mandible The mandibular broken end is pulled outward, and the inner side of the mandible is exposed on the subperiosteal or periosteum according to the condition of the mandible. The lingual muscles of the ankle should be peeled off from the bone surface and bundled and ligated. The ligature is not cut, so that the muscle can be pulled forward when the bone is implanted. Separation into the posterior molar region is connected to the buccal mucosal incision. The pterygoid muscle is separated from the inner side of the mandibular ascending branch, and the styloid mandibular ligament is removed at the posterior edge of the mandibular angle. The mandibular small tongue is exposed in the middle of the inner side of the mandibular branch, and the temporomandibular ligament attached to the small tongue is peeled off. The vascular bundle of the lower alveolar sac is separated and clamped, cut, and ligated. Peel the diaphragm attached to the anterior border of the condyle and the mandibular ascending branch, and use the tissue to cut the bone surface to cut the diaphragm muscle. The capsular capsule of the condylar neck was separated by a periosteal stripper, and the pterygoid muscle was peeled off from the anterior superior iliac crest of the condylar neck, and one mandible was removed. 7. Artificial jaw stent implantation After the removal of the whole mandible, the bleeding should be fully stopped and the wound should be washed with saline. A part of the mucosal tissue corresponding to the leading edge of the ascending branch is sutured first, and the sacral protrusions on both sides of the prefabricated artificial jaw are placed in the ulnar jaw joint socket. 8. Stitching As far as possible, the genioglossus and genioglossus muscles are pulled forward and sutured to make them close to the artificial jaw to eliminate the invalid cavity and prevent the tongue from falling. Then, the oral mucosa was sutured intermittently and sputum. Place half tube drainage (1 left and right) or negative pressure drainage. Layered suture muscles, subcutaneous tissue and skin. Preventive tracheostomy. complication After the complete mandibular resection, it is generally necessary to implant the artificial jaw immediately and to make a tracheostomy. Thus, the main complication is the intraoral mucosal wound rupture and infection, leading to failure of the repair surgery. Insufficient oral mucosa, tight suture, local blood flow and infection are the main causes of mucosal wounds in the mouth; while the wound is split, the fluid in the mouth enters the bone substitute and implants, which aggravates the infection. Before the operation, the intraoral mucosa should be fully estimated. If the soft tissue is insufficient, the pedicle flap or the musculocutaneous flap should be designed in advance. Make the stitching face good when stitching. Stitching and ligation is not too tight. After the operation, we must adhere to the nasal feeding diet and oral cleaning care. If a leak has formed between the oral cavity and the bone graft substitute, it is necessary to drain under the jaw in time and wash the sinus to avoid the spread of infection. If it can last for more than half a year, because of the scar formation, even if the bone graft substitute is removed, the tongue will not fall back and breathing difficulties.