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 Total resection. 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: sinus sinus malignant tumors Indication 1. Malignant tumors originating in the maxillary sinus, including preoperative radiotherapy for maxillary sinus cancer, or sarcoma of the maxillary sinus. 2. Malignant tumors that originate in the nasal cavity and ethmoid sinus, and invade 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 CT examination of the nose and sinuses should be done. 2. Preoperative preparation for general anesthesia. 3. Prepare blood. 4. Make a tray () to facilitate the recovery of the postoperative chewing function and facilitate the blockage of the surgical cavity. 5. Clean cheeks and mouth. 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 1. Incision An incision was made about 0.5 cm inside the affected side of the medial malleolus along the nasal side and the nose was turned inward to reach the nasal column, and then the upper lip was cut downward from the midline, and the incision was deep to the bone. The mucosa was cut along the labial sulcus on the affected side and outward to the posterior edge of the third molar. If the tumor invades to the zygomatic arch from above, the incision is cut from the medial malleolus along the inferior temporal margin to the external iliac crest or extended outward. The length of the incision depends on the extent of the tumor invading the zygomatic arch to achieve good Exposed. When cutting the upper lip, it is advisable to pinch the fingers on the inner and outer sides of the upper lip. After cutting, gradually relax the fingers to stop bleeding. 2, separation flap The muscle layers of the cheek skin, subcutaneous tissue, and cheeks are separated outward along the incision. If the tumor does not penetrate the anterior wall of the maxillary sinus, separation can be performed under the periosteum. If the tumor has penetrated the anterior wall, the soft tissue of the cheek should be separated from the outside of the tumor infiltrating adhesion. If the tumor is infiltrated or even adhered to the skin, the infiltrated skin should be removed after leaving a certain safety margin. The edges of the piriform holes, the nasal bones, the infraorbital margin, and part of the tibia are then exposed. 3. Exposing the nasal cavity Use a rongeur to bite the nasal bone and cut the mucosa of the nasal wall from the edge of the piri-like hole from the bottom of the nose to expose the nasal cavity. 4, cutting the maxillary frontal process and condyle Separate the periosteum from the base of the eyelid and the medial side of the eyelid. Use a flat chisel (or rongeur) to cut the frontal process of the maxilla, but not above the horizontal line of the pupil to avoid damage to the sieve. The condyle is then cut from the outer edge of the lateral iliac crest to the outer edge of the lateral wall of the maxillary sinus. 5, cut the hard palate and maxillary nodules The nasal mucosa and the nasal sacral mucosa were separated, and the affected incisor was pulled out. A longitudinal incision was made from the front to the back at the center of the hard palate, reaching the junction of the soft palate, and cutting the transverse direction along the posterior edge of the hard palate to the posterior margin of the third molar. Connected to the labial incision and deep into the bone. The hard palate is cut from the nose to the center. Finally, the cutting edge is used to cut the posterior edge of the third molar, which is equivalent to the connection between the maxillary nodules and the pterygoids, and is cut upward and inward along the posterior wall of the maxillary sinus to loosen the maxilla. 6, remove the maxilla Hold the maxilla with a bone holder, cut the tissue with a curved tissue, cut open the soft tissue of the maxilla and surrounding, quickly remove the maxilla, and immediately fill the compression cavity with hot saline gauze to achieve hemostasis. If the jaw bone is not loose, it should be carefully examined. There may be a joint between the maxillary bone and the surrounding bone structure that has not been cut off. 7, remove residual tumor tissue Remove the hot saline gauze, look for the bleeding pterygoid artery and its branches, suture and ligation to stop bleeding. Subsequently, the tumor tissue that may remain in the surgical cavity, such as the invading sieve and the sphenoid sinus, should be completely opened, and the pterygopalatine fossa should be cleaned and the wound of the surgical cavity be electrocauterized. 8, skin grafting The full-thickness skin on the inner side of the thigh was transplanted to the wound inside the cheek flap to reduce the deformation of the cheek and the limitation of the mouth caused by postoperative scar contracture. 9, blocked First install the tray, then paste the gelatin sponge on the wound, then lay the Vaseline gauze, and then block the cavity with iodoform gauze. One end of the sliver is drawn from the front nostril. 10, stitching Align the red line of the lips, first suture the upper and lower incisions of the upper lip, then suture the nasal incision, and pressurize the bandage. complication Wound infection and secondary bleeding.