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 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: maxillofacial bone giant cell tumor, mandibular ameloblastoma 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 nasal and sinus ct examination should be done. 2. Preoperative preparation for general anesthesia. 3. Prepare blood. 4. Make the tray to facilitate the recovery of the chewing function after surgery and facilitate the blockage of the operation 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. The incision is made in the inferior aspect of the medial side of the affected side about 0.5 cm along the nasal side and bypasses the nasal wing inward to reach the nasal column, and then the upper lip is cut downward from the midline, and the incision is 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. The separation flap separates the muscle layer of the cheek skin, subcutaneous tissue and cheeks 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. Expose the nasal cavity and bite the nasal bone with a rongeur. 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. Cut the maxillary frontal process and the condyle to separate the periosteum of the orbit and the medial side of the orbit. 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 the maxillary nodules to separate the nasal and nasal sacral periosteum, and pull out the affected incisor. Make a longitudinal incision from the front to the back in the middle of the hard palate, reach the soft palate junction, and cut along the trailing edge of the hard palate. Lateral to the third molar's trailing edge, connected to the labial incision, 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 and hold the maxilla with a bone holder. Cut the maxilla with the surrounding soft tissue and quickly remove the maxilla. 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 is transplanted to the wound inside the cheek flap to reduce the deformation of the cheek and the limitation of the mouth opening after the postoperative scar contracture. 9. The occlusion is first installed with a tray, followed by a gelatin sponge, and then Vaseline gauze, followed by an iodoform gauze to block the cavity. One end of the sliver is drawn from the front nostril. 10. Stitching: Align the red lines 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.