Radical removal of advanced cancer of the oral cavity and oropharynx

Abstract

Surgery for advanced cancer of the oral cavity and oropharynx are among the most difficult. This is due to the topographical and anatomical features that limit the operating field and the proximity of the internal carotid artery, which penetrates into the skull without branches. Her injury and bandaging are fraught with lethality. In the postoperative period, due to a violation of the function of swallowing, there is a stagnation of oral fluid in the oral cavity, which pro[1]motes healing by secondary tension. The functions of the oropharynx are impaired: swallowing, chewing, breathing and speech.Purpose of the study. To develop an operation in patients with advanced cancer of the oral cavity and oropharynx, allowing to visualize the area of the tumor with it’s radical removal and postoperative healing without suppuration.Patients and methods. We’ve operated a patient with advanced cancer of the oral cavity and oropharynx with me[1]tastases to the cervical lymph nodes (T4 N1 M0 – IV st.). Cervical lymphodessection and removal of the tumor from the oral cavity and oropharynx was performed according to the method developed at the National Medical Research Centre for Oncology of the Ministry of Health of Russia: the tumor was removed after a preliminary modified mandib-ulotomy. Good visualization allowed for a radical operation, after which a urostoma was formed, which promotes the free flow of oral fluid from the oral cavity, without its stagnation and without suppuration of the tissues. The jaw was restored with two titanium mini-plates.Results. The healing was carried out by primary tension. On the 7th day after the operation, breathing was restored[1]decanulated. On day 20, epithelialization of the wound surface of the oral cavity and oropharynx occurred. The nasoesophageal probe was removed. Plastic orostoma was produced. By this time, the functions of the oropharyngeal region were partially restored: chewing, swallowing, and speech. Discharged home. Remission for more than 2 years.Conclusions. Previously performed modifi ed mandibulotomy in patients with advanced cancer of the oral cavity and oropharynx, allows you to expand the view of the operating field and provide a radical operation. The formed orostoma, preventing suppuration in the oral cavity, accelerates healing with the restoration of functions: chewing, swallowing, breathing and speech.