METHOD FOR RECONSTRUCTION OF LARYNX AND PHARYNX IN LOCALLY ADVANCED TUMOURS Russian patent published in 2020 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to reconstructive laryngology. Method comprises three steps. At the first stage, general anaesthesia is performed, lower tracheostoma is applied, neck skin is cut from mastoid process on affected side to projection of upper pole of thyroid on opposite side. Then the skin flaps are diluted to the sides, lymphadenectomy is performed, lateral pharyngotomy is performed, and the front muscles of the neck are cut on the right - sternum-sublingual and sternum-thyroid. Using the electric coagulum, the hyoid bone and the edge of the thyroid cartilage are extracted, isolating and dissecting the greater horn of the hyoid bone, separating and cutting off the upper horn of the thyroid cartilage, posterior wall of laryngopharynx is exposed and larynx and tongue root are lifted, mucous membrane of posterior pharyngeal wall is separated from prevertebrate fascia. After opening the pharynx under direct visualization, the tumour is removed with a single unit, retreating 1 cm from the visible border in laryngopharynx and 0.5 cm in the larynx. At second stage transverse and longitudinal size of defect formed in hypopharynx and larynx is determined, in accordance with size of defect, skin area is marked in projection of large pectoral muscle. Transverse and longitudinal size of the skin flap must exceed the size of the defect in the laryngopharynx by at least 1 cm; then, the electrocoagulator is used to mobilize the marked skin flap together with a greater pectoral muscle and pass through the skin tunnel into a postoperative wound - a laryngopharyngeal defect. Wound on the chest involves thorough haemostasis; wound is closed with leaving aspiration drainage. At the third stage, an internal laryngopharynx is formed. Musculocutaneous flap is rotated and a nasopharyngeal tube is inserted. Then, the skin turned into a laryngopharyngeal lumen is anchored to the remaining mucosa in a circle by interrupted sutures of the absorbable material, thus ensuring tightness. Muscular portion of graft is anchored to local tissues, creating additional sealing and filling the volume of formed defect of soft tissues of neck after lymphadenectomy.

EFFECT: using the method enables preserving the larynx by avoiding complete removal of the larynx and laryngopharynx.

1 cl, 4 dwg, 1 ex