METHOD FOR SURGICAL REMOVAL OF TUMORS OF THE UPPER THIRD OF THE NECK AND THE OUTER BASE OF THE SKULL INVOLVING A NEUROVASCULAR BUNDLE USING INTRAORAL INTERCORTICAL OSTEOTOMY OF THE LOWER JAW Russian patent published in 2022 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: invention relates to the field of medicine, namely dentistry and maxillofacial surgery, oncology, neurosurgery, vascular surgery. The method for magnetic resonance imaging determines the localization, the area of the lesion and the depth of the lesion of the base of the skull and spine. Under endotracheal anesthesia, in the position of the patient on his back with a wedge under the ipsilateral shoulder with the head turned in the opposite direction from the pathological formation, the marking of the upcoming skin incision in the submandibular region is performed with ultrasound scanning and marking of the projection of the main arteries of the head and the pathological formation. Then an intraoral intercortical osteotomy of the mandible is performed with preservation of the branches of the mandibular nerve. The branch and angle of the lower jaw are mobilized and withdrawn anteriorly and temporarily fixed with a micro screw in a given position. Under additional mandibular and infiltration anesthesia, an incision of the mucosa is performed in the retromolar region and further along the transitional fold to the level of the premolars of the lower jaw. The branch and the body of the lower jaw are skeletonized from the vestibular surface and the inner surface of the lower jaw branch is skeletonized. The mandibular opening is visualized with a neurovascular bundle entering it. A reciprocal saw or piezo tool is used to cut the cortical layer and the cortical plate along the outer edge of the branch along an oblique line with a continuation to the level between the 6^th and 7^th teeth. Further, the cutting is continued perpendicular to the base of the lower jaw. With the use of chisels placed in the projection of the first and second molars, splitting of fragments of the lower jaw is performed with the exception of damage to the lower alveolar nerve. Then, after splitting the fragments of the mandible, its branch is brought forward from the operating wound and fixed for the duration of the main operation to a larger fragment of the mandible with the removal of the angle of the mandible forward by 1.5-2.5 cm. Then, a soft tissue incision is performed in the submandibular region along the natural fold of the skin in the oblique anterior-posterior direction from the cricoid cartilage to the mastoid process of the temporal bone. Dissection of soft tissues along the anterior edge of the sternocleidomastoid muscle is performed. The tissues are divided in layers bluntly and acutely, the internal jugular and facial veins, the common, internal and external carotid arteries are sequentially isolated. The vagus and sublingual nerves are taken on holders, the branches of the internal and external carotid arteries are isolated from the bifurcation of the common carotid artery to the base of the skull. The tumor is visualized and separated together with the affected vascular and neural structures, followed by primary vascular prosthetics and plasty of neural structures. After removal of the tumor, revision and hemostasis of the surgical wound are carried out. Ultrasound monitoring of patency of arterial and venous reconstructions is performed, suturing of a wound on the neck with the retention of Redone drainage. Then, the osteotomized fragments are compared by intraoral method along the cutting line with each other and fixed using one or two fixing plates made of titanium alloy with fixing screws. Occlusion control is performed. Drainage is installed in the oral cavity and the wound is sutured.

EFFECT: method makes it possible to significantly reduce the risk of traumatization of the main arteries of the head, branches of cranial nerves, including the sublingual nerve, pharyngeal plexus, branches of the facial nerve, trigeminal nerve, to expand the corridor during the main stages of surgery on the structures of the upper third of the neck and the outer base of the skull, to provide the possibility of isolation of anatomical structures and pathological formations of the upper third of the neck without the use of increasing the size of the skin incision and additional intersection of important anatomical structures, to minimize the risk of possible injury to the maxillofacial nerves, shorten hospital stays, and reduce the rehabilitation time of patients after surgery.

1 cl, 3 ex