FIELD: medicine.
SUBSTANCE: invention relates to medicine, namely to maxillofacial surgery. The submandibular salivary gland is removed with endoscopic assistance by intraoral access. With the help of a tongue retractor, the lateral surface and the root of the tongue are retracted to the opposite from the affected gland. Infiltration of the oral mucosa is carried out with a local anesthetic solution. A linear incision of the mucous membrane is made along the maxillary-lingual groove, retreating 0.7-1.0 cm from the inner surface of the lower jaw parallel to the course of the Varton duct, from the second premolar to the retromolar region with a total length of 3.5-4.0 cm. Mobilization is carried out the edges of the wound. The location of the lingual nerve is determined and it is freed from the tissues of the gland, the duct. The submandibular ganglion is cut off. After that, the nerve is taken on a holder and retracted lingually. The tissues of the sublingual salivary gland are retracted anteriorly. Then, the Wharton duct is isolated from the distal third to the ampullar part of the submandibular salivary gland. Wharton's duct is clamped, ligated and divided. Next, the superficial lobe of the gland is dissected from the maxillary-hyoid muscle, as well as from the connection with the hyoid-lingual and awl-hyoid muscles under constant digital pressure from the side of the submandibular triangle, pushing the gland into the region of the surgical field. With the help of a retractor, the fibers of the maxillohyoid muscle are retracted anteriorly. Under the control of the endoscope, the lower and posterior surface of the gland is dissected from the anterior and posterior belly of the digastric muscle and facial vessels, which are retracted together with the capsule of the gland, avoiding their damage. Then the lateral surface of the gland is dissected from the inner surface of the lower jaw. During dissection, collateral blood vessels coagulate. After mobilization of the salivary gland, it is removed through the formed tunnel. Conduct an audit of the bed under the control of the endoscope. Hemostasis. In the depth of the bed of the removed gland, the hypoglossal nerve is visualized. The wound is sutured with interrupted sutures.
EFFECT: method allows creating an adequate overview of the area of surgical intervention, avoiding the formation of visible scars in the lateral surface of the neck, postoperative paresis of facial muscles, maintaining the integrity of the subcutaneous muscle of the neck, muscles of the floor of the mouth, reducing the risk of damage to the marginal branch of the facial nerve, achieving a high functional and aesthetic result, reduce the time of rehabilitation of patients.
1 cl, 2 dwg, 2 ex
