FIELD: medicine; maxillofacial surgery.
SUBSTANCE: infiltration anaesthesia is performed when the patient is in the position with the head turned to the contralateral side. An incision is made in the behind-the-ear area according to preliminary marking. A fringing incision is made from the base of the earlobe, then up along the lower and middle third of the behind-the-ear furrow. Then the incision is extended upward and rounded along the projection of the mastoid process. The incision is continued linearly down the hairline 5–6 cm long. The skin flap with subcutaneous fat is raised in a sharp and blunt way to the anterior border of the sternocleidomastoid muscle. During the dissection, the greater auricular nerve and external jugular vein are isolated. Determine the contours of the angle of the lower jaw by palpation. Visualize the connection of the anterior edge of the sternocleidomastoid muscle and the posterior edge of the subcutaneous muscle of the neck. Mobilization and separation of the posterior sections of the subcutaneous muscle of the neck from the level of the angle of the lower jaw and further down the front edge of the sternocleidomastoid muscle with a total length of 4 cm are performed. The posterior belly of the digastric muscle is visualized. After that, they pass in a blunt and sharp way in the subfascial layer to the submandibular area along the outer surface of the posterior abdomen. In the formed tunnel the capsule of the submandibular salivary gland is determined. The lower and posterior surface of the gland is dissected from the muscle fibres of the digastric, stylohyoid muscles. Facial vessels that envelop the posterolateral pole of the gland are allocated. The vessels are isolated from the surrounding tissues, taken on a holder and taken up, if it is impossible to save them, they are tied up and crossed. Acute and blunt dissection of the tissues of the lateral surface of the gland from the inner surface of the lower jaw is carried out. Under the control of the endoscope, the upper and medial poles of the gland are isolated from the maxillo-hyoid, hyoid-lingual muscles. The main submandibular salivary duct is identified and isolated, after which the duct is stitched and crossed. In the projection of the upper pole of the gland, the submandibular vegetative ganglion with outgoing nerve fibres from the lingual nerve is determined, and the ganglion is cut off. In the course of dissection, coagulation of collateral supply vessels is carried out. Next, the submandibular salivary gland is removed through the formed tunnel. The bed of the removed gland is inspected under the control of the endoscope. Drainage is installed. The wound is sutured in layers with interrupted sutures.
EFFECT: method allows to create an aesthetically advantageous hidden tunnel access to the submandibular salivary gland with an adequate view of the area of surgical intervention, to avoid muscle delamination along the course of dissection, postoperative paresis of the mimic muscles innervated by the marginal and cervical branches of the facial nerve, to reduce the duration of rehabilitation of patients.
1 cl, 3 dwg, 2 ex
