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The International Federation
          of Head and Neck Oncologic Societies
Current Concepts in Head and Neck Surgery and Oncology 2012




Техника реконструкции в
 хирургии головы и шеи

                  Джатин Ша
Impact of Cancer Ablative
       Последствия радикального
        Surgery of the Oral Cavity
       лечения рака полости рта
        Aesthetic
        Aesthetic
       Эстетические               Functional
                                  Functional
                                 Функциональные
        Contour
        Contour
       Контур                    Speech
                                 Speech
                                 Речь
        Expression
       Выражение
        Expression               Mastication
                                 Жевание
                                 Mastication
       Нормальное
       Competence
       Competence                Swallowing
                                 Глотание
                                 Swallowing
       функционирование

                      Oral Cripple
                      Oral Cripple
                      Инвалид
2012
Extent of Tissue Loss from
     Область потери ткани при
  Cancer Ablative Surgery of the
радикальной хирургии рака полости
           Oral рта
                Cavity

       Soft Tissue
       Soft Tissue
       Мягкие ткани     Bone
                        Bone
                        Кости




         Mobile
        Подвижные
         Mobile
          Mobile       Immobile
                       Immobile
                      Неподвижные
           Mobile
2012
2012
Восстановление целевых функций
          полости рта:
       •  Нормальное функционирование полости рта
       •  Четкость речи
       •  Подвижность языка
       •  Жевание
       •  Прохождение пищевого комка
       •    регургитации
       •    аспирации
       •  Тактильная чувствительность
       •  Вкус
2012
Восстановление целевой эстетики
          полости рта:

       •  Костная основа
       •  Контур мягких тканей
       •  Выступ подбородка
       •  Подвижность
       •  Функционирование

2012
       •  Чувствительность кожи
Полость рта
           Потеря мягких тканей


       •  Слизистая
       •  Слизистая + подслизистая ткань
       •  Слизистая + подслизистая ткань + мышцы
       •  Слизистая + подслизистая ткань + мышцы
         + кожа
       •  Слизистая + подслизистая ткань + мышцы
         + кость
2012
Полость рта
                  Потеря кости
        Верхняя челюсть       Нижняя челюсть
•  Частично твердое небо •  Краевая

•  Все твердое небо        мандибулэктомия

•  Резекция верхних и     •  Восходящая ветвь
 нижних десен             •  Короткий сегмент тела

                          •  Гемимандибулэктомия

                          •  Резекция передней
 2012


                           дуги
Восстановление мягких тканей полости
                рта
                   Слизистая

        •  Нет

        •  Расщепленный кожный лоскут

        •  Первичное ушивание


 2012
Восстановление мягких тканей полости
                рта
        Слизистая и подслизистая ткань


             •  Кожный графт

             •  Первичное ушивание

             •  Местный лоскут


 2012
Кожный графт
       на диафрагме
        полости рта




2012
Реконструкция мягких тканей полости
                рта
   Слизистая, подслизистая и мышцы

       •  Кожный графт
       •  Первичное ушивание
       •  Местный лоскут
       •  Регионарный кожный лоскут
       •  Мышечно-кожный лоскут
       •  Лучевой предплечный свободный
2012

        лоскут
Реконструкция лица и шеи
       •  Местные лоскуты
       •  Регионарные кожные лоскуты
       •  Регионарные мышечно-кожные
        лоскуты
       •  Свободные лоскуты
        Лучевой предплечный,
        Переднебоковой бедра,
        Прямой мышцы живота,
2012

        Широчайшей мышцы спины и т.д.
Шейный лоскут для закрытия
    околоушного дефекта




2012
Цервикальный лоскут для
        закрытия дефекта шеи




2012
Дельто-пекторальный лоскут




2012
Пекторальные мышечно-
           кожный лоскут




2012
Кожно-мышечный лоскут из большой
  грудной мышцы с брахитерапией




2012
Вертикальный лоскут из
       трапециевидной мышцы




2012
Микрососудистые свободные
   лоскуты в восстановлении
         головы и шеи
       •  Радиальный предплечья
       •  Переднебоковой бедра
       •  Широчайшей мышцы спины
       •  Прямой мышцы живота
       •  Малоберцовая кость
       •  Тощая кишка
2012
Свободный радиальный
        предплечный лоскут




2012
Свободный радиальный
       предплечный лоскут при
           дефектах лица




2012
Свободный радиальный
       предплечный лоскут при
           дефектах лица




2012
Свободный лоскут прямой мышцы
            живота




2012
Реконструкция костных структур
                полости рта
          Верхние альвеолы (Небо)


          •  Нет (протез)

          •  Микрососудистый свободный
            лоскут

2012
Зубные протезы при дефекте неба




2012
Дефекты нижней челюсти




2012
Костная реконструкция полости рта

Восходящая ветвь нижней челюсти

       •  Нет

       •  Металлическая пластинка

       •  Микрососудистый свободный
        лоскут
2012
Костная реконструкция полости рта

         Тело нижней челюсти

       •  Нет
       •  Пластина
       •  Свободный графт без
         васкуляризации (короткий сегмент)
       •  Микрососудистый свободный лоскут
2012
Костная реконструкция полости рта

   Передняя дуга нижней челюсти

       •  Нет

       •  Микрососудистый свободный
        лоскут


2012
Радиальный предплечный
       кожно-мышечный лоскут




2012
Свободный лоскут
       малоберцовой кости




2012
Свободный лоскут малоберцовой кости
        при восстановлении языка и нижней
                    челюсти




2012
Свободный лоскут малоберцовой кости
        для передней дуги нижней челюсти




2012
Имплантация зубов в свободный
  лоскут малоберцовой кости




2012

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Техника реконструкции в хирургии головы и шеи, J. Shah