oncotomskСибирский онкологический журналSiberian journal of oncology1814-48612312-3168Tomsk National Research Medical Сепtеr of the Russian Academy of Sciences10.21294/1814-4861-2021-20-6-88-95oncotomsk-1990Research ArticleОПЫТ РАБОТЫ ОНКОЛОГИЧЕСКИХ УЧРЕЖДЕНИЙONCOLOGY PRACTICEМикрохирургическая реконструкция основания черепа и средней зоны лица после орбито-максиллярных резекций по поводу злокачественных опухолейMicrosurgical reconstruction of the skull base and midface after orbitomaxillary resections for malignant tumorshttps://orcid.org/0000-0001-7534-6565БолотинМ. В.BolotinM. V.

 кандидат медицинских наук, старший научный сотрудник

SPIN-код: 6105-5486

 Россия, 115478, г. Москва, Каширское шоссе, 23 

 MD, PhD, Senior Researcher

 23, Kashirskoe shosse, 115478, Moscow, Russia 

bolotin1980@mail.ruhttps://orcid.org/0000-0003-1255-5700МудуновА. М.MudunovA. M.

 доктор медицинских наук, заведующий отделением,

SPIN-код: 3516-6616

 Россия, Московская обл., Одинцовский р-н, д. Лапино, 1-е Успенское шоссе, 111 

 MD, DSc, Head of the Department

 111, Uspenskoye Shosse, Lapino, Odintsovky District, Moscow region, Russia 

https://orcid.org/0000-0003-3668-0741СоболевскийВ. А.SobolevskyV. A.

доктор медицинских наук, заведующий отделением 

 Россия, 115478, г. Москва, Каширское шоссе, 23 

 MD, DSc, Head of the Department

  23, Kashirskoe shosse, 115478, Moscow, Russia 

https://orcid.org/0000-0002-4496-6128ГельфандИ. М.GelfandI. M.

 кандидат медицинских наук, врач-онколог

SPIN-код: 7641-2039

 Россия, 115478, г. Москва, Каширское шоссе, 23 

 MD, PhD, Oncologist 

 23, Kashirskoe shosse, 115478, Moscow, Russia 

https://orcid.org/0000-0003-1578-3450ОрловаИ. В.OrlovaI. V.

 ординатор

SPIN-код: 6893-5113

 Россия, 115478, г. Москва, Каширское шоссе, 23 

 MD, Resident 

 23, Kashirskoe shosse, 115478, Moscow, Russia 

https://orcid.org/0000-0002-9543-990XАхундовА. А.AkhundovA. A.

 доктор медицинских наук, старший научный сотрудник

SPIN-код: 8895-9447

 Россия, 115478, г. Москва, Каширское шоссе, 23 

 MD, DSc, Senior Researcher 

 23, Kashirskoe shosse, 115478, Moscow, Russia 

ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина» Минздрава РоссииРоссияN.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of RussiaRussian FederationКлинический госпиталь «Лапино»РоссияClinical Hospital «Lapino» Russian Federation2021120120222068895Copyright © Болотин М.В., Мудунов А.М., Соболевский В.А., Гельфанд И.М., Орлова И.В., Ахундов А.А., 20222022Болотин М.В., Мудунов А.М., Соболевский В.А., Гельфанд И.М., Орлова И.В., Ахундов А.А.Bolotin M.V., Mudunov A.M., Sobolevsky V.A., Gelfand I.M., Orlova I.V., Akhundov A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.siboncoj.ru/jour/article/view/1990

Введение. Орбито-максиллярная резекция подразумевает под собой экзентерацию содержимого орбиты с резекцией нижнеглазничной и медиальной стенок. Основными задачами реконструкции являются: пластика мягкотканого дефекта и дефекта костных структур, тампонада полости орбиты и/или ее подготовка для дальнейшего глазного протезирования, реконструкция дефекта основания черепа. Цель исследования – представить непосредственные результаты орбито-максиллярных резекций у больных с обширными злокачественными новообразованиями средней зоны лица. Материал и методы. В отделении опухолей головы и шеи НМИЦ онкологии им. Н.Н. Блохина за период с 2014 по 2020 г. Под наблюдением находилось 6 пациентов. Во всех случаях дефект носил комбинированный характер. Для устранения дефекта, образовавшегося после резекции костных структур (верхняя челюсть, лобная, носовая кости) и кожных покровов в 3 (50%) случаях использован кожно-мышечный alt-лоскут, в 3 (50 %) – кожно-фасциальный лучевой лоскут. Результаты. Эстетический результат оценен у 6 больных. Во всех наблюдениях получен удовлетворительный результат. Ни у одного пациента, которому была выполнена резекция твердой мозговой оболочки с последующей пластикой, не отмечалось явлений ликвореи в послеоперационном периоде. Заключение. Выбор лоскута при орбито-максиллярной резекции зависит от объема дефекта. При небольшом объеме дефекта (до 70 см3) реконструкция может быть выполнена лучевым кожно-фасциальным лоскутом. При объеме дефекта более 71 см3 методом выбора является реконструкция с использованием кожно-мышечного alt-лоскута.

Background. Orbitomaxillary resection includes exenteration of the orbital contents with resection of the inferior orbital and medial walls. The main goals are: reconstruction of soft tissue and bone structure defects, tamponade of the orbital cavity and/or its preparation for further ocular prosthetics, and reconstruction of the skull base defect. The purpose of the study to present the immediate results of orbitomaxillary resections in patients with malignant neoplasms of the skull base and midface. Material and methods. Between 2014 and 2020, 6 patients who previously underwent surgery for primary cancer (n=3) and recurrent cancer (n=3) were treated at the Head and Neck cancer department of N.N. Blokhin National medical Research center of oncology. To reconstruct defects after resection of bone structures (maxilla, frontal and nasal bones) and skin, a musculocutaneous alt-flap was used in 3 (50 %) cases and a fascial skin radial flap in 3 (50 %) cases. Results. The aesthetic result was assessed in 6 patients. In all cases, a satisfactory result was obtained. None of the patients who underwent resection of the dura mater followed by reconstruction had no symptoms of liquorrhea in the postoperative period. Conclusion. Flap selection depends on the defect size. In cases with a small defect size (up to 70 cm3), reconstruction with the radial fascial skin flap can be performed. If the defect size is more than 71 cm3, reconstruction with musculocutaneous alt flap can be the method of choice.

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The authors declare that there are no conflicts of interest present.