HEMIGLOSSECTOMY WITH SOHND скачать в хорошем качестве

HEMIGLOSSECTOMY WITH SOHND

The hemiglossectomy with supraomohyoid neck dissection is a complex surgical procedure used primarily for the management of oral cancer. Today, we’ll go through a comprehensive overview of the procedure, followed by key aspects of post-operative care. Step 1: Pre-operative Considerations Before the procedure, a thorough assessment of the patient’s oral cavity and neck lymph nodes is critical. Imaging, like CT or MRI scans, helps to evaluate the extent of the tumor and determine the appropriate surgical margins. Anesthesia is administered, and the patient is positioned in a supine position with slight neck extension for optimal access. Step 2: Hemiglossectomy Overview The hemiglossectomy involves removing half of the tongue affected by the tumor. An incision is made along the planned resection lines, carefully maintaining oncological margins. The lingual artery and nerves are identified and preserved if possible, to minimize post-operative complications. The surgeon carefully dissects through the tongue tissue, achieving a clean removal of the tumor while avoiding excessive damage to surrounding structures. Step 3: Supraomohyoid Neck Dissection Next, we proceed with the supraomohyoid neck dissection, focusing on the removal of lymphatic tissue from levels I, II, and III of the neck. This dissection involves the removal of lymph nodes around the submandibular gland, internal jugular vein, and accessory nerve. Key structures, such as the spinal accessory nerve, hypoglossal nerve, and facial vein, are identified and preserved during the dissection to avoid nerve damage. The goal is to remove potential metastatic lymph nodes while preserving function. Step 4: Reconstruction and Closure Depending on the size of the resected area, primary closure or reconstruction using a local or free flap may be necessary to restore tongue mobility and function. A flap from the forearm or thigh is commonly used for larger defects. The surgical area is then irrigated thoroughly, and hemostasis is ensured before closing the incisions in layers. Step 5: Post-operative Care Post-operatively, patients are closely monitored in the ICU or a specialized recovery unit. Key aspects include maintaining a patent airway, monitoring for signs of bleeding or hematoma, and managing pain through intravenous analgesics. Speech and swallow therapy usually begin within the first few days to support the recovery of tongue function. Nutritional support is provided via nasogastric tube feeding until oral intake can be safely resumed. Antibiotics are often prescribed to prevent infection, and regular wound inspections are necessary to ensure proper healing. Step 6: Follow-Up and Long-term Care Patients typically require regular follow-up visits to monitor for any recurrence or complications. This may include imaging and physical exams. Long-term care often involves rehabilitation for speech and swallowing, as well as psychological support to help adjust to changes in oral function. Conclusion Understanding the hemiglossectomy with supraomohyoid neck dissection requires a balance of precision and careful attention to anatomical detail. With diligent post-operative care, patients can achieve good functional outcomes. Remember, the goal is to achieve oncological control while preserving as much function as possible. #ear #nose #throathealth