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INTRODUCTION

Theme urgency: Neoplasms okoloushnoj a sialaden (OSZH) parapharyngeal localisation meet seldom, making 0,5 % of all tumours of a head and a neck and less than 20 % of all tumours okoloushnyh sialadens [2, 16, 25, 67, 111, 113, 121, 181].

The majority of them (70-80 %) predstavlenny good-quality tumours [31, 36, 39, 44, 118, 121, 123, 124, 159].

The latent current and scarcity of clinical symptoms at development of tumours okoloushnoj a sialaden in parapharyngeal area conduct to that the majority of patients address in clinic already with extensive tumoral process and accruing clinical implications in the form of a stomatopharynx and laryngopharynx stenosis. Frequency of diagnostic mistakes at tumours of the specified localisation on various data varies from 20 to 40 % [7, 12, 17].

Recently there was a set of the publications devoted to studying of various factors, defining a current and the forecast of tumours okoloushnoj a sialaden [17, 28, 62, 132]. Tumours okoloushnoj a sialaden - gistologicheski heterogeneous. A variety of morphological variants and high frequency retsidivirovanija tumours of the specified localisation (20-60 %), demand special attention at a choice of effective surgical access [86, 93, 108, 129]. Hence, one of actual problems is treatment of patients with tumours of a pharyngeal process okoloushnoj a sialaden.

Owing to the anatomic locating similar tumours demand use of more invasive accesses on a neck which in some cases are necessary for combining with various variants mandibulotomii [12]. Thus it is frequent (in 20 % of cases), for the purpose of radical excision even good-quality neoplasms, it is necessary to use the various combined accesses [11]. The combined surgical interventions in turn, demand adequate use of various reconstructive stages [12].

There are two kinds of access to parapharyngeal space - without a mandible osteotomy, so-called transcervical, and with a mandible osteotomy - transmandibular transcervical. The access choice depends on the size of a tumour, character of tumoral process, involving degree in process of the next anatomic structures, presence of previous radial therapy and operation. Careful complex diagnostics of tumours with use of a magnitno-resonant tomography (MRT) and a multispiral computer tomography (MSKT) is a basis of planning of surgical tactics.

In connection with a rarity of the given pathology practically the scientific information on neoplasms okoloushnoj a sialaden of parapharyngeal area is based on not numerous observations. Complexities of diagnostics and a choice of an adequate surgical intervention at tumours okoloushnoj a sialaden of parapharyngeal localisation have served as motivation for studying of the given problem and carrying out of scientific research. Despite set of existing surgical accesses to parapharyngeal space accurate indications to use of this or that variant of access, especially depending on a morphological kind, character of growth and prevalence of tumoral process, now, are not developed. In this connection the estimation of clinicodiagnostic features and results of various surgical interventions at patients with tumours okoloushnoj a sialaden of parapharyngeal localisation represents the big clinical interest.

Research objective

Rising of efficiency of treatment of patients with tumours okoloushnoj a sialaden of parapharyngeal localisation by optimisation of diagnostics and surgical tactics.

Research problems

1. To estimate clinicodiagnostic features of tumours okoloushnoj a sialaden of parapharyngeal localisation.

2. To develop optimum algorithm of diagnostics of tumours okoloushnoj a sialaden of parapharyngeal localisation.

3. To estimate possibilities of modern surgical accesses in treatment of tumours okoloushnoj a sialaden of parapharyngeal localisation.

4. To estimate the immediate and remote results of treatment of tumours of a pharyngeal process okoloushnoj a sialaden of parapharyngeal localisation with use of various variants of surgical accesses.

Scientific novelty of work

For the first time on a sufficient clinical material (50 patients) clinicodiagnostic implications of tumours okoloushnoj a sialaden of parapharyngeal localisation are estimated.

The algorithm of a choice of sequence of diagnostic methods and medical tactics is developed at the given pathology.

For the first time possibilities of modern surgical accesses for radical excision of tumours of a pharyngeal process okoloushnoj a sialaden taking into account the immediate and remote results of treatment are estimated.

The practical importance

The developed algorithm of a choice of sequence of diagnostic methods will allow to receive the detailed characteristic of tumoral process in the field of pharyngeal process OSZH, that, in turn will allow to plan accurately surgical interventions in a parapharyngeal zone.

Application of rational surgical tactics will allow to raise radicalism of excision of tumours okoloushnoj a sialaden of parapharyngeal localisation and to improve efficiency of treatment of patients with the specified pathology.

The received results will allow to formulate the adequate medical plan, to improve results of treatment, to reduce terms of stay of patients with the given pathology on hospitalisation and to improve quality of a life.

The substantive provisions which are taken out on protection

1. Variety of morphological forms of neoplasms of a pharyngeal process okoloushnoj a sialaden, the sizes, character of tumoral process, involving degree in process of the next tissues, presence of previous radial therapy in the field of parapharyngeal space have great value at a choice of medical tactics and assume the disease forecast.

2. Not specificity of clinical implications of a tumoral lesion of parapharyngeal space neoplasms okoloushnoj a sialaden dictates necessity of careful inspection of patients with the given pathology.

3. Adequate planning of surgical tactics and a variant of reconstruction of defect of a pharynx in a parapharyngeal zone is not obviously possible without MRT and MSKT diagnostics.

4. The basic method of treatment of tumours of a pharyngeal process okoloushnoj a sialaden is the surgical intervention, which radicalism is defined by a choice of the most adequate (transcervical or rasshirenno-combined) access to parapharyngeal space.

Introduction of results of research

Are introduced: 1) algorithm of diagnostics of patients with tumours of pharyngeal process OSZH; 2) indications to use of this or that surgical access taking into account results of treatment.

Results of dissertational work are introduced in practical activities of unit of maxillofacial surgery on the basis of TSS and CHLH GBOU VPO MGMSU of A.I.Evdokimova MZ and SR the Russian Federation and units of tumours of top dyhatelno-digestive ways FBGU RONTS of N.N.Blohina of the Russian Academy of Medical Science.

Work approbation

Materials and results of research have been reported at XVII International conference of maxillofacial surgeons «New technologies in stomatology» (St.-Petersburg, 2012), on XXI congress of the European association on cranial-maxillofacial surgery «Surgery of tumours of a head and a neck» (Dubrovnik, Croatia, 2012), at XVIII International conference of maxillofacial surgeons «New technologies in stomatology» (Sankt - Petersburg, 2013), on I Interdisciplinary congress on diseases of organs of a head and a neck «XXI-st century Medicine - the interdisciplinary approach to a pathology of organs of a head and a neck. Head and neck tumours» (Moscow, 2013). Dissertation Substantive provisions are reported, discussed and approved at joint session of employees of chair of maxillofacial surgery and chair of radial diagnostics MGMSU of A.I.Evdokimova of Ministry of Health of Russia and unit of tumours of top dyhatelno-digestive ways FGBU RONTS of N.N.Blohina of the Russian Academy of Medical Science 13 sentjaboja 2013.

Publications

On a dissertation theme 7 scientific works, from them 3 articles in the leading reviewed editions recommended VAK are published.

Structure and work volume

The dissertation is stated on 160 pages of the typewritten text, consists of introduction, 4 heads including: the literature review, materials and inspection methods, results of own researches, the conclusions, conclusions, practical references and the list of the literature containing 183 sources (22 domestic and 161 foreign). The dissertation material is illustrated by 44 drawings and 34 tables.

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A source: Aslanova Ella Chermenovna. CLINICODIAGNOSTIC FEATURES And SURGICAL TACTICS of TREATMENT of PATIENTS With TUMOURS OKOLOUSHNOJ of the SIALADEN of PARAPHARYNGEAL LOCALIZATION. The dissertation on competition of a scientific degree of the candidate of medical sciences. Moscow - 2013. 2013

More on topic INTRODUCTION:

  1. in introduction
  2. INTRODUCTION
  3. INTRODUCTION
  4. 10.1. Introduction
  5. INTRODUCTION
  6. approbation and introduction of results.
  7. Introduction
  8. Introduction
  9. INTRODUCTION
  10. INTRODUCTION
  11. Introduction
  12. Introduction
  13. INTRODUCTION
  14. Instead of Introduction …