METHOD FOR SELECTING THE TACTICS OF MANDIBULAR DEFECT REPLACEMENT IN TUMOR DISEASES

FIELD: medicine.SUBSTANCE: invention refers to medicine, oncology, namely to dentistry, and is intended for use in selecting the tactics of mandibular defect substitution in tumor diseases after extensive resection. Degree of severity of bone tissue damage within the defect is evaluated according to a classification proposed by J. Brown in 2016, in which the length and shape of the defect of bone tissues according to I-IV classes are considered, wherein the degree of the conjugated soft-tissue defect is additionally assessed, and in the presence of only the bone defect, the first degree of difficulty is determined, in the presence of a bone defect and a defect in oral tissues or skin of the face or neck, a second degree of difficulty is determined, in the presence of a defect of three layers of jaw tissues: a bone defect in combination with a defect of oral tissues and skin of the buccal region or neck, third degree of difficulty is determined, further, after assessment of the degree of complexity of the defect of the lower jaw for the reconstruction of the bone defect of I and II class according to J. Brown classification in order to recreate the natural contour of the lower jaw, two bone blocks are used, and for reconstruction of bone defects of III and IV classes according to classification J. Brown for recovery of anterior contour of lower jaws form at least 3 bone blocks, also to recreate the required height of the lower jaw, forming a second row of 4-5 bone blocks, then one of modification of the fibular flap is selected: for damages of the first degree of complexity only a bone fibular flap is used; in case of defects of 2nd degree of complexity, the defect is closed with the skin-bone fibular flap; with a degree of complexity defect 3, a musculo-muscular fibular flap with two skin portions is used, at that, due to the bone portion of the fibular flap, the lower jaw reconstruction is performed by fixing the bone blocks to the mandibular defect edges by means of bone metallo-osteosynthesis, with subsequent application of microvascular anastomoses, mainly one arterial and two venous between the vessels of the flap and face vessels of neck.EFFECT: method, due to higher accuracy of determining the severity of damage surrounding tissue defect, enables improving the adequacy and completeness of recovering damaged tissues when reconstructing defects in patients with tumorous involvement of the lower jaw.1 cl, 3 ex Изобретение относится к медицине, онкологи