reconstruction surgery case presentation 洪凱風 kai-feng hung taipei vgh

reconstruction surgeryCase presentation

洪凱風 Kai-feng Hung Taipei VGH

personal data / chief complaint

evaluation classification reversible tx surgery

renal

personal data (case presentation)

Name: 黃霜清Age: 80 y/oSex: maleChart No: 8855525 Marital status: married

chief complaint (case presentation)

Mass lesion over L’t retromolar trigone with pain sensation for 3 months.

case presentation reconstruction surgery

> clinical examination > history > radiologic investigations > joint clinic > treatment plan > surgical procedures

physical examination


renal

physical examination (systemic)

General appearance: moderate looking appearanceVital sign: BP:138/64mmHg, PR: 72/min, RR: 22/min, BT:35.2Head: scar(+), trauma(-), bony mass(-)Neck: palpable mass(+), L’t submandibular region, 1.5cmEye: protruded eyes(-), pupils equal round reactive to

light(+)Ear: ear drum, otorrhea(-)Nose: rihnorrhea(-), sinus tenderness(-), nasal bleeding(-)Throat: ulceration over mucosa(-), tonsil enlargement(-)

>>

>>

>>

>

>

physical examination


renal

physical examination (systemic)

Chest & Lung: percussion: normal; auscultation: wheezing (-), rales (-) rhonchi(-), stridor (-)

Heart: regular heart beat, murmus (+/-)

Abdomen: soft and flat,

splenomegaly(-) hepatomegaly (-) Extremities: joint stiffness(-), pitting

edema(-)

>

>>

>

clinical examination (intraoral and extraoral)


renal

Ulcerative mass lesion over left buccal mucosa, extend to l’t retromolar trigone region, and close to l’t tuberosity. The size was about 4x3cm.

intraorally

extraorally

A palpable LN was noted over L’t level Ib which size about 1.5x1.5cm.

> clinical examination > history > radiological investigations > joint clinic > treatment plan > oral manifestation and dental management


radiological study


renal

Increased soft tissue density over l’t buccal mucosa, retromolar region

Multiple lymphadenopathy with central hypodensity, level Ib

CT scan

radiological study


renal

No obvious uptake over maxilla and mandible

whole body scan

No focal lesions in liver parenchyma, mild fatty liver Kidney, prostate gland: within normal size

abdomen sono

> clinical examination > history > radiological investigations > joint clinic > clinical diagnosis & treatment plan > oral manifestation and dental management



TMJ clinical diagnosis & treatment plan

[ left buccal mucosa, retromolar trigone ]

Primary lesion

- wide excision

- marginal resection of mandible

- partial maxillectomy

Clinical diagnosis and staging: squamous cell carcinoma over left buccal mucosa extend close to retromolar trigone, cT3N2bM0, stage IV


TMJ

[ central hypodensity LN over level Ib, 1.5cm in size ]

Neck mass

- left side modified radical neck dissection, type II

- right side suprahyoid neck dissection


clinical diagnosis & treatment plan


TMJ

[ hard tissue defect: mandible ]

Reconstruction

- posterior based tongue flap (combined with S.T.S.G)

- pectoralis major myocutaneous flap

- free forearm flap



[ soft tissue defect: mucosa of buccal side, retromolar trigone ]


TMJ

Airway management

- tracheotomy



> clinical examination > history > radiological investigations > joint clinic > clinical diagnosis & treatment plan > surgical procedures


surgical procedures


renal

the neck dissection

Single Y incision. Lower submandibular incision was below mandible lower border 2~3cm, vertical limb was placed posterior to carotid bifucation to clavicle (back of blade for cross-hatchings)

Tracheotomy

surgical procedures


renal

the neck dissection

Skin flap (ant border: strap muscle, post border: trapezius m, lower border: clavicle) in subplatysmal level

/ ext jugular vein, sternocleidomastoid m.

/ omohyoid m

/ phrenic n, brachial plexus, TCA, sup thyroid a, hypoglossal n

/ carotid sheath,

/ common carotid a, int jugular vein, and vagus n

/ small portion of lower pole of parotid tail

surgical procedures


renal

the primary lesion surgery

Lip-splitting procedures with elevation of lower cheek flap

/ incision of buccal and retromolar mucosa forming lateral margin of resection)

/ Incision of medial gingival mucosa forming medial margin of resection

/ Ramus is exposed subperiosteally

surgical procedures


renal


/ extraction of 32, incision and elevation of mucosa of soft tissue anterior margin

/ extraction of 26, incision and elevation of mucosa of soft tissue posterior upper margin

/ marginal resection of posterior mandible toward medially

/ partial maxillectomy of tuberosity

/ whole specimen with neck mass was resected in continuity

surgical procedures


renal


/ whole specimen with neck mass was resected in continuity

surgical procedures


renal

the reconstruction surgery

/ should tip to xiphoid

/ right angle line from middle of clavicle until meets this line

surgical procedures


renal


/ stay 2 cm lateral to sternum

/ elevation from lower upward

/ tunnel in the neck with stay suture traction

surgical procedures


renal


/ final intraoral closure, lip-splitting closure, neck closure with two exudrain

Thanks for your attention….

reconstruction surgery case presentation 洪凱風 kai-feng hung taipei vgh

Documents