Introduction. Oral squamous cell carcinoma is associated with a high risk of regional metastasis even in early stages (T1–2N0M0). Morphological examination reveals concealed metastases in 20 % of removed clinically unaffected lymph nodes.Objective – to evaluate the effectiveness of flow cytometry for detection of concealed metastases in sentinel lymph nodes as an indication for cervical lymph node dissection in patients with stage сT1–2N0M0 oral squamous cell carcinoma.Materials and methods. This study included 27 patients, including 13 patients (48.1 %) with stage T1N0M0 cancer and 14 patients with stage T2N0M0 cancer (51.9 %). At the first stage, all participants underwent primary tumor removal and cervical lymph node dissection with sentinel lymph node examination. After mobilization, half of these lymph nodes was used for routine morphological examination followed by immunohistochemical examination, while the second half of them was analyzed using flow cytometry. Then we compared the results obtained.Results. We examined 46 removed sentinel lymph nodes from 27 patients. Conventional histological examination revealed 4 concealed metastases (8.7 %). Polymerase chain reaction allowed us to detect another 16 metastases (37.8 %). Levels I, II, and III lymph nodes were most frequently affected. Flow cytometry demonstrated that 20 % of patients with a <4 mm invasion had concealed metastases, whereas patients with a 4 to 8 mm invasion had concealed metastases in 60 % of cases. Median follow-up time was 20.4 ± 11.7 months (range: 2.2 to 42.5 months; median 19.5 months). All participants were alive during this time. Seventeen out of 27 patients with stage T1–2N0M0 disease (63 %) were found to have concealed metastases, while the remaining ten patients (37 %) had no metastasis. One patient with stage T1N0M0 oral floor squamous cell carcinoma underwent the removal of the primary tumor and sentinel lymph node. Morphological examination and flow cytometry showed no metastatic lesions. After 14.8 months, the patient developed ipsilateral regional CN3 metastasis. The three-year progression-free survival rate was 94.7 ± 5.1 %.Conclusion. Highly sensible and rapid flow cytometry can become the method of choice in the diagnosis of metastases and deciding on cervical lymph node dissection in patients with cN0 disease. The study is still ongoing.

Introduction. Lymphomas are a heterogenic group of tumors of the lymphatic and hematopoietic systems, and in many cases tumor process develops in the area of the head and neck including skin and mucosa, orbit, nasal cavity and paranasal sinuses, oral cavity, oropharynx, salivary glands, thyroid, and cervical lymph nodes. Differential diagnosis of lymphomas of the head and neck is complicated because it can be accompanied by another non-tumor pathology. High heterogeneity of lymphomas of the head and neck requires structurization of knowledge on their epidemiological and clinical manifestations.The study objective is to optimize early diagnosis as it allows to significantly increase cancer alertness in local practitioners, oncologists, diagnosis specialists and, in turn, to decrease verification frequency in generalized disease processes. Study of clinical characteristics of lymphoproliferative disorders of the head and neck leads to increased quality of differential diagnosis.Materials and methods. A study of lymphoproliferative disorders affecting head and neck was performed. Study material consisted of data on 174 patients hospitalized at the N.N. Blokhin National medical Research Center of Oncology between 1999 and 2020.Results. Based on the current clinical and morphological classification of lymphoproliferative disorders, data on location of lesions, characteristic signs of extranodal lesions and cervical lymph nodes involvement, as well as methods of diagnosis of lymphomas of the head and neck, are presented.Conclusion. The obtained data helps solve problems of diagnosis of lymphoproliferative disorders affecting the head and neck and serve as a basis for successful, predictable treatment of lymphomas.

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.

Background. Lymphomas are a heterogeneous group of the lymphoid and hematopoietic system tumors. Neoplastic process often develops in head and neck area, including the integumentary tissues, orbit, nasal cavity, paranasal sinuses, oral cavity, pharynx, salivary glands, thyroid gland, as well as neck lymph nodes. The difficulties of head and neck lymphomas diagnosis are significant, since very often there is a combined non-tumor pathology. The high heterogeneity of lymphomas in the head and neck area requires structuring knowledge about their epidemiology and clinical manifestations.Objective: to study the epidemiological and clinical features of the head and neck lymphoproliferative diseases, which will lead to an improvement in diagnostic quality of this nosology’s.Materials and methods. The frequency of head and neck lymphoproliferative diseases detection was estimated based on the study of epicrisis and clinical data of 174 patients hospitalized at the N.N. Blokhin National Medical Research Center of Oncology in the period from 2000 to 2020.Results. Taking into account the modern clinical and morphological classification of lymphomas of the World Health Organization (2017), information about the features of localization, characteristic signs of extranodal foci and lymph nodes is presented. Detection frequency of various subtypes non-Hodgkin’s and Hodgkin’s lymphomas were determined on a sufficient cohort of patients.Conclusion. Based on the analysis of clinical and morphological features of head and neck lymphomas, epidemiological and clinical features are described in detail, and differences in the symptoms and clinical manifestations of non-Hodgkin’s and Hodgkin’s lymphomas with a predominant head and neck involvement are revealed.

Background. The main aims of hard palate reconstruction include separation of the nasal and oral cavities, restoration of chewing, swallowing, speech, ensuring good aesthetic results, and preparation for dental rehabilitation. The choice of reconstruction method is determined by such factors as the nature and location of the defect, surgeon’s experience in certain reconstruction methods, cancer prognosis, and patient’s preference. The study objective is to analyze the results of microsurgical reconstruction of hard palate defects using different types of flaps. Materials and methods. Forty-one (41) patients underwent microsurgical reconstruction of defects of the hard palate, soft palate, and alveolar process between 2014 and 2020. Defects of the anterior portion of the hard palate (grade I, IIc, IId according to the classification of J.S. Brown; grade IB, II, III according to the classification of D.J. Okay) were formed in 13 cases; all of them involved the alveolar margin of the maxilla to some extent. To repair these defects, we used flaps containing revascularized bone (n = 10; scapular tip flaps in 8 patients and fibular flaps in 2 patients) and fasciocutaneous or musculocutaneous flaps (n = 3; radial fasciocutaneous flaps in 2 patients and musculocutaneous flap from the anterior surface of the thigh in 1 patient). Defects of the posterior portion of the hard palate (grade Ib according to the classification of J.S. Brown; grade Ib according to the classification of D.J. Okay) were formed in 18 patients. To repair these defects, we used radial fasciocutaneous flaps (n = 17) and fibular autologous graft containing skin, muscles, and bone (n = 1). Soft palate resection was performed in 10 patients; all surgeries were combination, since the lateral oropharyngeal wall was included in the block of removed tissues. None of the patients had the opposite side affected. These defects were repaired using radial fasciocutaneous flaps. Results. Six patients (15 %) developed total flap necrosis due to venous thrombosis on days 2, 3, and 6 postoperatively; two patients developed flap necrosis due to arterial thrombosis 2 days postoperatively. Good speech quality was achieved in 33 patients (80 %), while 6 patients (15 %) had satisfactory speech; rhinolalia was observed in 2 patients (5 %). All patients with defects of the posterior hard palate and of the soft palate had excellent aesthetic results. Among participants with defects of the anterior hard palate and alveolar process, 10 patients had excellent aesthetic results, while 5 individuals had good results. Three patients had unsatisfactory results due to scarring in the middle portion of the face. Conclusion. Patients with subtotal defects of the hard palate and defects of its anterior portion (grade I, IIb, IIc according to the classification of J.S. Brown; grade II, III according to the classification of D.J. Okay) require repair of the alveolar margin of the maxilla; flaps containing revascularized bone are preferable in this case. The method of choice is defect repair using musculoskeletal scapular tip flap. In patients with short defects, defects located posteriorly, minimal or no defect of the alveolar margin of the maxilla (grade Ia, IB according to the classification of J.S. Brown; grade Ia, Ib according to the classification of D.J. Okay; grade V according to the classification of M.A. Aramany), soft palate defects, radial fasciocutaneous flaps should be used.

Introduction. Partial maxillectomy involves resection of 1 or 2 walls of the upper jaw, usually medial and anterior ones. The main purposes of reconstruction include the formation of an adequate support for the eyeball; isolation of the orbit from the nasal cavity, nasopharynx, and anterior skull base; normal symmetry; good aesthetic result.Materials and methods. Between 2014 and 2020, we followed up 13 patients. Nine of them (69 %) had combined defects involving the inferior orbital, anterior, and medial walls of the maxilla (class V according to according to the Brown–Shaw classification, 2010), as well as skin on the buccal and zygomatic areas; 1 patient also had lower eyelid affected. Four individuals (31 %) had isolated defects involving the inferior orbital, anterior, and medial walls of the maxilla (class V according to according to the Brown–Shaw classification, 2010). Twelve patients have undergone preoperative 3D-computer simulation. We divided patients into 2 groups according to the size of their defects and resection areas in the anterior wall of the maxillary sinus. Group 1 included 5 patients with partial maxillary defects (involving 25–40 % of the total area), whereas Group 2 comprised 7 patients with limited maxillary defects (involving 25–40 % of the total area).Five patients have undergone reconstructive surgeries with fasciocutaneous flaps, including anterolateral thigh flaps used in 4 individuals (31 %) and thoracodorsal flap used in 1 individual (8 %). Eight patients had their defects repaired using radial fasciocutaneous flaps. The inferior orbital wall was reconstructed using an individual titanium mesh implant.Results. All patients from Group 1 after defect repair with anterolateral thigh flaps and thoracodorsal flaps (4 individuals) had satisfactory aesthetic result. One patient had an unsatisfactory aesthetic result after reconstruction with a radial fasciocutaneous flap due to mesh implant protrusion and formation of an opening in the nasal cavity. The assessment of the eyeball position demonstrated that symmetry was achieved in 4 patients (80 %) after reconstruction using anterolateral thigh flaps (3 patients) and thoracodorsal flap (1 patient). Five patients from Group 2 (72 %) had excellent results, while 2 patients (28 %) had satisfactory results. The assessment of the eyeball position demonstrated that symmetry was achieved in 5 patients (70 %); two participants (28 %) had lower eyelid ectropion.Conclusion. Patients with large maxillary defects (involving 41–60 % of the total area of the anterior wall of the maxillary sinus and the alveolar process of the maxilla) should undergo reconstructive surgeries with fasciocutaneous anterolateral thigh flaps. In case of relatively small defects (involving 25–40 % of the total area of the anterior wall of the maxillary sinus and the alveolar process of the maxilla) the best option is defect repair with radial fasciocutaneous flaps. Such strategy ensures excellent aesthetic and functional results in 75 % of patients.

Background. The main aims of hard palate reconstruction include separation of the nasal and oral cavities, restoration of chewing, swallowing, speech, ensuring good aesthetic results, and preparation for dental rehabilitation. The choice of reconstruction method is determined by such factors as the nature and location of the defect, surgeon’s experience in certain reconstruction methods, cancer prognosis, and patient’s preference. The study objective is to analyze the results of microsurgical reconstruction of hard palate defects using different types of flaps. Materials and methods. Forty-one (41) patients underwent microsurgical reconstruction of defects of the hard palate, soft palate, and alveolar process between 2014 and 2020. Defects of the anterior portion of the hard palate (grade I, IIc, IId according to the classification of J.S. Brown; grade IB, II, III according to the classification of D.J. Okay) were formed in 13 cases; all of them involved the alveolar margin of the maxilla to some extent. To repair these defects, we used flaps containing revascularized bone (n = 10; scapular tip flaps in 8 patients and fibular flaps in 2 patients) and fasciocutaneous or musculocutaneous flaps (n = 3; radial fasciocutaneous flaps in 2 patients and musculocutaneous flap from the anterior surface of the thigh in 1 patient). Defects of the posterior portion of the hard palate (grade Ib according to the classification of J.S. Brown; grade Ib according to the classification of D.J. Okay) were formed in 18 patients. To repair these defects, we used radial fasciocutaneous flaps (n = 17) and fibular autologous graft containing skin, muscles, and bone (n = 1). Soft palate resection was performed in 10 patients; all surgeries were combination, since the lateral oropharyngeal wall was included in the block of removed tissues. None of the patients had the opposite side affected. These defects were repaired using radial fasciocutaneous flaps.Results. Six patients (15 %) developed total flap necrosis due to venous thrombosis on days 2, 3, and 6 postoperatively; two patients developed flap necrosis due to arterial thrombosis 2 days postoperatively. Good speech quality was achieved in 33 patients (80 %), while 6 patients (15 %) had satisfactory speech; rhinolalia was observed in 2 patients (5 %). All patients with defects of the posterior hard palate and of the soft palate had excellent aesthetic results. Among participants with defects of the anterior hard palate and alveolar process, 10 patients had excellent aesthetic results, while 5 individuals had good results. Three patients had unsatisfactory results due to scarring in the middle portion of the face.Conclusion. Patients with subtotal defects of the hard palate and defects of its anterior portion (grade I, IIb, IIc according to the classification of J.S. Brown; grade II, III according to the classification of D.J. Okay) require repair of the alveolar margin of the maxilla; flaps containing revascularized bone are preferable in this case. The method of choice is defect repair using musculoskeletal scapular tip flap. In patients with short defects, defects located posteriorly, minimal or no defect of the alveolar margin of the maxilla (grade Ia, IB according to the classification of J.S. Brown; grade Ia, Ib according to the classification of D.J. Okay; grade V according to the classification of M.A. Aramany), soft palate defects, radial fasciocutaneous flaps should be used.

The study objective is to evaluate the results of organ-preserving treatment of locally advanced larynx squamous cell carcinoma.Materials and methods. Analysis of 28 patients with locally advanced larynx squamous cell carcinoma (stages III-IV) who underwent treatment at the N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Health of Russia between 2017 and 2020 was performed. At the first stage, 2-3 courses of combined inductive polychemotherapy per the DCF scheme with 21-day interval were performed (docetaxel 60 mg/m2, cisplatin 60 mg/m2 intraarterially bolus with detoxication with sodium thiosulfate, 5-fluorouracil 1000 mg/m2/day as 96-hour infusion). The second stage included external beam radiotherapy (60-70 Gy, 2 Gy per day 5 days a week) as monotreatment if complete clinical response after chemotherapy was achieved or with regional administration of cisplatin (60 mg/m2 once per 3 weeks) if after inductive stage full clinical response wasn»t observed.Results. In 20 (71.5 %) patients, complete clinical response was observed after inductive treatment; in 7 (25 %) patients, partial response was observed. Tumor stabilization was detected in 1 (3.5 %) patient. Two-year overall survival was 95.8 ± 4.1 %, progression-free survival was 90.1 ± 6.8 %.Conclusion. The proposed strategy of organ-preserving treatment of stage III-IV larynx cancer with substitution of systemic chemotherapy with regional intraarterial chemotherapy prior to radiotherapy is highly effective from the point of view of direct anti-tumor effect and recurrence-free and overall survival.

The study objective is to report a case of successful treatment of recurrent unresectable squamous cell carcinoma of the head and neck using pembrolizumab (selective inhibitor, preventing the interaction between the programmed death receptor 1 (PD1) and its ligands PD-L1 and PD-L2).Materials and methods. A 72-year-old male patient was admitted to the Clinic of Head and Neck Tumors, N.N. Blokhin Russian Cancer Research Center with the following diagnosis: primary metachronous malignant tumors: 1) oropharyngeal cancer T2N3M0 (after chemoradiotherapy, no relapse or metastases), 2) skin cancer of the left ear (T2N0M0, stage II, after combination treatment); relapse. After multiple surgeries for repeated relapses and external beam radiotherapy in March 2017, the patient was found to have new metastatic lesions in the retropharyngeal lymph nodes and paravertebral soft tissues of the neck (left side). The tumor was considered unresectable. The patient had high level of PD-L1 expression in the tumor (50 %), therefore, it was decided to initiate treatment with PD-1 inhibitors. The patient received pembrolizumab (keytruda) 200 mg once every three weeks (7 courses).Results. Positron emission tomography performed in February 2018 demonstrated no increased uptake of radiopharmaceutical in the retropharyngeal lymph nodes and paravertebral soft tissues of the neck, which were earlier affected. Since that time, the patient demonstrates sustained remission without any therapy.Conclusion. This case not only shows high efficacy of PD-1 inhibitors for aggressive recurrent head and neck squamous cell carcinoma, but also opens new opportunities for the treatment of weakened patients after chemotherapy and radiation exposure.

The study objective is to investigate the causes of insufficient efficiency of neck lymph node dissection and possibilities of its improvement in cancer of the oral mucosa without clinically detectable metastases.Materials and methods. A review of literature on surgical methods of affecting regional lymph collectors in cancers of the oral cavity was performed, and preliminary data on possibilities of biopsy of the sentinel lymph node were obtained.Conclusion. Combination of fluorescent lymph node mapping andflow cytometry allows to identify the sentinel lymph node and detect hidden micrometastases with high sensitivity.

The study objective is to analyze mental state of patients with laryngeal cancer after laryngectomy.Materials and methods. The study included 38 patients at various stages of laryngeal cancer treatment. To assess mental state, we used the Hospital Anxiety and Depression Scale (HADS) and the Symptom Checklist-90-R (SCL-90-R).Results. In general, preoperative mental state of study participants was close to that in healthy individuals (described in literature), although there was a slight increase in their levels of depression and anxiety and higher distress severity indices. Six months after laryngectomy, a high level of distress was found; all patients had higher scores in all primary symptom dimensions; however, a significant increase was registered only for anxiety, depression, somatization, hostility, and interpersonal sensitivity. Six months postoperatively, mean anxiety score reduced, but was still higher than preoperative one and normal one. There was a significant increase in depression score and interpersonal sensitivity score. Conclusion. Our findings suggest the need for special programs of psychological rehabilitation for patients with laryngeal cancer to teach them the skills needed for self-regulation of mental state in order to increase their stress resistance.

Introduction . Chemoradiation therapy with a competitive regimen allows to avoid laryngectomy and increase patients’ quality of life. However, it’s highly toxic and this limits the use of this approach in patients with severe concomitant disorders. The alternative to systemic chemotherapy is infusion of high doses of chemotherapy drugs directly into a vessel supplying the tumor through a microcatheter. The study objective is to present a clinical case of using intra-arterial chemotherapy for treatment of locally advanced laryngopharyngeal cancer in a patient with a solitary functioning kidney. Materials and methods . Patient K., 55 years old, applied to the Head and Neck Tumors Clinical of the N.N.  Blokhin National Medical Research Center of Oncology with laryngopharyngeal cancer and bilateral metastases in the lymph nodes (T3N2M0,  stage IV). Use of systemic chemotherapy for this patient was limited because he had only 1 functional kidney. Three (3) courses of intra-arterial chemotherapy with docetaxel and cisplatin 60 mg/m 2 (with detoxification with sodium thiosulfate) and subsequent radiation therapy, systemic infusion of 5-fluorouracil were performed. Results . The main side effect of the treatment was edema of the pharyngeal and laryngeal mucosa but without severe respiratory distress. The symptoms were corrected with inhalations of oxygen-hydrocortisone mixture. Laboratory and instrumental control during treatment didn’t show any deterioration of the state of the solitary functioning kidney. Conclusion . Regional intra-arterial chemotherapy demonstrated a satisfactory effect in a patient with severe concomitant pathology and absolute counterindications for systemic chemotherapy.

The study objective is to report a case of mandibular ameloblastoma.Materials and methods. A 30-year-oldfemale patient presented with swelling of the right mandibular region that appeared 8 months ago and has been slowly increasing. The patient had no other symptoms, such as pain, anesthesia, paresthesia, difficulty swallowing, mouth opening, speech disorders, fever, chills, or weight loss. Orthopantomography revealed pronounced bone resorption in the right portion of the mandibular body. Computed tomography showed a cystic cavity in this area. After incisional biopsy, the patient was diagnosed with ameloblastic carcinoma. We performed segmental mandibular resection and installed a reconstructive plate to restore mandibular integrity. We also performed selective cervical lymph node dissection (levels Ia and Ib).Results. One yearpostoperatively, the results were considered aesthetically and functionally satisfactory.Conclusion. We observed an aggressive disease phenotype with extensive localized bone destruction, typical of ameloblastic carcinoma. Extensive excision of the primary tumor and selective cervical lymph node dissection without radiotherapy ensured a relapse-free period during patient’s follow up.

Introduction. Chemoradiation therapy with a competitive regimen allows to avoid laryngectomy and increase patients’ quality of life. However, it’s highly toxic and this limits the use of this approach in patients with severe concomitant disorders. The alternative to systemic chemotherapy is infusion of high doses of chemotherapy drugs directly into a vessel supplying the tumor through a microcatheter.The study objective is to present a clinical case of using intra-arterial chemotherapy for treatment of locally advanced laryngopharyngeal cancer in a patient with a solitary functioning kidney. Materials and methods. Patient K., 55 years old, applied to the Head and Neck Tumors Clinical of the N.N. Blokhin National Medical Research Center of Oncology with laryngopharyngeal cancer and bilateral metastases in the lymph nodes (T3N2M0, stage IV). Use of systemic chemotherapy for this patient was limited because he had only 1 functional kidney. Three (3) courses of intra-arterial chemotherapy with docetaxel and cisplatin 60 mg/m2 (with detoxification with sodium thiosulfate) and subsequent radiation therapy, systemic infusion of 5-fluorouracil were performed.Results. The main side effect of the treatment was edema of the pharyngeal and laryngeal mucosa but without severe respiratory distress. The symptoms were corrected with inhalations of oxygen-hydrocortisone mixture. Laboratory and instrumental control during treatment didn’t show any deterioration of the state of the solitary functioning kidney.Conclusion. Regional intra-arterial chemotherapy demonstrated a satisfactory effect in a patient with severe concomitant pathology and absolute counterindications for systemic chemotherapy.

The study objective is to report a case of successful treatment of disseminated nasopharyngeal carcinoma with nivolumab. Materials and methods . A 22-year-old male patient was admitted to N.N. Blokhin National Medical Research Center of Oncology with a diagnosis of T3N3M1 stage IV nasopharyngeal carcinoma with bone metastasis. After a course of radical chemoradiotherapy, the patient was found to have cancer progression. Between September 2016 and July 2017, the patient received chemotherapy with 3 lines of drugs, but with no effect. We decided to initiate treatment with PD-1 inhibitors. The patient received nivolumab 3 mg/kg every 2 weeks between July 2017 and March 2018. Results. Positron emission tomography (September 2018) demonstrated no increased uptake of [18F]-fluorodeoxyglucose in earlier identified cancer foci. Since September 2018, the patient has been in persistent remission without any therapy. Conclusion. This case report demonstrates high efficacy of PD-1 inhibitors in the treatment of disseminated recurrent nasopharyngeal squamous cell carcinoma, resistant to standard radiotherapy and chemotherapy.

The objective is using a clinical example to demonstrate the possibilities of intra-arterial polychemotherapy (PCT) in the combined treatment of oral squamous cell carcinoma.Clinical case. A 43-year-old oral squamous cell carcinoma patient with metastases to cervical lymph nodes, left side (T3N2bM0, stage IV) underwent 2 courses of regional neoadjuvant intra-arterial PCT (docetaxel at a dose of 105 mg, cisplatin at a dose of 105 mg), accessed through a. lingualis. A total dose of 6,800 mg of 5-fluorouracil was administered as a 96-hour infusion. PCT induced oral mucositis of grade 2, no hematological side effects were observed. Clinical examination revealed that tumor volume decreased by 60 %. Ultrasound detected no changes in lymph nodes. Second step included resection of oral cavity bottom tissues, atypical tongue resection, marginal resection of the lower jaw on the left, radical neck dissection on the left. Histological study of the surgical material of primary tumor region as well as metastases of the cervical lymph nodes on the tumor side revealed pathomorphism of 4 grade. In the postoperative period, oral cavity and neck were irradiated from 2 sides. No signs of the disease were detected within 9 months after the combined treatment.Conclusion. The clinical case demonstrates the high efficiency of regional intra-arterial PCT in patients with locally invasive oral squamous cell carcinoma. It seems relevant to further study its possibilities in the combined treatment of locally invasive forms of oral squamous cell carcinoma.

Radical surgical management of tongue cancer results in sever speech and swallowing disruption, impaired airway protection and life-threatening aspiration. Surgical objective of total glossectomy defect management is an adequate restoration of lingual mass and affected tissues of the floor of the mouth. Range of flaps are known to provide the adequate outcome, i. e. pediculed pectoralis major flap, anterolateral free thigh flap, rectus abdominis flap, radial free forearm flap and latissimus dorsi flap.In the current report, we present a case of glossectomy defect reconstruction with pediculed latissimus dorsi flap.Postoperative assessment of the transplant was made according to clinical criteria and viability of the flap was assessed via laser Doppler flowmetry. Signs of microcirculation improved starting from day 5 postoperatively, and were almost equal with donor site microcirculation signs on day 14. A sufficiently large mass of the transplant allowed to create a thickening over the epiglottis, as well as to close the defect in the oral cavity. The latissimus dorsi flap in the tongue reconstruction has a high potential: its use provides a relatively good quality of articulation, recovery of deglutition.

Introduction. Patients are characterized by locally advanced tumors in 70–80 % of cases at presentation, so possibility of cure and surgical treatment is limited. Total glossectomy, tongue base resection is associated with severe and permanent disability. Such surgical procedures lead to severe dysphagia, alalia and social maladjustment. Enumerated issues motivated us to develop new method of surgical treatment  of locally advanced base of tongue cancer. Objective is to introduce new opportunities of surgical treatment of locally advanced cancer of the tongue base. Materials and methods . Glossectomy is accomplished in 5 patients suffering from tongue cancer and admitted to N.N. Blokhin National Medical Research Center of Oncology. Swallowing and speech is preserved in all 5 cases. Results. The main advantage of the proposed method is that the cut out muscle flap has a different innervation from different cranial nerves involved in the rate of swallowing, so there is not just a mechanical movement of the epiglottis, but also the control of swallowing by the central nervous system. The reduction of injury and operation time in the proposed method is due to the fact that tissues directly contacting with the defect are used to preserve swallowing and speech. The proposed muscle flap has various sources of blood supply, which improves its nutrition and reduces the risk of complications, and healing occurs in a shorter time in comparison with the prototype. All of the above reduces the duration of hospitalization for an average of 7–9 days. Conclusion . The developed surgical technique allows to achieve early rehabilitation; patients are able to breathe effortlessly, swallow and speak. There is no need in permanent tracheostoma and percutaneous endoscopic gastrostomy tube. All patients remains socially active.

Reconstruction of vast penetrating defects after radical resection of advanced tumors of the head and neck is a complex problem of reconstructive oral and maxillofacial surgery. In case of a vast full-thickness defect of the chick, it is necessary to create isolated walls both inside and outside the oral cavity, i.e. to perform two-layer reconstruction. In most articles, use of 2 distant flaps or a double folded free revascularized autologous transplant are described. However, performance of such large-scale and long surgical interventions can be limited by patient’s age or functional status, as well as other objective factors.In reconstruction of full-thickness chick defects, a submental flap is an adequate alternative to a free revascularized autologous transplant. This surgery is technically much easier and produces a better esthetic effect compared to the use of a combination of temporal myofacial and cervicofacial flaps, as well as a double cervicopectoral flap. The proposed modification of the method–sialoadenectomy at the stage prior to harvesting of the pedicle flap – not only makes dissection easier but allows to determine tumor advancement. Temporal ligation of the facial artery above the branching site of the submental artery reduces blood loss during removal of a primary tumor of the chick.

In this literary review analyzed the possibilities of combination therapy in the treatment of locally advanced squamous cell carcinoma of the nasal cavity and paranasal sinuses, compares the frequency and nature of side effects in its different variants, assessed the effectiveness of intra-arterial chemotherapy in comparison with other methods.Combined treatment with the use of systemic chemotherapy allows not carry out massive surgical operations, but does not improve the long-term results of treatment. Regional intra-arterial chemotherapy has a number of advantages: improves the tumor response to treatment, long-term results, as well as expands the possibilities of organ-preserving treatment performance and, accordingly, improves the quality of life of patients. Another advantage is the possibility of a parallel use of detoxifier, which excludes the toxic effect, which is inherent in systemic chemotherapy. The implementation of this technology in a wide clinical practice is limited by the need for special equipment for interventional radiology and, consequently, the increased cost of treatment. However, the high efficiency of this method in the future is likely to lead to its active implementation in clinical practice.