Malignant tumors of the head and neck are still one of the most challenging problems of treatment in modern oncology. The disease affects mainly the capable people (from 30 to 60 years old). Tumor lesions of the paranasal sinuses lead to disability and have a high mortality rate. Head and neck tumors comprise of 20–30 % of all cancer cases. People with early paranasal sinus cancer have minor complaints, their general condition doesn’t get affected so they don’t seek for medical care in a while. As a result, patients start on treatment at tumor grades III–IV. This article provides the most complete information about the causes, frequency and special features of the course of paranasal sinus cancer, as well as about modern methods of it’s diagnosis and combination treatment. Despite the great advances in the treatment of these malignant tumors the three and five year survival rates remain unsatisfactory, which requires a research for new effective treatments. Currently the main treatment methods for these malignant tumors are combination and complex (involving surgery, radiotherapy and chemotherapy) treatments. The standard treatment approach includes radical surgical removal of the primary tumor and metastatic lymph nodes followed by radiation or chemoradiation therapy. Chemotherapy as monotherapy is administered in non-resectable primary or recurrent tumors, distant metastases or when a patient refuses the radical surgery. Improvement of existing treatment methods and development of new ones are an essential need. Earlier detection of the disease requires primary care physicians to be trained to diagnose tumor lesions of the paranasal sinuses, and highly specialized physicians (dentists, otorhinolaryngologists, maxillofacial surgeons, dermatologists) to express their cancer alertness.

Relevance. Staged orthopedic treatment was used to improve the quality of life of patients who underwent radical maxillofacial surgeries for cancer.Patients and methods. 197 patients receiving treatment for maxillofacial cancer were observed at the Department of head and neck tumors, National Medical Research Centre for Oncology of the Ministry of Health of Russia, in 1998- 2018. All patients underwent radical surgical treatment resulting in postoperative defects of the upper jaw, soft tissues of the zygomatic- buccal-orbital region, nose, or auricle.Results. Removable obturator prostheses with various supporting and retaining elements were made for 159 (80.7 %) patients. Individual facial prostheses were made for 38 (19.3 %) patients: 17 (44.7 %) – external orbital prostheses, 14 (36.8 %) – external nasal prostheses, 6 (15.8 %) – external zygomatic- buccal-orbital prostheses, 1 (2.7 %) – external auricle prosthesis. Combined prostheses were made for 4 patients– removable upper jaw obturator and nose prosthe[1]sis; removable upper jaw obturator and eye prosthesis. Combined prostheses were fixed to each other using magnets. The results of maxillofacial prosthetics were evaluated according to the aesthetic requirements of the patients and their quality of life. Maxillofacial prostheses allowed a complete restoration of chewing, swallowing, and speaking, restored facial deformation, and improved the appearance of patients.Conclusions. Timely and comprehensive orthopedic treatment of patients with postoperative maxillofacial defects after radical surgeries for malignant tumors takes the main place in the complex of rehabilitation measures. Early elimination of extensive defects is aimed at maximum restoration of oral dysfunctions and appearance preservation. The apparent advantages of maxillofacial prostheses involve improvement of social adaptation and the quality of life of patients, which promotes complete rehabilitation and a return to socially useful activities.

The article describes a clinical example of primary adenoid cystic carcinoma of the trachea, characteristics of its clinical course, diagnosis and the choice of treatment. We noted the non-specificity of complaints and clinical man-ifestations of tracheal cancer, the period between its beginning and diagnosis, the development of severe complica-tions in the respiratory and cardiovascular systems due to the long asymptomatic course of the disease, the need for an integrated approach by various specialists in the treatment of such a complex category of patients. An approach to the surgical treatment of tracheal cancer is described taking into account its extension to the subglottic larynx, which required laryngeal extirpation. We showed the possibility of radical treatment of patients with tracheal cancer in large medical centers with such specialists as head and neck cancer surgeons, thoracic surgeons, endoscopists, anesthesiologists and resuscitators, therapists, radiologists, and chemotherapists.

КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ ВТОРИЧНОГО ПОРАЖЕНИЯ ТЕЛА НИЖНЕЙ ЧЕЛЮСТИ ПРИ РАКЕ ТЕЛА МАТКИ Аединова И.В. 1 , Чертова Н.А. 1 , Ульянова Ю.В. 1 , Волкова В.Л. 1 , Пустовая И.В. 1 , Баужадзе М.В. 1 , Порываев Ю

Aim. To improve the results of treatment of patients with locally advanced laryngeal cancer by developing organ preservation surgery combined with radiation therapy. Methods. 20 patients with locally advanced laryngeal cancer stage III (T3N0-1M0) were examined. A surgery was developed that involves lateral resection of the larynx in conjunction with the underlying thyroid cartilage, preserving its upper 1/3-1/4 portion as a horizontal plate not affected by a tumor. On the affected side of the neck, a skin flap is preliminarily harvested, by 1.5-1.0 cm longer and wider than the resulting laryngeal defect. It is put over the fragment of thyroid cartilage left after resection and sutured to the healthy mucosa of the preserved part of the larynx. Laryngostomy and tracheostomy are formed. Tracheostomy tube is inserted. Formed laryngostomy is freely tamponed with two to three tampons with an antiseptic solution for up to 7 days. Naso-esophageal probe is inserted. Patients who did not receive radiation treatment before surgery, receive postoperative gamma-therapy after 14-20 days with cumulative dose up to 40 Gy. Plastic surgery of laryngostomy and tracheostomy is performed after 4-5 months after the intervention. Results. The developed method of surgery for patients with stage 3 of one half of the larynx allowed a radical removal of the tumor with the restoration of breathing, swallowing and speech. The event-free 5-year survival rate was 80±4.5%, and the total 3-year survival was 100%. Сonclusion. The developed technique of organ-preserving surgery in patients with locally advanced laryngeal cancer stage 3 involving its one half can provide oncological radical technique with the rehabilitation of the functions of the larynx.

КЛИНИЧЕСКИЕ НАБЛЮДЕНИЯ МЕЛАНОМЫ ПРИДАТОЧНЫХ ПАЗУХ НОСА Енгибарян М.А. 1 ,Ульянова Ю.В. 1 , Волкова В.Л. 1 , Аединова И.В. 1 , Мещеряков П.Н. 1 , Чертова Н.А. 1 , Баужадзе М

ПЕРСПЕКТИВЫ ИСПОЛЬЗОВАНИЯ ЭНДОВАСКУЛЯРНОЙ ХИРУРГИИ В ЛЕЧЕНИИ РАКА ЯЗЫКАКит О.И., Енгибарян М

1ФГБУ «Ростовский научно-исследовательский онкологический институт Минздрава России», Ростов-наДону, e-mail: aedinovai@mail.ru Злокачественные опухоли гортани представляют одну из сложнейших медико-социальных проблем в современной онкологии и относятся к группе социально значимых заболеваний, являясь одной из причин инвалидности и смертности населения. В структуре заболеваемости опухолей головы и шеи по Российской Федерации рак гортани составляет 20% от общего числа злокачественных опухолей и занимает 1-е место. В первый год с момента установления диагноза рак гортани в Российской Федерации летальность составляет 23%. Операции при местнораспространенных опухолях гортани, ввиду анатомических особенностей органа и высокой его функциональной нагрузки, относятся к наиболее сложным. Утрата социально значимых функций гортани, таких как голосовая и дыхательная, в ходе выполняемого стандартного хирургического лечения в виде ларингэктомии, нередко приводит к отказу со стороны больного от оперативного вмешательства. Цель органосохраняющего лечения состоит в том, чтобы при хороших функциональных результатах частота местных рецидивов и региональных метастазов была сопоставима с частотой рецидивов после ларингэктомий. Этот подход представляет собой сочетание радикального удаления опухоли и реконструкции оставшейся части гортани, что позволяет достигнуть хороших функциональных и онкологических результатов, тем самым получить максимально возможную психосоциальную реабилитацию пациента. Ключевые слова: рак гортани, реконструкции гортани, органосохраняющие операции.

ВОЗМОЖНОСТИ ОРГАНОСОХРАНЯЮЩЕГО ЛЕЧЕНИЯ МЕСТНОРАСПРОСТРАНЕННОГО РАКА ГОРТАНИ Светицкий П.В. 1 , Волкова В.Л. 1 , Аединова И.В. 1 ,Чертова Н.А. 1 , Ульянова Ю.В. 1 , Баужадзе М.В. 11 ФГБУ «Ростовский научно-исследовательский онкологический институт Минздрава России», Ростов-на-Дону, e-mail:

Aim. To improve the results of treatment of patients with advanced oral and oropharyngeal cancer. Methods. To achieve the aim, studies were carried out on 30 patients with advanced cancer of the oral cavity and oropharynx. An operation was developed that involved modified mandibulotomy with vertical slanting jaw incision and separation of its fragments, and radical removal of the tumor under visual and manual control, which was performed in 14 patients (study group). Postoperative osteosynthesis was performed by fixing jaw fragments with a titanium miniplate. For comparison, 16 patients were operated in a traditional way (control group), in which the cheek was dissected up to the projection of the mandible branch, the tongue was stitched and stretched, the tumor process was removed. Results. Use of the proposed method provides visibility of the tumor process, its boundaries, topography of the internal carotid artery, facilitates radical removal of the tumor. The event-free 2-year survival in the study group was 43±7.2%, in control group - 25±6.0%. The median event-free survival in the study group was 22 months, in control group - 14 months. Conclusion. The proposed method of surgery provides radical removal of the tumor while monitoring the internal carotid artery, and in the post-operative period - rehabilitation of the resected organs of the oral cavity.