This paper describes an example of radical surgical treatment of a patient with a giant retrosternal goiter complicated by compression of the organs of the neck and mediastinum. Considering all the risks and possible complications, we should take into account the fact that enlarged thyroid (T) body with retrosternal location can cause displacement and stenosis of the trachea and esophagus, and dislocation of large vessels and nerves of the mediastinum. This anatomical specificity is an imminent threat to successful treatment, and it also carries a certain risk of asphyxia and sudden death of the patient. In this clinical case, radical surgical treatment in this patient included sequential mobilization in two pleural cavities, and then the total removal of T through the traditional surgical access. The anesthetic complexity to support the surgical intervention involved both difficult intubation due to tracheal stenosis, and also the required separate ventilation of the lungs to visualize anatomical structures and mobilize a multinodular formation in two pleural cavities. Standard methods of artificial lung ventilation could be ineffective and even dangerous in this case due to the location and size of the tumor. We focused our attention on high-frequency ventilation (HFV), the best method of respiratory support during surgeries for tracheal and bronchial pathologies. The main task of the anesthetic team in this clinical case was to prevent the development of hypercapnia and hypoxia during intubation of the stenotic tracheal segment, and then adequate ventilation of the lungs with reduced area of proper gas exchange due to bilateral surgical pneumothorax. Thus, the full treatment was carried out due to the only safe method of compensating lung ventilation with anesthesia by HFV. The applied HFV method creates an adequate gas exchange in the lungs due to the small ventilation volume and high frequency of respiratory cycles per minute. HFV both prevented the development of threatening complications during intubation of the stenotic tracheal area and ensured an adequate gas exchange during successive thoracoscopic stages of thyroid tumor mobilization.

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.

Purpose of the study . Improvement of surgical treatment outcomes in patients with advanced cancer of the tongue and the mouth floor providing radical surgery with preservation of the organ functions. Materials and methods . Two patients with advanced cancer of the tongue and the mouth floor with metastases to lymph nodes in the neck (St.4 (IVA, рT4a N2b M0), clinical group 2, were operated on according to our special technique. The surgery was performed under endotracheal anesthesia. After cervical lymph node dissection, the tongue and the mouth floor tissues were resected intraorally. The incisions were made through their entire thickness along healthy tissues. Smears were taken from the dissected tissues for intraoperative pathology consultation control for the presence of cancer cells. The tissues of the mouth floor affected by the tumor were completely removed without going beyond the hyoglossus muscle, since the lingual and hypoglossal nerves go along its outer surface. This allowed radical tumor removal with preservation of the tongue functions. Results . Patients operated on according to our special technique have been observed for more than 9 months without continued tumor growth and recurrences tumor with preservation of the tongue and the mouth floor functions. Conclusion . In such patients, ablastics principles are combined with the preservation of the tongue functions. This can be achieved because after removal of the tongue tumor, resection of the mouth floor is performed without going beyond the hyoglossus muscle not affected by the tumor, since the lingual and hypoglossal nerves go along its outer surface. Complying with ablastics, it preserves the tongue functions: chewing, swallowing, articulate speech, taste perception.

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.

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

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: