Dentist № 3 (42) – 2021, pp. 20-24                                                                                                                             SCIENTIFIC PUBLICATION

Innovative methods of diagnosis and surgical treatment of median neck fistulas

A.S. Lastovkaa, T.V. Kakhanovichb, V.V. Kitelc, A.M. Nerovnyac

aMD, PhD, DMSci, Professor, Belarusian State Medical University, Minsk, Belarus
bMD, PhD, Belarusian State Medical University, Minsk, Belarus
cPhD, Associate Professor, Belarusian State Medical University, Minsk, Belarus

https://doi.org/10.32993/dentist.2021.3(42).1

ABSTRACT
The aim of the study is to develop new methods of diagnosis and treatment of median neck fistulas.
Objects and methods of research. Examination and surgical treatment of 15 patients with a diagnosis of “Median neck fistula” was performed. Preoperative examination of patients was carried out according to the standard scheme in the medical institution “Minsk Clinical Consulting and Diagnostic Center”. Surgical treatment of patients was carried out on the basis of the departments of maxillofacial surgery of the “11th City Clinical Hospital” of Minsk. Histological examination of the surgical material was carried out in the pathoanatomic bureau of the UZ “11th City Clinical Hospital” in Minsk. For a detailed study of the morphological structure of the hyoid bone and its connection with the median fistula of the neck, the preparations were subjected to a clarifying diagnosis at the Department of Human Morphology of BSMU and at the Department of Pathological Anatomy of BSMU.
The results of the study and their discussion. For the diagnosis of median neck cysts, a modification of the CBCT examination method was developed. When conducting a study of a soft-tissue component on a CBCT scan, we proposed the injection of a contrast agent into the fistula. At the stage of preoperative examination, CBCT with simultaneous injection of an X-ray contrast agent into the fistula makes it possible to determine in detail the passage of the fistula and the spatial relationship with the body of the hyoid bone, which is essential for determining the subsequent zone of its resection. Based on the conducted clinical and morphological study, we have developed a microsurgical technique for the operation of removing the median fistulas of the neck with resection of a fragment of the hyoid bone and preserving its anatomical continuity. We have been using the developed method of surgery in the clinic since 2013 in the surgical treatment of patients with median neck fistulas.
Conclusion. A new microsurgical technique for removing median fistulas of the neck with resection of the hyoid bone body without violating its anatomical continuity provides the necessary radicalism of the operation and the most sparing attitude to the hyoid bone, allows you to preserve its anatomical continuity, as well as the correct spatial position of the hyoid bone and the muscle structures attached to it, which ultimately provides a complete exclusion or a significant reduction in the development of possible postoperative complications.

Keywords: median fistula of the neck, cone-beam computed tomography, surgical methods of treatment

References

  1. Gemonov V.V., Lavrova Je.N., Falin L.I. Razvitie i stroenie organov rotovoj polosti i zubov [Development and structure of the organs of the oral cavity and teeth]. M.: GOU VUNMC MZ RF, 2002. 256 p.
  2. Girvigian M.R., Rechdouni A.K., Zeger G.D. [et al.] Squamous cell carcinoma arising in a second branchial cleft cyst. Am. J. Clin. Oncol., 2004, vol. 27, pp. 96–100.
  3. Tkachenko P.I. [et al.] Istochniki razvitija, kliniko-morfologicheskaja harakteristika i principy lechenija sredinnyh kist shei [Sources of development, clinical and morphological characteristics and principles of treatment of median neck cysts]. Zhurnal Grodnenskogo medicinskogo universiteta. – Journal of the Grodno Medical University. 2014, no. 2, pp. 61–66.
  4. Gadzhimirzaev G.A. [et al.] Vrozhdennye kisty i svishhi shei [Congenital cysts and fistulas of the neck]. Vestnik otolaringologii. – Bulletin of Otolaryngology. 2016, no. 81 (5), pp. 27–29.
  5. Astarita R.W. Cythopathology of lymph nodes. Practical Cythopathology, 1990, vol. 3, pp. 379–402.
  6. Kwan W., Fei-Fei L., Benergea D. Concurrent papillary and syuamous carcinoma in a thyroglossal duct cyst: A case report. Can. G. Surg., 1996, vol. 39, no. 4, pp. 328–332.
  7. Ivanova S.V. Kliniko-morfologicheskaja harakteristika bokovyh, sredinnyh kist i svishhej shei: avtoref. dis. kand. med. nauk [Clinical and morphological characteristics of lateral, median cysts and fistulas of the neck: author. dis. Cand. med. Sciences]. Omsk, 2003. – 29 p.

Correspondence to:  Е-mail: LastovkaAS@bsmu.by