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The study objective is to present the experience of performing extensive cranioorbital resection with subsequent arthroplasty of the hard palate and the dentition of the alveolar process of the maxilla.Materials and methods. In 2018, in the Department of Microsurgery of the P.A. Hertzen Moscow Oncology Research Institute, extensive cranioorbital surgery for recurrent sarcoma of the upper jaw was performed, after the treatment in other clinics. The extensive intervention included the exposure of the dura and the single-stage reconstruction of tissue defect, bone defect of the skull base by using the displaced aponeurotic flap of scalp and microsurgical reconstruction of the soft tissues of the face and mouth left free of the gastro-omental flap. In the early postoperative period, the patient underwent endoprosthesis replacement of the hard palate and alveolar process with a dentition. Results. Extensive intervention with resection of the structures cranioorbital zone and the skull base with a single-stage reconstruction with free gastro-omental flap with subsequent arthroplasty of the hard palate and the alveolar process dental arch allowed to rehabilitate the patient.

Distant metastasis of thyroid cancer are founded in 10% of all metastases. Bone metastases are founded in 23% of distant metastasis. Complications associated with metastatic skeletal involvement often lead to a deterioration in the overall condition and a decrease in the quality of life of patients. Surgical treatment, chemotherapy are less effective, provide a higher injury rate and toxicity. This is a reason of increasing of cost of treatment. Bisphosphonates are a class of drugs that prevent the loss of bone mass, which can prolong the time to releasing bone complications: bone fracture, spine column fracture with spinal medulla compression, which decrease the QoL. Surgical treatment and chemotherapy have worse outcomes, higher injury rate, toxicity and increase cost of treatment. Bisphosphonates decrease the level of pain syndrome. Bisphosphonates are used in treatment of oncological patients since 1990. First medication was Fosamax (Aledronat). Later more medications with better efficacy and more useful were synthesised. The last one was Zoledronic acid. Rezorba (zoledronic acid) was synthesised in 2006 in Russia. Rezorba has a same efficacy with other bisphosphonates, it was shown in clinical studies with groups of breast cancer and prostatic cancer. Clinical case of 67 y.o. male patient with diagnosis: Thyroid cancer IV c st pT1bN1bM1, right neck, paratraсheal, bone and lung metastasis. Complex treatment (surgery + radioiodine therapy + 5 courses of Rezorba) was presented. After 3 courses the level of pain was decreased from 3 to 1,5. After 5 courses the ECOQ score was decreased from 2 to 1 point. Inclusion of Resorba in complex treatment of patients with bone metastasis after thyroid cancer at all stages of treatment decreases the score of pain syndrome and bone tissue reparation.

Introduction. Facial nerve paralysis disconnects person»s emotions and expression, causes lagophthalmos, disorders of taste, touch, salivation, and lymph efflux in the damaged area. Among causes of consistent facial nerve conduction defects, the most common is iatrogenic injury during extensive surgical interventions for removal of tumors of the parotid gland. Various surgery interventions are used for correction of such disorders. The article objective is to present results of performed static plastic surgeries using polypropylene thread in patients with facial nerve damage caused by radical parotidectomy.Materials and methods. From 2014 to 2016 in the Department of Microsurgery of the P.A. Hertzen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Center, 14 patients underwent static correction using polypropylene thread to treat iatrogenic injury of the facial nerve after radical surgery for malignant and benign tumors.Results. In all patients, optimal results of repair of the esthetic component of the facial nerve were achieved. Postoperative period didn»t exceed 3 days. Effect duration is longer than 3 years.Conclusions. Use of polypropylene thread in static plastic surgery allows to perform cosmetic facial correction, eliminate gravitational ptosis and lymphostasis in patients with consistent syndrome of complete damage of facial nerve conductance.

A surgical approach as dysmasking implies a bitemporal skin incision followed by a single flap from upper facial soft tissues. The advantages of this technique may include a wide surgical approach to the structures of the anterior skull base, a possibility of intraoperative extension of the approach through parapalpebral and/or pre-auricular incisions, the lack of incisions in the central zone of the face, the preservation of the integrity of mimic muscles and the sensitivity of soft tissues in the central zone of the face. This paper gives experience in surgically treating 5 patients with malignant tumors of the paranasal sinuses and skull base. All the cases required a wide approach to the skull base and anterior facial skeleton. This was achieved by the use of the dysmasking approach, if need be, parapalpebral incisions or facial nerve resection followed by single-stage microsurgical neurorrhaphy were made. All operations were performed under endotracheal anesthesia. The wide surgical approach to the tumor, which permitted its removal in the maximum volume without skin incisions in the central zone of the face, as vitally indicated, could be achieved by dysmasking that yielded satisfactory postoperative cosmetic and functional results in all the cases.

After surgical treatment for locally advanced oral tumors with resection of soft tissues, mucosal membrane, and facial skeletal structures, there are penetration combined defects, removal of which is a challenge for reconstructive surgeons. Mandibular repair is one of the problems in the correction of combined oral defects. Surgeons use different grafts to remove mandibular defects. One-flap transplantation does not always solve all reconstruction problems and ensure the repair of the mucosal membrane, a soft-tissue component, skin integuments, and facial skeleton.The authors describe a clinical case of successful single-stage correction of penetration combined orofacial defect after resection of the tongue, mouth floor, en bloc resection of the lower jaw and mental soft tissues, bilateral cervical supramyochoroidal lymphadenectomy, stage LCL CM mandibular defect formation after J. Boyd, by using two microsurgical autografts (a peroneal skin-muscle-skin autograft and a radial skin-fascia one) in a 39-year-old female patient clinically diagnosed with carcinoma of the left mandibular alveolar ridge mucosa, Stage IVA (T4аN0M0).The Department of Microsurgery, P.A. Herzen Moscow Oncology Research Institute, Ministry of Health of Russia, has gained experience in comprehensively correcting extensive combined maxillofacial defects with two or more grafts in 27 patients who underwent autografting with a total of 73 flaps. The most functionally incapacitating and life-incompatible defect was removed at Stage 1 of reconstructive treatment. Delayed reconstruction was made after a complex of specialized antitumor therapy and assessment of treatment results in the absence of progressive growth. A great problem during multi-stage defect correction is presented by the lack of recipient vessels after cervical lymphadenectomy, the presence of soft tissue scar changes, trismus, temporomandibular joint ankylosis, contractures and displacement of the edges of the resected mandible, and autografting into the chronically infected area.Single-stage repair, including that using a few microsurgical autografts, is the operation of choice for adequate anatomic and functional rehabilitation, permits the promptest recovery of patients, reduces a postoperative period, and allows them to undergo an antitumor treatment cycle. However, the repair is possible, when the risk of disease progression is low, in specialized centers and when there are trained head and neck surgery and reconstructive microsurgery specialists and anesthesiologists.