[Restoration of speech function in oncological patients with maxillary defects].

Speech quality was evaluated in 188 patients with acquired maxillary defects. Prosthetic treatment of 29 patients was preceded by pharmacopsychotherapy. Sixty three patients had lessons with a logopedist and 66 practiced self-tuition based on the specially developed test. Thirty patients were examined for the quality of speech without preliminary preparation. Speech quality was assessed by auditory and spectral analysis. The main forms of impaired speech quality in the patients with maxillary defects were marked rhinophonia and impaired articulation. The proposed analytical tests were based on a combination of "difficult" vowels and consonants. The use of a removable prostheses with an obturator failed to correct the affected speech function but created prerequisites for the formation of the correct speech stereotype. Results of the study suggest the relationship between the quality of speech in subjects with maxillary defects and their intellectual faculties as well as the desire to overcome this drawback. The proposed tests are designed to activate the neuromuscular apparatus responsible for the generation of the speech. Lessons with a speech therapist give a powerful emotional incentive to the patients and promote their efforts toward restoration of speaking ability. Pharmacopsychotherapy and self-control are another efficacious tools for the improvement of speech quality in patients with maxillary defects.

[Results of organ-preserving and reconstructive surgery of the mandible in patients with cancer of the oral cavity]. / Rezul'taty organosokhraniaiushchikh i rekonstruktivnykh operatsii na nizhnei cheliusti u bol'nykh rakom polosti rta.

Surgery is the basic procedure of combined therapy for locally-advanced carcinoma of the oral mucosa. It is intended to excise involved mucosa and soft tissues of the oral cavity and to resect the mandible. Rim resection (55) produces good functional and cosmetic results and was followed by 5-year survival in 76.4%. Due to median mandibulotomy (24), optimal access was provided to tumor involving the whole tongue and sitting at the back of the oral cavity (5-year survival--58.3%). Postoperative complication incidence was significantly lowered when titanium miniplates were used for mandibular arch reconstruction. When these miniplates and osteomyocutaneous flaps were used for mandibular reconstruction, following segmental resection, good cosmetic and functional results were recorded in 5 out of 8 cases (5-year survival--75%).

[Choice of the optimal variant of plastic surgery in head and neck tumors]. / Vybor optimal'nogo varianta plastiki pri opukholiakh golovy i shei.

Indications for planning primary and delayed operations for head and neck tumors have been evolved on the basis of our 15-year experience with 667 reconstructive surgeries (550 patients) 425 of which (77%) were conducted in one stage.

[Combined plastic repair in head and neck tumors]. / Kombinirovannaia plastika pri opukholiakh golovy i shei.

Combinations of arterialized flaps with other grafts have to be used for repair of extensive perforating defects caused by removal of local disseminated malignant tumors of the head and neck. A total of 635 plastic surgeries were carried out during the latest 15 years at Department for Tumors of the Upper Respiratory Tract, Cancer Research Center, Russian Academy of Medical Sciences. Of these, combined plasty was carried out in 79 cases; in 28 patients the tumor was localized in the median area of the face, in 37 in the lower part, and in 14 on the neck. Primary combined plasty was carried out in 41 patients, delayed repair in 38. Musculocutaneous flaps were used in 42 cases, fatty-cutaneous ones in 37. A working schematic classification of variants of primary and delayed combined plasty in patients operated on for tumors of the head and neck has been developed.

[Morphological and biological features of squamous cell carcinoma of the larynx]. / Morfologicheskie i biologicheskie osobennosti ploskokletochnogo raka gortani.

The study of morphological and biological criteria of laryngeal squamous cell carcinoma in 81 patients proved essential in the disease prognosis. In grade I malignancy 90 +/- 6.7% of patients were 3 years free of recurrences and metastases, in grade 11 - 76 +/- 8.6%, in grade III - 50 +/- 15.8%. Aneuploid laryngeal tumors produced recurrences 6 times more frequently than diploid ones. 3-year recurrence--and metastases-free survival was reported in 88.7 +/- 6.3% of patients with diploid and 59.3 +/- 7.7%. 7% with aneuploid tumors (p < 0.05).