After radical removal of regional tumors of the middle third of the face, defects of facial skeleton and adjacent anatomical structures in the maxillofacial region develop, including defects of the floor of the mouth, tongue, oropharynx, base of the skull, orbital tissues. Surgeons have proposed several classifications aimed at categorization of complexity and volume of the defects and promoting easier selection of the type of reconstruction. This article describes the main classifications of maxillary and mandibular defects. All classifications consider the problem from the point of view of a different practical approach, but most of them haven’t received wide acceptance. The available classifications do not fully take into account all components of the defects forming after surgical treatment of regional tumors. The authors propose a modification of the classification of maxillary defects by J. S. Brown and R. J. Shaw (2010). The modified classification should include not only bone defects but also other parts of the maxilla: epithelium, oropharynx, base of the skull, dura mater.
The authors present a classification of mandibular defects based on the classification by M. L. Urken et al. (1991). The new classification includes notations of mandibular regions as well as extraskeletal components of defects of the lower third of the face. The authors distinguish anatomo-functional regions of the maxilla and mandibula and 3 complexity categories of defects of the facial skeleton. This allows to determine the necessity of single flap or complex reconstruction and its staging. The article also describes a classification developed at the P. A. Hertzen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Center, Ministry of Health of Russia, which considers combined defects of the maxilla and mandibula and takes into account adjacent resected anatomical structures.
The proposed classifications allow to categorize defects after resection of the maxillofacial area of any volume including removal of regional tumors, and promote optimal selection of the tactics of surgical reconstruction.

Introduction. The future of thyroid gland fast-track surgery depends largely on early hypocalcemia prediction. We describe our experience of using intraoperative indocyanine green fluorescent angiography (IGFA) of parathyroid glands to access their function in the early postoperative period.
The study objective is to evaluate the possibility of prediction of early postoperative hypocalcemia after thyroidectomy using intraoperative indocyanine green fluorescent angiography.
Materials and methods. Thirty five (35) patients with benign and malignant thyroid tumors eligible for thyroidectomy were included in the study. Intraoperative IGFA was performed using the SPY SP2000 (Novadaq Technologies Inc., Canada) device and visual assessment of vascularization of the parathyroid glands. The glands without fluorescence were considered ischemic. Ionized calcium test was performed 4, 8, and 18–24 hours after the surgery. Significance of the difference in its levels in patients with normal and ischemic parathyroid glands was evaluated.
Results. In 26 patients, vascularization was considered sufficient, in 9 patients the glands were ischemic per the fluorescent examination.
Statistically significant difference of ionized calcium levels were observed between groups with ischemic and normal glands at 18 hours after the surgery (mean 1.060 ± 0.53 in ischemic vs. 1.110 ± 0.56 in normal group, p <0.05).
Conclusion. Intraoperative IGFA of the parathyroid glands can successfully predict early postoperative hypocalcemia. Further studies for accessing correlation with permanent hypocalcemia are required.

Introduction. Many researchers are currently searching for new, safe, and effective methods of maxillofacial reconstruction in cancer patients.
In this case, special attention should be paid to ceramic implants.
Objective: to develop a personalized approach to the maxillofacial reconstruction using bioactive ceramic implants.
Materials and methods. We performed virtual planning of the implants for the reconstruction of the maxillofacial region basing on the preoperative spiral computed tomography scans of the facial skeleton.
Results. We have developed a new method of preoperative planning and creation of individualized implants made of bioactive ceramics for reconstructing the maxillofacial region. This method is demanded in reconstructive surgery and can be applied in routine clinical practice.
Conclusion. Reconstructive surgeries with the implants made of bioactive ceramics allow achieving good functional and aesthetic results in patients with large postoperative defects in the maxillofacial region, thus, improving their quality of life.

Introduction. The problem of treatment and rehabilitation of patients with laryngeal cancer has been a complicated and controversial one.
Important conditions for selection of the type and scale of functionally sparing surgical intervention are accurate preoperative diagnosis of advancement of the tumor and oncological appropriateness of the intervention. Currently, the problem of single-step reconstruction of lost laryngeal functions after organ-preserving surgeries remains open. For this purpose, researchers use both auto-/homografts and endoprosthetics made of various materials. In some cases, endoprosthetics in lyrengectomy didn’t allow to restore laryngeal lumen due to granulation tissue, cicatricial stenosis, laryngotracheomalacia.
The study objective is to increase treatment and rehabilitation effectiveness in patients with laryngeal cancer after open laryngectomy.
Materials and methods. Our experience is based on open laryngectomies in 86 patients performed at the Clinical Oncology Dispensary No. 1 of the Moscow Healthcare Department in the period from 2011 to 2014. Primary laryngeal cancer was diagnosed in 84 (97.7 %) patients, recurrent laryngeal cancer after a full course of radiation therapy – in 2 (2.3 %) patients. Vertical laryngectomy was performed in 74 patients, horizontal – in 12 patients.
Vertical laryngectomies were performed for tumors located near the vocal and vestibular flaps, anterior commissure, subglottis, laryngeal sinus;
horizontal for tumors located near the epiglottis, vestibular flaps, vallecula, root of the tongue if arytenoids were intact and vocal cords were mobile. In the postoperative period, an important factor was restoration of the organ’s function through early rehabilitation of respiratory, vocal, and protective functions. Evaluation of the laryngeal lumen was performed using endoscopic examination. Any diagnosed ligatures, granulation tissue, scars were resected. Prior to decannulation, ultrasound examination of the larynx was performed. Effectiveness of vocal function restoration was evaluated using computer acoustic analysis of the voice.
Results. Restoration of the lost laryngeal functions after organ-preserving open laryngectomies in patients with laryngeal cancer is achieved through reconstruction of the remaining parts of the organ, formation of an adequate lumen for breathing through postoperative endoscopic correction, and early rehabilitation of respiratory, vocal, and protective function.
Conclusion. Open laryngectomies with restoration of the remaining parts and single-step reconstruction of the lumen with an endoprosthesis, as well as subsequent combined treatment, allowed to restore respiratory function in 93.1 % patients, vocal function – in 91.9 % patients.

Introduction. Surgical treatment of patients with malignant neoplasms of the oropharyngeal region less disrupts the functional state of the maxillofacial region, reduces the relapse of diseases and maintains a satisfactory cosmetic result due to modern technologies. However, the future adequate rehabilitation provides a high indicator of the quality of life of such patients during antitumor treatment.
The aim of this study was assessment of the quality of life of the patient with malignant neoplasm of the oropharyngeal region at the pretreatment stages, after surgical treatment with the imposition of an individual temporary prosthesis on the upper jaw, after the fabricate of obturator prosthesis, 3 months after orthopedic rehabilitation.
Materials and methods. The quality of life of a patient with salivary gland cancer (T3N0M0) according to international scales for assessment of dental health of patients with head and neck tumors was analyzed: FACT-H&N, QLQ-C30 H&N35, OHIP-14; and the assessment of general health: SF-36, Karnovsky, ECOG Perfomance Status, EORTC-QLQ-C30.
Results. The results of the evaluation on the questionnaires reflect the same dynamics, but they are not adapted for the analysis of the stages of dental rehabilitation, which is the final link in the treatment of patients with malignant neoplasms of the oropharyngeal region.
Conclusion. The level of quality of life of a patient depends on the methods of orthopedic treatment during antitumor treatment on all scales.

Oral and oropharyngeal tumors are the most frequent cancers in the head and neck region. Despite their visual localization, the majority of cases is diagnosed at advanced stages. The treatment should be planned only after assessment of all pathways of tumor advancement taking into account anatomical characteristics of the area. In this review, diagnostic criteria affecting the method and extent of surgical treatment and the role of computed tomography and magnetic resonance imaging in their assessment are presented.

In this report we present a case of patient with a tumor of the paranasal sinuses. A non-homogeneous formation spreading to the right maxillary sinus, right nasal cavity, and right orbit (with the destruction of the bone wall of the anterior cranial fossa) in the ethmoid bone was detected on a computed tomography scan. A esthesioneuroblastoma was suspected after the needle biopsy (accompanied by bleeding). To clarify the diagnosis and to determine treatment strategy, we performed open biopsy under general anesthesia, which showed that the patient had hemangioma. The patient underwent radical removal of the tumor. Histopathological examination confirmed the diagnosis of hemangioma.
The aim of this study was to describe a case of orbital tumor, when the results of needle biopsy were inconsistent with clinical manifestations.
In this case, clinical manifestations had the decisive role in determining treatment strategy.

In the structure of oncological morbidity of the upper respiratory tract, malignant tumors of the larynx, including tumors of mesenchymal origin, are the most common. From 1959 to 2013, 55 cases of laryngeal leiomyosarcoma were described in scientific literature. Rarity of this localization of the tumor was the reason for publication of a clinical observation of a patient with endophytic tumor of the right vocal fold.
Differential diagnosis for myofibro-, fibro-, and leiomyosarcoma was conducted. Based on immunohistological examination, well-differentiated laryngeal leiomyosarcoma was diagnosed.

In the article, a description of a clinical observation of laryngopharyngeal fibromyxoma and a short literature review are presented. This is a rare variant of fibromyxoma localization. There»s no description of laryngopharyngeal fibromyxoma in Russian or international literature.

Introduction. Pituitary adenomas comprise 10–15 % of all intracranial tumors. Despite being benign tumors, 25–55 % of them exhibit invasive growth spreading into surrounding structures (sphenoid sinus, cavernous sinus, etc.). In literature, there isn’t a generally accepted definition of aggressive pituitary adenomas. As a result, there aren’t any studies reporting on the therapy of choice for this disease, except for several reports on using temozolomide as a “salvage” therapy in patients who didn’t respond to standard treatment methods.
We present a clinical observation of a patient with “refractory” pituitary adenoma who successfully underwent 4 surgical interventions and 2 courses of high-dose stereotactic radiotherapy.
Results. Application of stereotactic radiotherapy at high (59.4 Gy) dose, which is usually used for treatment of patients with malignant tumors, allowed to achieve long recurrence-free period of 5.5 years (65 months). Observation has shown that repeated courses of stereotactic irradiation can be sufficiently effective and safe in patients with large and gigantic tumors including “refractory” pituitary adenoma.
Conclusion. Further studies are necessary for specification of parameters of “refractory” adenomas and their detection at the early stages of diagnosis. Confirmed diagnosis requires more aggressive surgical, radiological, and drug treatment.