The treatment tactics of patients with cerebral metastases of various solid tumors in the brain currently does not have a accurate determination. This article presents a discussion of the choice of treatment options for patients with cerebral metastases of solid tumors. Discussexistingrecommendations,identifies controversies.

Introduction. For now surgery is a key element in the treatment of advanced laryngeal cancer due to the most radical resection. Although, the incidence of complications in the form of pharyngocutaneous fistula is high, which leads to unsatisfactory functional and aesthetic results, increased treatment duration and cost.

The study objective is to improve the method for radical surgical treatment in patients with laryngeal cancer, to assess its impact on the frequency of postoperative complications.

Materials and methods. Our experience is based on the performed laryngectomy in 124 patients since 2009 to 2017. Laryngectomy was performed in 85 (68.5 %) patients, combined laryngectomy – in 17 (13.7 %) and extended combined laryngectomy – in 22 (17.8 %) patients.

Results. The developed approach method for surgical treatment of malignant laryngeal tumors allowed to avoid formation of pharyngocutaneous fistula and wound complications in postoperative period, and to achieve high functional and aesthetic results, decrease duration of inpatient care.

Conclusion. New treatment method provides favourable conditions for social, labor, medical rehabilitation of patients and allows to reduce treatment duration and cost.

Reconstruction of vast penetrating defects after radical resection of advanced tumors of the head and neck is a complex problem of reconstructive oral and maxillofacial surgery. In case of a vast full-thickness defect of the chick, it is necessary to create isolated walls both inside and outside the oral cavity, i.e. to perform two-layer reconstruction. In most articles, use of 2 distant flaps or a double folded free revascularized autologous transplant are described. However, performance of such large-scale and long surgical interventions can be limited by patient’s age or functional status, as well as other objective factors.

In reconstruction of full-thickness chick defects, a submental flap is an adequate alternative to a free revascularized autologous transplant. This surgery is technically much easier and produces a better esthetic effect compared to the use of a combination of temporal myofacial and cervicofacial flaps, as well as a double cervicopectoral flap. The proposed modification of the method–sialoadenectomy at the stage prior to harvesting of the pedicle flap – not only makes dissection easier but allows to determine tumor advancement. Temporal ligation of the facial artery above the branching site of the submental artery reduces blood loss during removal of a primary tumor of the chick.

Rosai–Dorfman disease or sinus histiocytosis is a rare entity which may affect various lymph node groups. Extranodal form is observed in 45 % of cases, facial bone involvement is especially rare. A 62-year old male presented with complaints on dumb sensation of the chin and lower lip. After clinical assessment and surgical exploration an intraosseous extranodal Rosai–Dorfman disease was diagnosed. The patient under-went free fibula osseous graft reconstruction. After 2 years the patient is recurrent free. The purpose of this publication is to describe a rare case of lower jaw involvement in an intraosseous form with significant bone destruction. The clinical and microscopic features of the process are discussed.

Introduction. With the advance of new technology like endoscopic laser and robotic surgery the interest in surgical treatment of the oropharyngeal cancer has been icreasing. However, the possibilities of the traditional techniques are not fully understood.

The study objective is to analyze functional and oncologic results of transcervical approach in surgical treatment of oropharyngeal cancer.

Materials and methods. Since April, 2009 through August, 2016 47 patients with oropharyngeal cancer (34 male and 13 female, aged between 44 and 69 years, mean – 57.6) were operated on through the transcervical approach. All but 2 patients with adenoid cystic (1) and acinic cell (1) had squamous cell carcinoma; 27 tumors originated from the tonsil, 13 – from the base of the tongue, 7 – from the soft palate; 42 (89.4 %) patients had stage III–IV disease. Among them 28 (60 %) were diagnosed with T3–T4 primary tumors; 37 (79 %) patients hadmetastases in lymph nodes. Perioperative tracheostomy was performed in all cases. All patients underwent neck dissection that was bilateral in 3 cases. Modified radical was the most frequent type of neck dissection. The operative approach was enhanced by lip-splitting in 12 patients who had marginal mandibulectomy. Local tissues were used for the reconstruction of the pharyngeal defect in 22 patients. In 25 cases flaps were used: free flaps – in 15, regional flaps with axial blood supply – in 10; thereafter 28 patients received adjuvant radiation with or without chemotherapy. Survival was calculated according to Kaplan–Mayer method.

Results. There was 1 death in early postoperative period with the death rate of 2.1 %. Complications were registered in 13 patients (28 %), 4 of them had multiple complications: total or partial flap necrosis – 6, wound infection – 4, postoperative bleeding – 2, perforative duodenal ulcer – 1, gastric bleeding – 1, neck wound breakdown – 1, pharyngeal wound breakdown – 1. Salivary fistula developed in 3 patients (6.5 %). Tracheostomy tube was removed on postoperative day 6.4 on average. In 43 (91.5 %) cases patients were able to resume oral diet 14 days after the operation on average. The mean follow up was 31.1 (3–101) months. Overall 3-year survival was 54.7 % with 63 % locoregional control. Locoregional failure was the most common cause of death – in 13 patients. Among 26 long-term survivors 25 are able to take food orally, 1 (3.8 %) patient remains to be gastrostomy tube dependent.

Conclusion. Transcervical approach for oropharyngeal cancer is a valuable alternative to mandibulotomy because it characterized by acceptable functional results.

A review of the literature on the problem of surgical treatment of local invasive thyroid cancer with damage to surrounding structures is presented. The comparative characteristics of various surgical tactics for the invasion of highly differentiated thyroid cancer into recurrent guttural nerves, larynx and trachea, esophagus have been performed. The advantage of intraoperative neuromonitoring was shown when deciding whether to retain the recurrent laryngeal nerve in the presence of invasion. The systems of staging of laryngotracheal invasion depending on the degree of its spread and surgical tactics used for each degree of laryngotracheal invasion are considered.

Defects after laryngopharyngectomies create a complex esthetics and functional problem. In this article, we present clinical cases of using a supraclavicular island flap for closing defects after surgical treatment of neck tumors.

In the 1^st case, a female patient with poorly differentiated squamous-cell carcinoma of the laryngopharynx underwent modified radical neck dissection on the right, laryngopharyngectomy with pharyngeal reconstruction using a fasciocutaneous supraclavicular flap. In the postoperative period, marginal necrosis of the deltopectoral flap developed but it healed by secondary intention. Control X-ray of the esophagus with barium sulfate showed that the pharynx transplant was functioning, anastomosis with the esophagus was consistent.

In the 2^nd case, a male patient with cancer of the vestibular larynx underwent surgical (tracheostomy, laryngectomy, modified radical neck dissection) and radiation treatment. During follow-up monitoring, a parastomal recurrence was detected which was removed with trachea resection, circular resection of  the cervical esophagus, removal of  the  right lobe of  the  thyroid, and combined defect reconstruction using a  fasciocutaneous supraclavicular flap (circular esophageal defect) and a pectoralis major myocutaneous flap. Postoperative period was complications-free. Control X-ray showed transplant patency and anastomosis consistency.

Therefore, the use of a supraclavicular flap is one of possible variants for closure of circular pharyngeal and esophageal defects and an alter-native for free revascularized flaps in cases where they can’t be used.

Radical surgical management of tongue cancer results in sever speech and swallowing disruption, impaired airway protection and life-threatening aspiration. Surgical objective of total glossectomy defect management is an adequate restoration of lingual mass and affected tissues   of the floor of the mouth. Range of flaps are known to provide the adequate outcome, i. e. pediculed pectoralis major flap, anterolateral free thigh flap, rectus abdominis flap, radial free forearm flap and latissimus dorsi flap.

In the current report, we present a case of glossectomy defect reconstruction with pediculed latissimus dorsi flap.

Postoperative assessment of the transplant was made according to clinical criteria and viability of the flap was assessed via laser Doppler flowmetry. Signs of microcirculation improved starting from day 5 postoperatively, and were almost equal with donor site microcirculation signs on day 14. A sufficiently large mass of the transplant allowed to create a thickening over the epiglottis, as well as to close the defect   in the oral cavity. The latissimus dorsi flap in the tongue reconstruction has a high potential: its use provides a relatively good quality of articulation, recovery of deglutition.

Oropharyngeal metastases are very rare and occur in approximately 1.0–1.5 % of all malignant tumors of the oral cavity and oropharynx.

Information on oropharyngeal localization of metastases of kidney cancer is almost absent in the literature. A description of a rare clinical observation of metastasis of clear cell renal cell carcinoma into the oropharynx is presented.

Lymphedema of  the head and neck after combination treatment of tumors of  this localization is an important problem as it leads to functional disorders, including life-threatening, and significantly decreases the quality of life. Early start of treatment prevents complications at the stage of edema. Currently, complete decongestive therapy in combination with low-level laser therapy allows to abate lymphedema manifestations.