RU2248760C2 - Method for vestibular plasty of mouth cavity in its lateral department - Google Patents

Abstract

FIELD: medicine, oral surgery.

SUBSTANCE: one should perform an incision along mucous-gingival border of patient's jaw up to periosteum, separate mucosa at the section of transitional fold, replace separated mucosa into area of deeper vestibular arch to be sutured to periosteum, cover wound surface with a not free fragment out of the section of alar-mandibular fold. One should perform the first incision to form a fragment at the part of mucous-gingival maxillary border behind the tuber, continue this incision downwards along anterior edge of medial alar muscle towards mandibular transitional fold behind the 8^th tooth. Then it is necessary to perform the 2^nd incision at the part of maxillary transitional fold behind the 8^th tooth by leaving 1 cm against the 1^st one. One should continue the incision along the cheek at projection of anterior edge of mandibular branch, connect the second incision with the onset of the first one, separate mucous-submucous fragment beginning from inferior end, moreover, the width of developed fragment in central department should correspond to 1 cm. One should rotate the fragment upon nutritive pedicle at the angle of 90 deg., apply the fragment onto wound surface of vestibular side of maxillary alveolar process, fix the fragment with sutures to mucous edges. In another variant, the first incision for developing a fragment should be performed at the part of transitional maxillary fold behind the 8^th tooth. One should continue this incision downwards along anterior edge of medial alar muscle to mandibular mucous-gingival border the 8^th tooth. Then one should perform the second incision at the part of maxillary transitional fold behind the 8^th tooth from the onset of the first incision by continuing this incision along the cheek at projection of anterior edge of mandibular branch towards transitional fold. Then one should separate mucous-submucous fragment by starting from superior edge, moreover, the width of formed fragment in central department should correspond to 1 cm. Then one should rotate the fragment upon nutritive pedicle at the angle of 90 deg. and apply it onto wound surface of vestibular side of mandibular alveolar part. The innovation suggested enables to improve functional and esthetic results of vestibular plasty of mouth cavity.

EFFECT: higher efficiency of vestibular plasty.

2 cl, 2 ex

Description

The method relates to medicine, in particular to maxillofacial surgery, and is used to deepen the vestibule of the oral cavity.

A known method of plastic surgery of the vestibule of the oral cavity [1], which consists in the formation of a flap from the mucous membrane of the lips with a base on the alveolar process (part). After separation of the mucosa from the periosteum, the flap is placed on the alveolar process (part) and sutured to the periosteum at the deepest point of the arch of the vestibule of the oral cavity.

The disadvantages of this method are:

- the formation of an open wound surface and its healing by secondary intention;

- the possibility of severe lip scarring;

- the possibility of impaired lip function.

There is also known a method of plastic surgery of the vestibule of the oral cavity [1], which consists in making an incision to the periosteum along the mucous-gingival border within the lower frontal teeth. The mucous membrane from the region of the transitional fold is separated, moved to the region of the deeper arch of the vestibule of the oral cavity and is sutured to the periosteum. The disadvantages of this method are:

- healing by secondary tension of the resulting wound surface;

- the possibility of severe scarring of the vestibule of the oral cavity with its subsequent flattening;

- lack of sufficient growth in the depth of the vestibule of the oral cavity.

The closest analogue is the method of plastic surgery of the vestibule of the oral cavity [2], which includes the above methods using a free graft taken on a solid palate in the region of molars. After preparing the wound surface of the alveolar ridge (part) using the above methods, it was covered with a free autograft, fixed sutures and a protective dressing.

The disadvantages of this method are:

- the invasiveness of the donor area during graft collection;

- the possibility of rejection of the autograft.

The above methods are applicable for plastic surgery of the vestibule of the oral cavity in both the anterior and lateral regions.

The purpose of the invention is to achieve optimal functional and aesthetic results in plastic surgery of the vestibule of the oral cavity in the lateral region.

To achieve this goal, when plastic surgery of the vestibule of the oral cavity in the lateral region, according to the invention, it is proposed for the first time to use a non-free flap from the area of the pterygo-maxillary fold.

The unsatisfactory results obtained when using the closest analogues led to this work.

The method of plastics of the vestibule of the oral cavity in the lateral region is as follows.

For plasty of the vestibule in the lateral part of the upper jaw, the incision is made along the mucous-gingival border of the upper jaw to the periosteum. The mucous membrane in the area of the transitional fold is separated, moved to the area of the deeper arch of the vestibule of the oral cavity and sutured to the periosteum. To form the flap, the first incision is made on the site of the mucous-gingival border of the upper jaw beyond the tubercle. The incision is continued down the front edge of the medial pterygoid muscle to the transitional fold of the lower jaw behind the 8th tooth (if there is an 8th tooth). The second incision is made in the area of the transitional fold of the upper jaw behind the 8th tooth (if there is an 8th tooth), departing from the first by 1 cm, continuing along the cheek on the projection of the front edge of the lower jaw branch, and connect to the beginning of the first cut. Starting from the lower end, a mucosal submucosal flap is separated. The width of the formed flap in the central section should be 1 cm. Then the flap on the feeding leg is rotated at an angle of 90 °, laid on the wound surface of the vestibular side of the alveolar process of the upper jaw and fixed with sutures to the edges of the mucosa.

For plasty of the vestibule in the lateral part of the lower jaw, the incision is made along the mucous-gingival border of the lower jaw to the periosteum. The mucous membrane in the area of the transitional fold is separated, moved to the area of the deeper arch of the vestibule of the oral cavity and sutured to the periosteum. The first incision for the formation of the flap is done on the transitional fold of the upper jaw behind the 8th tooth (if there is an 8th tooth). The incision is continued down the front edge of the medial pterygoid muscle to the mucous-gingival border of the lower jaw behind the 8th tooth (if there is an 8th tooth). The second incision is made in the area of the transitional fold of the upper jaw behind the 8th tooth (if there is an 8th tooth) from the beginning of the first cut, continuing along the cheek on the projection of the front edge of the lower jaw branch to the transitional fold. Starting from the upper end, the mucous-submucosal flap is separated. The width of the formed flap in the central section should be 1 cm. Then the flap on the feeding leg is rotated at an angle of 90 °, placed on the wound surface of the vestibular side of the alveolar part of the lower jaw and fixed with sutures to the edges of the mucosa.

Clinical example. Patient B., 10 years old. Diagnosis: small vestibule of the mouth, atrophic gingivitis. The operation was performed according to our technique. An incision is made along the mucosal-gingival border of the lower jaw to the periosteum, the mucous membrane in the transitional fold section has been separated and moved to the area of the deeper arch of the vestibule of the oral cavity, the wound surface is closed with a flap from the pterygo-maxillary fold. Viewed after 6 months. The result is rated as good.

Clinical example. Patient X., 8 years old. Diagnosis: small vestibule of the mouth, atrophic gingivitis. The operation was performed according to our technique. An incision is made along the mucosal-gingival border of the lower jaw to the periosteum, moving the mucous membrane to the area of the deeper arch of the vestibule of the oral cavity, and closing the wound surface with a flap from the area of the maxillary fold. Examined after 11 months., The result is rated as good.

The proposed method of taking a non-free flap for plastics of the vestibule of the oral cavity in the lateral region improves the adaptability of surgical intervention and allows to achieve optimal functional and aesthetic results.

Literature

1. Middleton R.A. Preprosthetic surgery. In: McDonald R.E., Hurt W.C., Gilmore H.W., Middleton R.A. Current therapy in dentistry, V.7, St. Louis, C.V. Mosby company, 1980, p. 267-272.

2. Artyushkevich A.S., Krishtopenko L.S. Comparative characteristics of vestibuloplasty methods. Dentistry, 1990, No. 6, p. 54-56.

Claims (2)

1. The method of plasty of the vestibule of the oral cavity in the lateral region, including an incision along the mucous-gingival border of the upper jaw to the periosteum, separation of the mucous membrane in the transitional fold with its movement to the deeper arch of the vestibule of the oral cavity and suturing to the periosteum, closing the wound surface, characterized in that the wound surface is covered with a non-free flap from the area of the pterygo-maxillary fold, for the formation of this flap, the first incision is made in the area of the mucous-gingival border of the upper her jaw beyond the tubercle, continue to cut down the front edge of the medial pterygoid muscle to the transition fold of the lower jaw behind the 8th tooth, make a second cut in the transition fold of the upper jaw behind the 8th tooth, departing from the first by 1 cm, continue the cut along on the projection of the anterior edge of the lower jaw branch, connect the second incision with the beginning of the first incision, separate the mucous-submucosal flap, starting from the lower end, while the width of the formed flap in the central section should be 1 cm, then rotate scoot on the feeding leg at an angle of 90 °, laid on the wound surface of the vestibular side of the alveolar process of the upper jaw and fixed with sutures to the edges of the mucosa. 2. A method for plastic surgery of the vestibule of the oral cavity in the lateral region, including an incision along the mucous-gingival border of the lower jaw to the periosteum, separation of the mucous membrane in the transitional fold with its movement to the deeper arch of the vestibule of the oral cavity and suturing to the periosteum, closing the wound surface, characterized in that for closing the wound surface a non-free flap is used from the section of the maxillofacial fold, for the formation of this flap, the first incision is made at the transitional fold in jaw jaw behind the 8th tooth, continue the incision down the front edge of the medial pterygoid muscle to the mucous-gingival border of the lower jaw behind the 8th tooth, make a second incision in the transitional fold of the upper jaw behind the 8th tooth from the beginning of the first cut, continue a cut along the cheek on the projection of the front edge of the branch of the lower jaw to the transitional fold, the mucous-submucosal flap is separated, starting from the upper end, while the width of the formed flap in the central section should be 1 cm, then the flap is turned on the feeding ozhke angle of 90 °, is placed on the wound surface buccal alveolar mandibular joints and fixed to mucous edges.