RU2264793C2 - Method for making plastic repair in frontal part of the oral cavity - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves making cut along mucogingival boundary of the maxilla down to periosteum. The mucous membrane is detached in transition fold area. It is moved towards deeper oral cavity atrium fornix and sutured to periosteum. Wound surface is covered with bound flap taken from buccal area behind lip commissure. To form the flap, the first incision is made on the maxillary transition fold area behind lip commissure. The incision is continued downwards over the cheek 2-3 mm far from the commissure towards mandibular transition fold. The second incision is done in maxillary transition fold area 1 cm distal from the previous one. The incision is continued downwards over the cheek and connected to the first incision end. Mucosubmucous flap is detached beginning from the lower end. The formed flap width in the central region is to be equal to 1 cm. The flap is turned on the feeding pedicle at an angle of 90°, laid over the wound surface on vestibular side of maxillary alveolar process and fixed with sutures on mucous membrane edge. Another version of the method involves making incision along mucogingival boundary of the mandible down to periosteum. The mucous membrane is detached in transition fold area. It is moved towards deeper oral cavity atrium fornix and sutured to periosteum. Wound surface is covered with bound flap taken from buccal area behind lip commissure. To form the flap, the first incision is made on the maxillary transition fold area along projection immediately behind lip commissure. The incision is continued downwards over the cheek towards mandibular transition fold. The second incision is done in maxillary transition fold area from the beginning of the first incision. The incision is continued downwards over the cheek towards mandibular transition fold. Mucosubmucous flap is detached beginning from the upper end. The formed flap width in the central region is to be equal to 1 cm. The flap is turned on the feeding pedicle at an angle of 90°, laid over the wound surface on vestibular side of mandibular alveolar process and fixed with sutures on mucous membrane edge.

EFFECT: improved esthetic and functional results.

2 cl

Description

The method relates to medicine, in particular to maxillofacial surgery, and may be applicable 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 purpose of the invention is to achieve optimal functional and aesthetic results in plastic surgery of the vestibule of the oral cavity in the anterior region.

To achieve this, with plastic surgery of the vestibule of the oral cavity in the anterior region, according to the invention, it is proposed for the first time to use a non-free flap from the cheek area behind the lip commissure.

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

The method of plastics vestibule in the anterior is as follows.

For plasty of the vestibule in the anterior maxilla, an incision is made along the mucous-gingival border of the maxilla 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 in the area of the transitional fold of the upper jaw projected beyond the commissure. The incision is continued down the cheek, departing 2-3 mm from the commissure, to the transitional fold of the lower jaw. The second incision is made on the transition junction of the upper jaw, 1 cm distal from the previous one. Then, the incision is continued down the cheek and connected to the end of the first incision. 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 plastics of the vestibule in the anterior lower jaw, an 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 made on the site of the transitional folds of the upper jaw projected immediately after the commissure of the lip. The incision is continued down the cheek to the transitional fold of the lower jaw. The second incision is made in the area of the transitional fold of the upper jaw from the beginning of the first cut, continuing along the cheek to the transitional fold of the lower jaw, 1 cm distal from the previous one. 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.

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

Patient Yu., 9 years old. Diagnosis: small vestibule of the mouth, high attachment of the frenum of the lower lip, atrophic gingivitis. Plastic surgery of the vestibule of the oral cavity was performed according to the specified method, with the closure of the wound surface with a non-free flap from the cheek area behind the commissure of the lip, according to the specified method. Examined after 6 months. There are no complaints, the functional and aesthetic result is good, the graft engraftment.

Patient T., 10 years old. Diagnosis: small vestibule of the oral cavity, atrophic gingivitis. Plastic surgery of the vestibule of the oral cavity was performed according to the claimed method, an incision along the mucous-gingival border of the upper jaw, separation and movement of the mucous membrane into the region of the deeper arch of the vestibule of the oral cavity, closing the wound surface with a non-free flap from the cheek area behind the lip commissure. Viewed after 8 months. Functional and aesthetic results are good.

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 plastic surgery of the vestibule of the oral cavity in the anterior section, including an incision along the mucous-gingival border of the upper jaw to the periosteum, separation of the mucous membrane in the transitional fold area with its movement to the area of 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 closed with a non-free flap from the cheek area behind the commissure of the lip, for the formation of the flap, the first incision is made at the transition junction of the upper jaw about the projection beyond the commissure of the lip, continue the incision down the cheek, 2-3 mm from the commissure, to the transitional fold of the lower jaw, make a second incision in the transitional fold of the upper jaw distal to the previous one 1 cm, continue the incision along the cheek down and connect to the end of the first incision, the mucous-submucosal flap is separated, starting from the lower end, while the width of the formed flap in the central section should be 1 cm, then the flap on the supply leg is rotated at an angle of 90 °, placed on the wound surface of the vestibules molecular weight side alveolar ridge of the upper jaw and fixed seams to mucous edges. 2. A method for plastic surgery of the vestibule of the oral cavity in the anterior section, including an incision along the mucosal-gingival border of the lower jaw to the periosteum, separating the mucous membrane in the transitional fold with moving it to the area of 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 cheek area behind the commissure of the lip, for the formation of the flap, the first incision is made at the transitional fold of the upper jaw along projections immediately after the commissure of the lip, continue to cut down the cheek to the transitional fold of the lower jaw, make a second cut on the transitional fold of the upper jaw from the beginning of the first cut, continue the cut along the cheek to the transitional fold of the lower jaw, starting from the upper end, separate the mucous-submucosa a flap, while 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 part mandibular joints and fixed to the edges of the mucosa.