Method for vestibuloplasty

FIELD: medicine, surgical stomatology.

SUBSTANCE: one should make vertical mucosal incision in area of labial frenum and other mucosal incisions which should be fulfilled vertically, as well. The innovation enables to decrease traumatism and risk in development of cicatricial deformations.

EFFECT: higher efficiency.

7 dwg, 1 ex

 

The invention relates to medicine, namely to dental surgery.

Vestibulopathies operation is shown in the small vestibule of the oral cavity, which can be observed in the following pathological processes: periodontal diseases, malocclusion, deformities, after osteoplastic operations on the background of cicatricial deformities of the vestibule, etc.

There is a method of vestibuloplasty, according to which the incision of the mucous membrane of the oral cavity is within the lips, some distance from the alveolar ridge of 1.0-1.5 cm in the front-tooth region and 0.5-0.8 cm in the area of premolars. The mucous membrane is peeled from the submucosal tissue to the gingival part of the alveolar ridge. Acute dissected by soft tissue, connective tissue fibers, muscles parallel to and near the periosteum to the required depth for the entire length of the incision (10-12 mm in the front-tooth region and 7-9 mm in the area of premolars). The free edge of the debonded flap of mucous membrane immersed in the depth created vestibule and is stitched to the periosteum tension of the flap. The wound surface on the lower lip cover protective bandage (A.E. Stepanov "the Surgical treatment of periodontal diseases". - M., 1991. - P.61-64).

The disadvantages of this method include the presence of the wound defect, R is d 10-13 cm 2the possibility of damage to the branches of the mental nerve in the area of mental openings of the lower jaw, the preservation of the pain syndrome of moderate intensity in the first 3 days after surgery, the onset of epithelialization of donor wounds on 14-20 days after surgery depending on the size of the defect.

Closest to the proposed method is a method of vestibuloplasty, which spend a vertical incision along the frenectomy on its entire length (from its fixation on the attached gingiva and to commit to the lip of approximately 20-25 mm). In the area of premolars spend a horizontal incision along the transition lines with a length of about 20 mm

Stupidly prepare the chin mucosa from the submucosa tissue along the periosteum along the entire length of the operated area, without damaging the integrity of the mucosa. Spend exfoliation of the submucosal tissue along the periosteum at the planned depth without compromising the integrity of the mucosa. Visually and instrumentally determined the absence of muscle fibers and cords attached to the periosteum. Debonded mucous patches fixed to the periosteum at the depth of 10-12 mm Vertical incision is sutured to itself, also fixing to the periosteum at the specified depth. The mucous membrane in the horizontal cuts from the free gingival hem the periosteum at a distance of 5-8 mm from the cutting position. The remaining wound areas impose a protective bandage (grudanov A.I., Erokhin A.I. "How vestibuloplasty", EN 2162663 C1, 10.02.2001, bull. # 4 - prototype).

The disadvantages of this method is the presence of two traumatic defects of the mucous membrane of 0.5-1.0 cm2the possibility of trauma branches of the mental nerve in the area of mental openings on the lower jaw, the duration of the pain syndrome is observed for 0.5-1 hour after the operation, the epithelialization of donor RAS occurs on day 5-7.

When performing vestibuloplasty the proposed method there is no formation of wound surfaces. This causes a decrease in the morbidity of the operation, the reduction of pain syndrome in the postoperative period (not more than 0.5 days after surgery), a significant reduction in the risk of damage to the mental nerve, reducing the risk of postoperative cicatricial deformities. When performing vestibuloplasty the proposed method has the ability to deepen the vestibule of the oral cavity throughout the jaw.

The essence of the proposed method of vestibuloplasty is that all sections of the mucous produce vertically (such orientation of the incisions leads to lack of education of wound surfaces, namely in addition to the vertical mucosal incision in the region of the STI frenectomy (as in the prototype) also produce vertical sections of the mucous in the natural mucous strands, located mostly in the field of 14 and 13, 23 and 24 of the teeth and/or in the field 34 and 33, 43 and 44 teeth when vestibuloplasty upper and/or lower jaw, respectively.

Figure 1 shows a mouth with small threshold on the lower jaw before the operation (the dashed line (1) shows the depth of the vestibule before the operation). The method is as follows. On the mucous membrane of the vestibule of the oral cavity produce a vertical incision in the field frenectomy (2) and the natural mucous strands (3), located mostly in the areas 33 and 34, 43 and 44 teeth when vestibuloplasty lower jaw, see figure 1, 2 (and/or in areas 13 and 14, 23 and 24 teeth - at vestibuloplasty upper jaw). Through the incisions stupidly prepare the chin mucosa from the underlying tissues along the length of the operated area, without damaging the integrity of the mucosa. Then prepare the chin submucosal tissue along the periosteum at the planned depth. Visually and instrumentally determined the absence of muscle fibers and cords attached to the periosteum (figure 3). Debonded mucous membrane is fixed to the periosteum at the depth of 10-12 mm, vertical incisions are sutured, also locking the mucous to the periosteum at the specified depth (figure 4).

List of figures illustrative material:

Figure 1. The oral cavity with a small advance before the operation (schematic image is agenie). The dashed line (1) shows the depth of the vestibule (before surgery), (2) the frenulum of the lower lip, (3) - natural mucous strands.

Figure 2. Online access: (1) the depth of the vestibule (before surgery), (4) - cuts mucous.

Figure 3. State after peeling submucosal tissue to the periosteum at the planned depth of the vestibule (schematic): (1) the depth of the vestibule (quickly created).

Figure 4. Fixation of the mucosa to the periosteum and suturing of wounds after surgery (schematic): (1) the depth of the vestibule (quickly created).

Figure 5. The oral cavity of a patient with a small advance before the operation.

6. State after peeling submucosal tissue to the periosteum at the planned depth.

7. After fixing the mucosa to the periosteum and the suturing of wounds.

Example. Patient M., 23 years old, diagnosis: chronic generalized catarrhal gingivitis moderate severity, the small vestibule of the mouth.

After a course of anti-inflammatory therapy conducted vestibuloplasty on the lower jaw of the proposed method. In the photo (figure 5) shows the oral cavity of the patient with a small advance before the operation. Under infiltration anesthesia, incisions of the mucous membrane of the vestibule of the oral cavity in along the frenulum of the lower lip and mucous strands at all and the length between 33 and 34, 43 and 44 teeth. Stupidly debonded submucosal tissue along the periosteum at the planned depth of the vestibule, defined by the absence of fibers and muscle fibers (6). Mobilized the mucous membrane is bound to the periosteum at a depth of 12 mm resorbable suture material (Dexon), vertical incisions are sutured with fixation to the periosteum at the required depth (Fig.7).

The patient had pain within 8 hours after surgery, the next day after surgery revealed a slight swelling of the soft tissues of the lower lip. Sutures were removed on the 6th day after the operation.

How vestibuloplasty, including vertical incision of the mucous membrane in the area frenectomy and other sections of the mucous membrane, characterized in that the other sections of the mucosa also produce vertically.



 

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