Many oral and maxillofacial surgical procedures necessitate incisions. A few basic principles are important to remember when performing incisions.
The first principle is that a sharp blade of the proper size should be used. A sharp blade allows incisions to be made cleanly, without unnecessary damage caused by repeated strokes. The rate at which a blade dulls depends on the resistance of tissues through which the blade cuts. Bone and Iigamental tissues dull blades more rapidly than does buccal mucosa. Therefore the surgeon should change blades whenever the knife does not seem to be
The second principle is that a firm, continuous stroke should be used when incising.Repeated, tentative strokes increase both the amount of damaged tissue within a wound and the amount of bleeding, there by impairing wound healing. Long, continuous strokes ‘are preferred to short, interrupted ones (Fig. 3-1, A).
The third principle is that the surgeon should carefully avoid cutting vital structures when incising. No patient’s microanatomy is ‘exactly the same. Therefore to avoid unintentionally ‘cutting large vessels or nerves, the surgeon must incise only deeplyenough ta define the next layer. Vessels can be more easily controlled before they are completely divided, and important nerves can usually be freed from adjacent tissue and retracted away from the area to be incised. In addition, when using a scalpel the
surgeon’s focus must remain on the blade to avoid accidentally
cutting structures such as the lips when introducing and removing·the blade to and from the mouth.
The fourth principle is that incisions through epithelial surfaces that the surgeon plans to reapproximate should be made with the blade held perpendicular to the epithelial surface. This angle produces squared wound
edges that are both easier to reoriertt properly during suturing and less susceptible ta necrosis of the wound edges as a result of ischemia (Fig. 3-1, B).
The fifth principle is that incisions in the oral cavity should be properly placed. It is more desirable to incise through attached gingiva and over healthy bone than through unattached gingiva and over unhealthy or missing bone. Properly placed incisions allow the woun margins to be sutured over intact, healthy bane that is a e a few millimeters away from the damaged bone, providing support for the healing wound. In placed near the teeth for extractions should be m in the gingival sulcus, unless the clinician feels it is necessary to, excise the marginal gingiva or to leave arginal gingiva untouched.