Maxiliary Tubersity Reduction

Maxiliary Tubersity Reduction

_-:::::::::””-‘FI” ~ntal or vertical excess (or both) of the maxillary tuberosity area may be a result of excess bone, an increase in the thickness of soft tissue overlying the bone, or both. A preoperative radiograph or selective probing with a local anesthetic needle are often useful to determine the extent to which bone and soft tissue contribute to this  exc ess and to locate the floor of the maxillary sinus. Recontouring of the maxillary tuberosity area may be necessary to remove bony ridge irregularities or to create adequate interarch space, which will allow proper construction
of prosthetic appliances in the posterior areas. Surgery can be accomplished using local anesthetic infiltration or posterosuperior alveolar and greater palatine blocks. Access to the tuberosity for bone removal is
accomplished by making a crestal incision that extends up the posterior aspect of the tuberosit y area. ‘The most posterior aspect of this incision is often best made with a no. 12 scalpel blade. Reflection of a full-thickness
mucopertosteal flap is completed in both the buccal and palatal directions to allow adequate access to the entire tuberosity area (Fig. 13-10). Bone can be removed using . either a side-cutting rongeur or rotary instruments, with care taken to avoid perforation of the floor of the maxillary sinus. If the maxillary sinus is inadvertently perforated, no specific treatment is required, provided that the .sinus membrane has not-been violated. After the appropriate amount of bone has been removed, the area should
be smoothed with a bone file and copiously irrigated with saline. The mucoperiosteal flaps can then be readapted. Excess, overlapping soft tissue resulting from the bone removal is excised in an elliptic fashion. A tension-free closure over this area is important, particularly if the floor  of the sinus has been perforated. Sutures should remain in place for approximately 7 days. Initial denture impresslonscan be completed approximately
4 weeks after surgery~ . In the event of a gross sinus perforation involving an . opening in the .sinus membrane, the use of postoperative antibiotics and sinus’ decongestants is recommended, Penicillin or a penidIlin derivative (amoxicillin with clavulanate) is usually the antibiotic of choice, unless contraindicated by allergy. Sinus -decongestants, such as pseudo phedrine with or without an antihistamine, are  adequate. Both the antibiotic and decongestant should be given for 7 to 10 days postoperatively. The patient is informed of the potential complications and cautioned against creating excessive sinus pressure, such as nose
blowing or sucking with a straw, for 10 to 14 days

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