SURGERICAL MANAGEMENT OF BENEFITLESIONS IN ORL SOFT TISSUSE
Superficial soft tissue lesions of the oral mucosa arc Usually benign and in niost instances lend themselves tu simple surgical removal using biopsy techniques (see Chapter 21), They include fibromas, pyogenic granulomas.
papillomas, peripheral giant cell granulomas, verruca vulgaris; rnucocclcs (i.e .. mucous extravasation phenomena), and epulis Iissuratum, All of these lesions are overgrowths (If the normally present histologic clements i.11the oral “Iucosa and submucosa. The principles of rem ova I are
,’t’ same as those outlined previously and include the use , elliptic, wedge type of incisions during removal. In the of lesions that appear associated with the dentition I i.e., pyogenic granuloma), the associated tooth or teeth should be thoroughly curetted and polished to remove . plaque, calculus, or foreign material that may have played a role in the lesion’s development and that may cause a recurrence if not removed.
When the patient has lost a portion of the maxilla, the maxillary sinuses or nasal cavity may be continuous with the oral cavity, which presents great difficulties for the patient in speaking and eating. Defects of the maxilla can
be managed in one of two ways: The first is with surgery. Defects that are not excessive may be closed with available soft tissues of the buccal mucosa and palate. Bone grafts may also be used to provide the patient with a’ functional alveolar process. Very large defects or defects
in patients who are poor surgical risks may, require prosthetic obliteration in which a partial- or complete denture extends into the maxillary sinus or nasal cavities and effectively partitions the mouth from these structures
Several urgcom’ also delay reconstruction of defects caused by removal of benign tumors.The surgerical of the presence of a simultaneous intraoral and cxtraoral defect, which frequently is necessary to remove the
tumor, cont raindicates all immediate reconstruction of the mandible. Instead, a -pacc-mnintaimng device is placu at till time of resection, and a secondary recon-tnu ton h prortected weeks to months later.
When delayed reconstruction is decided upon. consld cration should be given to ‘maintaining the rcxidua: mandibular tragments ill their normal anatomic relationship with intermaxillary fixation, external pin lixat ion
splints, internal fixation, or a combination of these modalities. This technique prevents cicatricial and muscular eformation and displacement of the segments and simplifies secondary reconstructive efforts.
Clinical results have shown that immediate reconstruction is a viable option and has the advantages of requiring a single surgical procedure and having an early return to function with a minimal compromise to facial
esthetics.” A possible disadvantage is loss of the graftfrom infection. The risk of infection may be higher when a graft is placed transorally or in an extraoral wound that was orally contaminated during the extirpative surgery. Because· the recurrence rate is substantial in some. tumors, prudent planning and meticulous surgery are mandi\tory before reconstruction is attempted. These measures minimize the risk of failure as a result of recurrence. Three choices for immediate reconstruction are
1. The entire surgical procedure is performed intraorally by first removing the. tumor and then grafting the defect.
2. The tumor is removed by a combined intraoral and extraoral route. A watertight oral closure is obtained, which is followed Immediately by grafting the defect through the extraoral incision.
3..When the tumor has not destroyed the alveolar crestal bone and when no extension of the tumor into oral soft tissues has occurred, the involved
teeth are extracted. A wait ng period of 6 to Rweeks is allowed for healing of the gingival tissues. “J he tumor is then removed and the defect grafted
through an exrraoral inci ion, with care taken to avoid perforation of the oral soft tissues. This procedure is the only type of immediate reconstruction with which oral contamination can be avoided.