Vestibule and Floor-of-Mouth Extension Procedures Medical Assignment Help

Vestibule and Floor-of-Mouth Extension Procedures

In addition to the attachment of labial muscles and soft tissues to the denture-bearing area, the mylohyoid and genioglossus muscles in the floor of the mouth present similar problems on the lingual aspect of the mandible. Trauner-” described detaching the mylohyoid muscles from the ‘mylohyoid ridge area and repositioning them inferiorly, effectively .deepentng the floor of the mouth, area and relieving theinfluence of the mylohyoid musde on the d enture. MacIntosh and Obwegeser-? later
described the effective use of a labial extension proce- • dure combined with <[rauner’s procedure to provide maximal vestibular extension to both the buccal and lingual aspects of the mandible. The technique for extension of the labial vestibule is a modification of a labially pedicled supraperiosteal flap described by Clark.v” After the two vestibular extension techniques, a skin graft can be used to cover the area of denuded periosteum – (rig. 13-39), The combination procedure effectively eliminates the dislodging forces of the mucosa and muscle attachments and provides a broad base of fixed keratinized tissue on the primary denture-bearing area (Fig, 13-40). Split-thickness skin grafting with the buccal

vestibuloplasty and floor-of-mouth procedure is indicated when adequate alveolar ridge for a denture;bearing area is lost but at least 15 rnm of mandibular bone height remains. The remaining bone must have adequate contour so that the form of the alveolar ridge exposed after the procedure is adequate for dentr- c construction. Endosteal implants are generally a much more suitable treatment and therefore vcstibuloplasty with skin grafting is not commonly performed. If gross bony irregularities exist, such as large concavities in the superior aspect of the posterior mandible, they should. be corrected through grafting or minor alveoloplasty procedures
before the soft tissue procedure. . The technique has the advantage of early covering of the exposed periosteal bed, which improves patient comfort
and allows earlier denture construction. In addition, the long-term results of ,;csHbular extension are predictable. The need for hospitalization and donor-site surgery combined with the moderate swelling and discernfort discernfort experienced by the patient postoperatively are the
primary disadvantages . Patients rarely complain about, the appearance or function of skin in the oral cavity. If the skin graft is too thick at the time of harvesting, hair  follicles may not totally degenerate, and hair growth may
occasionally be s een in isolated areas of the graft.Tissue other than skin has been used effectively for grafting over the alveolar ridge. Palatal tissue offers the potential advantages of providing a firm, resilient tissue. with minimal contraction of the grafted area.” Although palatal tissue is relatively easy to obtain at the time of surgery, the limited amount of tissue
and the discomfort associated ‘with donor-site harvesting are the primary drawbacks. In areas where mil)’ a smallloQlized graft is required, palatal tissue is usually adequate. Full-thickness buccal mucosa harvested from the’ inner aspect of the cheek provides advantages similar to those of palatal tissue. However. the need for specialized

FIG. 13-39 Labial vestibuloplasty, floor-of-mouth lowering procedure, and skin grafting (i.e., Obwegeser's technique). A, Preoperative muscle and soft tissue attachments near crest of rernaininq mandible. B, A crestal incision is made. Buccal and lingual flaps are created by a supraperiosteal dissection. C, Flaps are sutured near inferior border of mandible, with sutures passed under inferior border of mandible, tethering labial and lingual tissues near inferior border of mandible. D, Skin graft held in place with splint. E; Postoperative view of newly created vestibular depth and floor-of-mouth area

FIG. 13-39 Labial vestibuloplasty, floor-of-mouth lowering procedure, and skin grafting (i.e.,
Obwegeser’s technique). A, Preoperative muscle and soft tissue attachments near crest of rernaininq
mandible. B, A crestal incision is made. Buccal and lingual flaps are created by a supraperiosteal dissection.
C, Flaps are sutured near inferior border of mandible, with sutures passed under inferior border
of mandible, tethering labial and lingual tissues near inferior border of mandible. D, Skin graft held
in place with splint. E; Postoperative view of newly created vestibular depth and floor-of-mouth area

mucotornes to harvest huccal mucosa and extensive buccal  mucosa carring after harvesting LJf a full-thickness graft are disadvantages. This mucosa does not become kera tinized, is generally mobile, and often results in an inadequate denture-bearing surface,

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