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Defects and deformations of the mucosa of vestibules of the vestibule and the bottom of the oral cavity
Last reviewed: 23.04.2024
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Defects of the alveolar process with scar deformity of the mucous membrane of the vestibule of the mouth can arise as a result of gunshot wounds, oncology operations and inflammatory processes. They greatly impair the conditions of dental prosthetics. If the defect of the alveolar process is combined with the scars of the mucous membrane of the bottom of the oral cavity, it also causes cicatricial stiffness of the tongue, which leads to difficulty and distortion of speech, a violation of the act of eating.
After resection of the lower jaw followed by bone grafting, very unfavorable conditions for prosthetics arise.
A mandatory requirement for the manufacture of fully functional prostheses is surgical preparation of the oral cavity. In such cases, you have to surgically deepen the vestibule of the mouth and the bottom of the mouth, using a free skin transplant. For this purpose, a thin epi-dermal flap is used according to Yatsenko-Tirsch or, more appropriately, a split flap of Blair-Brown.
Vestibuloplasty by the method of LI Evdokimova
Cicatrical concretions of the mucous membrane dissect along the body of the jaw in the intraoral incision. The ends of this incision should go 1 cm anteriorly and posteriorly from the border of the scars. The incision is conducted so as not to dissect the periosteum of the jaw. The dissector expands the tissue to a depth of 1-1.5 cm, which almost corresponds to the height of the alveolar ridge. Abundant capillary bleeding is stopped with a tight tamponade gauze soaked in a solution of hydrogen peroxide.
Tightly tamped tampons are left for 10-15 minutes, during which a split transplant is taken on the abdomen or thigh; by the shape and size of the groove formed in the mouth, the iodoform gauze roll is folded onto which the split skin is applied to the epidermal side. Then the transplant is fixed on the roller along and across the thin polyamide thread (vein), the ends of which are tied with a triple knot.
The tampon is removed from the wound and a roller with a skin graft is inserted instead. The roller is pressed down to the bottom and sides of the wound deepening. Over the platen, several seams are laid with a polyamide fillet 0.2 mm in diameter, bringing the edges of the severed Scar tissue several times above it. The patient is given general and local rest.
After 10 days, the stitches are removed, the gauze roll is removed from the wound. By this time, the whole surface of the wound is already covered with a grayish-blue layer of epithelium. Immediately remove the impression reflecting the depth of the newly created "arch" or the deepened bottom of the mouth, and it produces a removable forming prosthesis, which should be worn for 2.5-3 months before the final formation of the contours created by the indentation. At the end of this period, the final removable denture is manufactured using the formed prosthetic field.
KA Orlova (1969), on the basis of transplantation of a thin skin graft (on a soft liner according to AI Evdokimov) into the oral cavity (456 patients) and into the nasal cavity (92 patients), it was engrafted in 96.8% of cases. At the same time, good anatomical and functional results of the operation were achieved.
As the results of observations for many years show, the skin tolerates a moist environment well, withstands the load of a removable denture, does not ulcerate and does not undergo maceration.
If, on the basis of the oncologic evidence, the bilateral operation of R.X. Banach is performed and, moreover, the mucosa of the bottom of the oral cavity and the lower surface of the tongue is removed, it is possible to replace the defect of the mucous membrane and the soft tissues of the bottom of the mouth with the help of the Filatov stalk: two tapes, with the help of the holders are inserted into the oral cavity and hemmed to the edges of the wound of the tongue and mucous membrane of the lower jaw. With the catgut sutures, the flattened part of the stem is connected to the skin of the submandibular triangles and the chin area, with the same purpose, three U-shaped seams are applied with a capron. As a result, a skin duplication is created from the skin of the stem and the upper part of the neck (more precisely - the submandibular and chin areas) - the newly formed bottom of the oral cavity (according to NA Shinbirev).
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