Defects and deformities of the mucous membrane of the vaults of the vestibule and floor of the oral cavity

Alveolar ridge defects with cicatricial deformation of the oral vestibule mucosa may occur as a result of gunshot wounds, oncological operations and inflammatory processes. They significantly worsen the conditions of dental prosthetics. If the alveolar ridge defect is combined with cicatricial deformation of the oral floor mucosa, this also causes cicatricial stiffness of the tongue, which leads to difficulty and distortion of speech, disruption of the act of eating.

After resection of the lower jaw with subsequent bone grafting, very unfavorable conditions for prosthetics arise.

A mandatory requirement for the production of functionally complete prostheses is surgical preparation of the oral cavity. In such cases, it is necessary to surgically deepen the vault of the oral vestibule and the floor of the oral cavity itself, using free skin grafting. For this purpose, a thin epidermal flap according to Yatsenko-Tirsch or, which is more acceptable, a split flap according to Blair-Brown is used.

Vestibuloplasty by the method of L. I. Evdokimova

The cicatricial contractions of the mucous membrane are dissected by an intraoral incision along the body of the jaw. The ends of this incision should extend 1 cm forward and backward from the border of the scars. The incision is made so as not to dissect the periosteum of the jaw. The tissues are moved apart to a depth of 1-1.5 cm with a raspatory, which almost corresponds to the height of the alveolar ridge. Excessive capillary bleeding is stopped with a tight tamponade of gauze soaked in a solution of hydrogen peroxide.

Tightly packed tampons are left for 10-15 minutes, during which a split graft is taken from the abdomen or thigh; an iodoform gauze roll is rolled up to the shape and size of the cavity formed in the mouth, onto which the split skin is applied with the epidermal side. Then the graft is fixed on the roll lengthwise and crosswise with a thin polyamide thread (vein), the ends of which are tied with a triple knot.

The tampon is removed from the wound and a roll with a skin graft is inserted in its place. The roll is pressed to the bottom and sides of the wound cavity. Several stitches with a 0.2 mm diameter polyamide line are applied over the roll, bringing the edges of the dissected scar tissues slightly closer together above it. The patient is prescribed general and local rest.

After 10 days, the stitches are removed and a gauze roll is removed from the wound. By this time, the entire surface of the wound is already covered with a grayish-blue layer of epithelium. An impression is immediately taken, reflecting the depth of the newly created "vault" or deepened floor of the vestibule of the oral cavity, and a removable forming prosthesis is made according to it, which should be worn for 2.5-3 months until the final formation of the contours of the created depression. After this period, the final removable dental prosthesis is made, using the formed prosthetic field.

K. A. Orlova (1969), based on thin skin graft transplants (on a soft liner according to A. I. Evdokimov) into the oral cavity (456 patients) and into the nasal cavity (92 patients), noted its engraftment in 96.8% of cases. In this case, good anatomical and functional results of the operation were achieved.

As the results of observations over many years show, the skin tolerates a humid environment well, withstands the load of a removable denture, does not ulcerate and is not subject to maceration.

If, for oncological indications, a bilateral R. H. Banach operation was performed and, in addition, the mucous membrane of the floor of the mouth and the lower surface of the tongue was removed, it is possible to replace the defect of the mucous membrane and underlying soft tissues of the floor of the mouth using a Filatov stem: its free end is spread out into two strips, introduced into the oral cavity using holders and sutured to the edges of the wound of the tongue and the mucous membrane of the lower jaw. The spread part of the stem is connected to the skin of the submandibular triangles and the chin area with catgut sutures; three U-shaped sutures with nylon are applied for the same purpose. As a result, a skin duplicate is created from the skin of the stem and the upper part of the neck (more precisely, the submandibular and chin areas) - a newly formed floor of the oral cavity (according to N. A. Shinbirev).

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