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4 DISADVANTAGES OF BUCCAL FLAPS Buccal flaps are successfully used but as in any technique it will have its disadvantages
1. Unstable due to cheek movement 2. Possible harm to the parotid papilla 3. The flap is thin and may be poorly vascularized 4. Tendency to obliterate mucobuccal fold
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flap that provides a thick stable mucosa and is richly nourished by the greater palatine nerve
palatal pedicle flap
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what do you call the lining of maxillary sinus?
Sinus Cavity Proper
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Displacement Of Tooth Or Root Into The Maxillary Sinus Lining Or The Sinus Cavity Proper
• It is basically a mishap incident results from a neglected act by the operator while applying wrong force. • Occurs with poor surgical technique • Occurs rarely but the 3rd molar and 2nd premolar are the most at risk of dislodgment • May occur during forceful mouth opening of unconscious patient when using mouth gag of periodontally involved teeth. • May occur with severe maxillofacial injures
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2 Immediate Management/Investigations
1. Confirm the existence of oro-antral fistula and the presence of tooth or root in sinus 2. Locate the precise position of the foreign body within the sinus lining
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• Intraoral approach via lateral access to the maxillary sinus • A trapezoidal flap design is performed in this approach in order to expose the lateral wall of the maxillary sinus
Caldwell-Luc Approach
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4 Post Operative Instructions:
1. Pressure pack on the area for 1-2 hours 2. Advise patient to avoid nose blowing, sucking and smoking 3. Antibiotic Therapy for 7- 10 days 4. Nasal Decongestants for 7- 10 days
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4 reasons why success of operation is not always guaranteed
1. Presence of infection 2. Patients General Physical Condition 3. Inadequate tissue relief resulting in suture tension 4. Failure to freshen wound edge
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9 Sign and Symptoms to Recognize Malignant Disease Of The Maxillary Sinus
1. Non-inflammatory swelling of cheek 2. Pain of non-dental origin 3. Severe tooth mobility 4. Epistaxis and gingival bleeding 5. Narrowing of the palpebral fissure 6. Depression of the corner of the mouth 7. Intra-oral swelling obliterated the sulcus 8. Proptosis and facial paresthesia and numbness 9. Radiographical evidence of invasive tumor
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2 teeth commonly in danger of being dislodged into the sinus
2nd premolar 3rd molar
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where can you find the ostium maxillare sinus?
between nasal cavity and maxillary sinus
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method done to liquify the secretions
steam inhalation
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structure included when designing palatal pedicle flap
thick stable mucosa/greater palatine nerve
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Superior boundary of maxillary sinus
Orbital floor
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Medial boundary of maxillary sinus
Lateral nasal wall fossa
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Anterior boundary of maxillary sinus
Canine Fossa
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Inferior boundary of maxillary sinus
Alveolar process
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Lateral boundary of maxillary sinus
Faciall wall of Maxilla
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Extraction To Teeth That Are Close To The Maxillary Sinus May Result In: (2)
• Perforation of the floor of the sinus • Accidental dislodgement of part or whole tooth
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5 SURGICAL MANAGEMENT OF ORO-ANTRAL FISTULA
1. Elimination of disease and pathologic tissue 2. Flap should have good blood supply. 3. Flap tissue must be handled gently. 4. Flap should lie in its new position without tension. 5. Good haemostasis must be achieved before discharging the patients