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Clasp retained devices for drainage of marsupialized cysts
TECHNICAL NOTES J Oral Maxillofac 40.759-761,
Surg
1962
Clasp Retained Devices for Drainage of Marsupialized Cysts W. 0. RAMSEY,
DDS,* R. F. DENEGRI,
DDS,t
AND W. F. KING, AA, CDT*
3. Identification upon the cast of the planned site of fenestration and simulation of the diameter, depth, and angulation of the drainage tube desired (Fig. 1). The projected path of insertion of the drainage tube must be approximately parallel to the vertical axis of the intended abutment. Impingement of the tube against tooth roots must be avoided. 4. Preparation on the stone cast of a template of autopolymerizing resin, which will facilitate location of the planned site of incision at the time of surgery. The template should be adapted over the facial surfaces and buccal cusp tips of two or more teeth, and it should cover the area of mucosa surrounding the proposed site of fenestration, leaving an opening over the point of penetration (Fig. 2). 5. Completion of the technical laboratory services-cast duplication, waxing, casting, and finishing of the appliance (Fig. 3). Reproduction of the fenestration simulated on the cast may be facilitated by inserting a section of semirigid polyethylene or polypropylene rod or tubing of appropriate diameter into the cast orifice prior to duplication (Fig. 1). The insert is withdrawn from the cast by the duplicating material and serves as a casting pattern when embedded within the refractory cast. Alternatively, simulation of penetration may be performed entirely upon the refractory cast, in which case the stone master cast must be sectioned or the opening enlarged in order to fit and adjust the finished appliance. When the planned fenestration is 3 mm or less in diameter, the insert into the cyst should be designed as a solid rod. Openings of greater diameter permit the use of tubular inserts. Tubes should be supplied with a crossbar within the lumen so that the patient may temporarily occlude the lumen with a cotton pellet prior to eating. Figures 5 and 6 illustrate the clinical use of the cast apparatus. Clasp design will vary to accommodate the dentition; however, it is essential that clasp units provide positive retention. Type I (Akers) clasps and embrasure or crib clasp designs have proven effective. Bar clasps (Roach) are of particular value, since they frequently permit retentive clasp tips to engage infrabulge areas on both mesial and distal aspects of
A cast appliance is suggested for maintaining patency of the fenestration when marsupialization of an intraosseous cyst is performed. The appliance consists of a clasp, a connector, and an insert, formed as a one-piece casting of chromium alloy and attached to a tooth or teeth adjacent to the surgical site. The device may be fabricated before or after surgery; however, construction before surgery is preferable. Characteristics A one-piece cast appliance has several advantages over the more conventional metal “collar button,“l plastic tube,2 tooth-ligated acrylic resin insert,3 tampon, or gauze wick. Among these advantages are (1) positive retention, stability, and comfort; (2) minimum irritation of the wound margins; (3) positive maintenance of the orifice diameter; (4) no irritation of the periodontal attachment of the ligated tooth; (5) use of a non-porous material; (6) ease of removal for cleaning and irrigation; (7) ease of adjustment of insert to accommodate bone regeneration; and (8) radiopacity of the appliance. A patient may swallow or aspirate a small dental appliance; therefore, particular attention must be devoted to clasp design to assure maximum retention and an uncomplicated path of insertion. Awkward or poorly coordinated patients should be treated by other modalities. The following prosthodontic procedures are necessary prior to surgical intervention: 1. Modification of a tooth or teeth adjacent to the planned site of intervention to permit secure retention of a single clasp unit. 2. Construction of a dental stone cast from an elastic material impression of the arch or quadrant involved. * Professor. Department of Removable Prosthodontics; ASsistant Dean for Advanced Specialty Education Programs, University of Maryland, School of Dentistry. t Lieutenant. Peruvian Navy; Clinical Instructor, Dental School. University of San Marcos, Lima, Peru. $ Associate, Department of Removable Prosthodontics, University of Maryland, School of Dentistry. Address correspondence and reprint requests to Dr. Ramsey: 666 West Baltimore Street, Baltimore, MD 21201.
027&2391/82/l 10010759$00.60 @ American Association
759
of Oral and Maxillofacial Surgeons
760
DEVICES FOR CYST DRAINAGE
should be used to maintain patency of the cyst orifice. T-shaped tubing connectors readily serve this purpose (Fig. 4). Autoclavable polypropylene connectors (Nalgene)* are available from chemical and medical supply houses in six diameters ranging from 3.2 to 13 mm (OD). A T-connector is of particular value as a temporary drainage tube when an incision involves movable vestibular tissue. A temporary drainage tube should be approximately 2 mm greater in diameter than the planned casting to accommodate healing and shrinkage of the prepared orifice during the period of appliance construction. Temporary T-tubes should be retained by sutures.
FIGURE 3. Below, A clasp-retained device for drainage of a cyst of the anterior body of the mandible is shown upon a stone cast of the dental arch.
an axial plane. Regardless of the type of retentive clasp arm used, other clasp components must provide positive reciprocal or bracing action. When it is impractical to construct a drainage 1 . . . . c . . . . tune prior to aeroonng a cyst, a temporary msert
FIGURE 4. Above, Commercially available T-shaped tubing connectors provide a convenient, temporary means of maintaining patency of a cyst orifice when postsurgery construction of a drainage device is indicated. FIGURE 5. Center, Postoperative radiograph of a patient showing relations1 lip of the drainage device to the abutment tooth and ‘1.0 rri=t lllr _J DI. J aero FIGURE o. n ’ M’. Area shown in Figure 5. one week postoperatively. Noticc : the well-circumscribed orifice established by the drainage device.
761
RAMSEY ET AL
Summary A clasp-retained drainage tube is suggested as a means of maintaining patency of a cyst orifice when long-term drainage is anticipated after marsupialization. Also, commercially available T-shaped tubing connectors are suggested as temporary drainage devices.
J Oral Maxillofac 40.761.
References 1. Thomas E: Saving involved vital teeth by tube drainage. J Oral Surg 5:1, 1947 2. Patterson SS: Endodontic therapy: Use of a polyethylene tube and stent for drainage. J Am Dent Assoc 69:71 I, 1964 3. Kruger GO (Ed): Textbook of Oral Surgery, 2nd ed. St Louis. CV Mosby Co, 1964. p 286
Surg
1982
Combination Retractor and Suction Tube for Use in Obtaining Iliac Bone PIETER N. S. BOSHOFF,
BCHD,* AND JAN G. DUVENAGE,
Obtaining cortical bone from the ilium while other surgeons prepare a bed for the autogenous transplant causes crowding for the whole surgical team. Moreover, adequate tissue retraction and suctioning of the field for optimum visibility when resecting either the inner or the outer iliac cortex is a problem, especially in the depths of the surgical site. An inexpensive retractor has been designed to deal with such problems.
H DIPDENT, M CHDt
noisy, as it tended to suck in and vibrate the adjacent tissues. Because the suction tube is attached to the retractor, one person can retract and evacuate the operative field, thus eliminating the need for an additional assistant. The serrated edge and weight of the retractor allow the surgeon to leave it in position while selecting new instruments and return to a clear, evacuated operative field.
Description The retractor consists of a 24 cm X 3 cm X 0.3 cm stainless steel plate, which is bent at a 130” angle 6 cm from its tip (Fig. 1). The tip of the retractor has a shallow transverse groove, the outer edge of which is sharply serrated for grip on the cortical surface of the ilium. A stainless steel tube, 0.4 cm in diameter, is welded to the undersurface of the retractor. This tube opens into the center of the transverse groove. The free portion of the tube is bent slightly away from the handle and is flared at the tip to allow attachment of the rubber suction pipe (Fig. 2). Discussion A broad, heavy instrument of this type facilitates easy retraction of the gluteus muscles and convenient access to the outer iliac cortex. The centrally placed suction hole is efficient and relatively silent. In previous prototypes the suction tube and hole were placed on the side of the retractor, but this was * Resident. t Head, Maxilla-facial and Oral Surgery Department, Dental Faculty, University of Pretoria. Address correspondence and reprint requests to Dr. Boshoff: P.O. Box 1266, Pretoria, Republic of South Africa.
FIGURE 1. Ahorv. Views of retractor showing position and angle of the bend. FIGURE 2. B&W. View of retractor showing location of the suction tube.
0278-2391/82/l 100/0761 $00.20 @ American Association
of Oral and Maxillofacial Surgeons
Surg
1962
Clasp Retained Devices for Drainage of Marsupialized Cysts W. 0. RAMSEY,
DDS,* R. F. DENEGRI,
DDS,t
AND W. F. KING, AA, CDT*
3. Identification upon the cast of the planned site of fenestration and simulation of the diameter, depth, and angulation of the drainage tube desired (Fig. 1). The projected path of insertion of the drainage tube must be approximately parallel to the vertical axis of the intended abutment. Impingement of the tube against tooth roots must be avoided. 4. Preparation on the stone cast of a template of autopolymerizing resin, which will facilitate location of the planned site of incision at the time of surgery. The template should be adapted over the facial surfaces and buccal cusp tips of two or more teeth, and it should cover the area of mucosa surrounding the proposed site of fenestration, leaving an opening over the point of penetration (Fig. 2). 5. Completion of the technical laboratory services-cast duplication, waxing, casting, and finishing of the appliance (Fig. 3). Reproduction of the fenestration simulated on the cast may be facilitated by inserting a section of semirigid polyethylene or polypropylene rod or tubing of appropriate diameter into the cast orifice prior to duplication (Fig. 1). The insert is withdrawn from the cast by the duplicating material and serves as a casting pattern when embedded within the refractory cast. Alternatively, simulation of penetration may be performed entirely upon the refractory cast, in which case the stone master cast must be sectioned or the opening enlarged in order to fit and adjust the finished appliance. When the planned fenestration is 3 mm or less in diameter, the insert into the cyst should be designed as a solid rod. Openings of greater diameter permit the use of tubular inserts. Tubes should be supplied with a crossbar within the lumen so that the patient may temporarily occlude the lumen with a cotton pellet prior to eating. Figures 5 and 6 illustrate the clinical use of the cast apparatus. Clasp design will vary to accommodate the dentition; however, it is essential that clasp units provide positive retention. Type I (Akers) clasps and embrasure or crib clasp designs have proven effective. Bar clasps (Roach) are of particular value, since they frequently permit retentive clasp tips to engage infrabulge areas on both mesial and distal aspects of
A cast appliance is suggested for maintaining patency of the fenestration when marsupialization of an intraosseous cyst is performed. The appliance consists of a clasp, a connector, and an insert, formed as a one-piece casting of chromium alloy and attached to a tooth or teeth adjacent to the surgical site. The device may be fabricated before or after surgery; however, construction before surgery is preferable. Characteristics A one-piece cast appliance has several advantages over the more conventional metal “collar button,“l plastic tube,2 tooth-ligated acrylic resin insert,3 tampon, or gauze wick. Among these advantages are (1) positive retention, stability, and comfort; (2) minimum irritation of the wound margins; (3) positive maintenance of the orifice diameter; (4) no irritation of the periodontal attachment of the ligated tooth; (5) use of a non-porous material; (6) ease of removal for cleaning and irrigation; (7) ease of adjustment of insert to accommodate bone regeneration; and (8) radiopacity of the appliance. A patient may swallow or aspirate a small dental appliance; therefore, particular attention must be devoted to clasp design to assure maximum retention and an uncomplicated path of insertion. Awkward or poorly coordinated patients should be treated by other modalities. The following prosthodontic procedures are necessary prior to surgical intervention: 1. Modification of a tooth or teeth adjacent to the planned site of intervention to permit secure retention of a single clasp unit. 2. Construction of a dental stone cast from an elastic material impression of the arch or quadrant involved. * Professor. Department of Removable Prosthodontics; ASsistant Dean for Advanced Specialty Education Programs, University of Maryland, School of Dentistry. t Lieutenant. Peruvian Navy; Clinical Instructor, Dental School. University of San Marcos, Lima, Peru. $ Associate, Department of Removable Prosthodontics, University of Maryland, School of Dentistry. Address correspondence and reprint requests to Dr. Ramsey: 666 West Baltimore Street, Baltimore, MD 21201.
027&2391/82/l 10010759$00.60 @ American Association
759
of Oral and Maxillofacial Surgeons
760
DEVICES FOR CYST DRAINAGE
should be used to maintain patency of the cyst orifice. T-shaped tubing connectors readily serve this purpose (Fig. 4). Autoclavable polypropylene connectors (Nalgene)* are available from chemical and medical supply houses in six diameters ranging from 3.2 to 13 mm (OD). A T-connector is of particular value as a temporary drainage tube when an incision involves movable vestibular tissue. A temporary drainage tube should be approximately 2 mm greater in diameter than the planned casting to accommodate healing and shrinkage of the prepared orifice during the period of appliance construction. Temporary T-tubes should be retained by sutures.
FIGURE 3. Below, A clasp-retained device for drainage of a cyst of the anterior body of the mandible is shown upon a stone cast of the dental arch.
an axial plane. Regardless of the type of retentive clasp arm used, other clasp components must provide positive reciprocal or bracing action. When it is impractical to construct a drainage 1 . . . . c . . . . tune prior to aeroonng a cyst, a temporary msert
FIGURE 4. Above, Commercially available T-shaped tubing connectors provide a convenient, temporary means of maintaining patency of a cyst orifice when postsurgery construction of a drainage device is indicated. FIGURE 5. Center, Postoperative radiograph of a patient showing relations1 lip of the drainage device to the abutment tooth and ‘1.0 rri=t lllr _J DI. J aero FIGURE o. n ’ M’. Area shown in Figure 5. one week postoperatively. Noticc : the well-circumscribed orifice established by the drainage device.
761
RAMSEY ET AL
Summary A clasp-retained drainage tube is suggested as a means of maintaining patency of a cyst orifice when long-term drainage is anticipated after marsupialization. Also, commercially available T-shaped tubing connectors are suggested as temporary drainage devices.
J Oral Maxillofac 40.761.
References 1. Thomas E: Saving involved vital teeth by tube drainage. J Oral Surg 5:1, 1947 2. Patterson SS: Endodontic therapy: Use of a polyethylene tube and stent for drainage. J Am Dent Assoc 69:71 I, 1964 3. Kruger GO (Ed): Textbook of Oral Surgery, 2nd ed. St Louis. CV Mosby Co, 1964. p 286
Surg
1982
Combination Retractor and Suction Tube for Use in Obtaining Iliac Bone PIETER N. S. BOSHOFF,
BCHD,* AND JAN G. DUVENAGE,
Obtaining cortical bone from the ilium while other surgeons prepare a bed for the autogenous transplant causes crowding for the whole surgical team. Moreover, adequate tissue retraction and suctioning of the field for optimum visibility when resecting either the inner or the outer iliac cortex is a problem, especially in the depths of the surgical site. An inexpensive retractor has been designed to deal with such problems.
H DIPDENT, M CHDt
noisy, as it tended to suck in and vibrate the adjacent tissues. Because the suction tube is attached to the retractor, one person can retract and evacuate the operative field, thus eliminating the need for an additional assistant. The serrated edge and weight of the retractor allow the surgeon to leave it in position while selecting new instruments and return to a clear, evacuated operative field.
Description The retractor consists of a 24 cm X 3 cm X 0.3 cm stainless steel plate, which is bent at a 130” angle 6 cm from its tip (Fig. 1). The tip of the retractor has a shallow transverse groove, the outer edge of which is sharply serrated for grip on the cortical surface of the ilium. A stainless steel tube, 0.4 cm in diameter, is welded to the undersurface of the retractor. This tube opens into the center of the transverse groove. The free portion of the tube is bent slightly away from the handle and is flared at the tip to allow attachment of the rubber suction pipe (Fig. 2). Discussion A broad, heavy instrument of this type facilitates easy retraction of the gluteus muscles and convenient access to the outer iliac cortex. The centrally placed suction hole is efficient and relatively silent. In previous prototypes the suction tube and hole were placed on the side of the retractor, but this was * Resident. t Head, Maxilla-facial and Oral Surgery Department, Dental Faculty, University of Pretoria. Address correspondence and reprint requests to Dr. Boshoff: P.O. Box 1266, Pretoria, Republic of South Africa.
FIGURE 1. Ahorv. Views of retractor showing position and angle of the bend. FIGURE 2. B&W. View of retractor showing location of the suction tube.
0278-2391/82/l 100/0761 $00.20 @ American Association
of Oral and Maxillofacial Surgeons