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Minimal incision third molar impaction surgery
026C
Miscellaneous
57
026C - Miscellaneous 2. Tooth Autotransplant Study 1. Minimal Incision Third Molar Impaction Surgery
Hernandez, M., Valencia, E., Pillard, A., Lopez, C., Landaetta, L.
Donlon, W., Triuta, M. Facultad de Odontolgia, Universidad de Valparaiso, Chile Peninsula Maxillofacial Surgery, Burlingame, California A technique was developed to minimize mucoperiosteal incisions and flap elevation for removal of partial and complete bony impacted third molar teeth. In a non-blinded clinical study, this approach was compared to standard incisionsI and flap handling described in oral surgery textbooks2 using one side for the experimental technique and the antimere for the "textbook" approach. Later, the minimal incision surgery was used exclusively and evaluated in a retrospective clinical manner. In the mandible, the technique consists of a full thickness incision with a #15 blade from the mid-portion of the retromolar trigone beginning at the second molar and angling posteriorly 45 ~ toward the external oblique ridge for a distance 8 to 10 ram. Periosteal elevation is done only lateral to the coronal area over the ridge to the buccal cortex. The maxillary incision begins at the midpoint of the tuberosity just anterior to the hamular notch and continues anterolaterolaterally in a straight line to the mucogingival line buccal to the second molar tooth. Again, this is done as a full thickness incision with a #15 blade. Periosteal elevation is limited to the expected occlusal level of the impacted tooth. There was a 4% incident of anterior flap tear in the experimental mandibular sites requiring one suture in the second molar buccal gingival area. In the retrospective study, this was reduced to 2% of all mandibular incisions. The need to extend the incision to a conventional envelope or vertical release did not occur at any time during the study. No other sutures placed in the minimal incision sites. Gelfoam or Surgicel was used in 5% of both groups. Control sites were closed in standard fashion with 2 to 3 sutures. There was no statistically significant difference in inferior alveolar hypesthesia. There were no cases oi" lingual~hypesthesia in either group. By observation of the surgeon and report of the patients, there was a substantial reduction in swelling in the majority of cases. Surgical time was 20 to 50% iess using the minimal incision technique; thereby Substantially reducing total anesthesia times. Wounds healed more quickly with this technique and postoperative visits were decreased in the experimental cohort. This study suggests that experienced oral surgeons can reduce the morbidity o f third molar impaction surgery by modifying standard soft tissue approaches to one using minimal incisions and reduced flap elevation. References 1. S z ~ L. Mucoperiosteal flaps. Dent Clin N A 1971: 15: 299-318. 2. ALL~NG CC, HELFRICK JF, ALLING R D (eds), Impacted Teeth. Philadelphia: WB Saunders, 1993: 49-55.
Since John Hunter in the 1700's made his first attempt in tooth transplants, transplanting a tooth to a cock crest, there have been many attempts for making tooth autotransplants a reliable and predictable technique. For five years up to date, we have been working in tooth autotransplants with a high success rate. The aim of this study is to evaluate the actual state of some of the cases we have performed. For this purpose we have made: clinical periodontal examination and a quantitative evaluation for periodontal healing using Periotest | (Siemens), pulp vitality testing (in cases that it's indicated) using Digilog | (Demetron), and Xray retroalveolar exams. We took 30 autotransplanted teeth from which we have been able to make the most complete long-term control. From these, we have been able to perform the complete series of exams in 14 cases. Results of our test and records have shown that tooth autotransplantation is a very predictable and reliable technique in the well-indicated cases. During the exposition we will show several examples of different types of tooth autotransplants.
3. Swallowing Disorders in Post-Surgical Tongue Cancer Patients
Yokoyama, 3/1., Michiwaki, Y, Takahashi, K., Hirano, K., Ozawa, M., Michi, K. First Department of Oral and Maxillofacial Surgery, School of Dentistry, Showa University, Tokyo, Japan The purpose of this study was to make clear the influences of glossectomy on swallowing function in post-surgical tongue cancer patients. The subjects consisted of two patients after partial glossectomy, two patients after resection of half of the oral tongue, and five patients after hemi-glossectomy. All patients had surgical reconstruction using radial forearm flaps. The swallowing function was assessed by analyzing frame-by-frame videofluorographic (VF) images. VF images were examined focusing on severity of aspiration, residue in t h e pharynx, and time lags of the following three measurements: (a) pharyngeal delay time, the time lag until the first laryngeal elevation after the bolus head arrives to the intersecting point of the mandibular lower rim and the tongue base; (b) pharyngeal passing duration after the bolus head passes from the above-mentioned point to opening of the cricopharyngeal region; (c) criopharyngeal response time, during which the cricopharynx opens, then closes.
Miscellaneous
57
026C - Miscellaneous 2. Tooth Autotransplant Study 1. Minimal Incision Third Molar Impaction Surgery
Hernandez, M., Valencia, E., Pillard, A., Lopez, C., Landaetta, L.
Donlon, W., Triuta, M. Facultad de Odontolgia, Universidad de Valparaiso, Chile Peninsula Maxillofacial Surgery, Burlingame, California A technique was developed to minimize mucoperiosteal incisions and flap elevation for removal of partial and complete bony impacted third molar teeth. In a non-blinded clinical study, this approach was compared to standard incisionsI and flap handling described in oral surgery textbooks2 using one side for the experimental technique and the antimere for the "textbook" approach. Later, the minimal incision surgery was used exclusively and evaluated in a retrospective clinical manner. In the mandible, the technique consists of a full thickness incision with a #15 blade from the mid-portion of the retromolar trigone beginning at the second molar and angling posteriorly 45 ~ toward the external oblique ridge for a distance 8 to 10 ram. Periosteal elevation is done only lateral to the coronal area over the ridge to the buccal cortex. The maxillary incision begins at the midpoint of the tuberosity just anterior to the hamular notch and continues anterolaterolaterally in a straight line to the mucogingival line buccal to the second molar tooth. Again, this is done as a full thickness incision with a #15 blade. Periosteal elevation is limited to the expected occlusal level of the impacted tooth. There was a 4% incident of anterior flap tear in the experimental mandibular sites requiring one suture in the second molar buccal gingival area. In the retrospective study, this was reduced to 2% of all mandibular incisions. The need to extend the incision to a conventional envelope or vertical release did not occur at any time during the study. No other sutures placed in the minimal incision sites. Gelfoam or Surgicel was used in 5% of both groups. Control sites were closed in standard fashion with 2 to 3 sutures. There was no statistically significant difference in inferior alveolar hypesthesia. There were no cases oi" lingual~hypesthesia in either group. By observation of the surgeon and report of the patients, there was a substantial reduction in swelling in the majority of cases. Surgical time was 20 to 50% iess using the minimal incision technique; thereby Substantially reducing total anesthesia times. Wounds healed more quickly with this technique and postoperative visits were decreased in the experimental cohort. This study suggests that experienced oral surgeons can reduce the morbidity o f third molar impaction surgery by modifying standard soft tissue approaches to one using minimal incisions and reduced flap elevation. References 1. S z ~ L. Mucoperiosteal flaps. Dent Clin N A 1971: 15: 299-318. 2. ALL~NG CC, HELFRICK JF, ALLING R D (eds), Impacted Teeth. Philadelphia: WB Saunders, 1993: 49-55.
Since John Hunter in the 1700's made his first attempt in tooth transplants, transplanting a tooth to a cock crest, there have been many attempts for making tooth autotransplants a reliable and predictable technique. For five years up to date, we have been working in tooth autotransplants with a high success rate. The aim of this study is to evaluate the actual state of some of the cases we have performed. For this purpose we have made: clinical periodontal examination and a quantitative evaluation for periodontal healing using Periotest | (Siemens), pulp vitality testing (in cases that it's indicated) using Digilog | (Demetron), and Xray retroalveolar exams. We took 30 autotransplanted teeth from which we have been able to make the most complete long-term control. From these, we have been able to perform the complete series of exams in 14 cases. Results of our test and records have shown that tooth autotransplantation is a very predictable and reliable technique in the well-indicated cases. During the exposition we will show several examples of different types of tooth autotransplants.
3. Swallowing Disorders in Post-Surgical Tongue Cancer Patients
Yokoyama, 3/1., Michiwaki, Y, Takahashi, K., Hirano, K., Ozawa, M., Michi, K. First Department of Oral and Maxillofacial Surgery, School of Dentistry, Showa University, Tokyo, Japan The purpose of this study was to make clear the influences of glossectomy on swallowing function in post-surgical tongue cancer patients. The subjects consisted of two patients after partial glossectomy, two patients after resection of half of the oral tongue, and five patients after hemi-glossectomy. All patients had surgical reconstruction using radial forearm flaps. The swallowing function was assessed by analyzing frame-by-frame videofluorographic (VF) images. VF images were examined focusing on severity of aspiration, residue in t h e pharynx, and time lags of the following three measurements: (a) pharyngeal delay time, the time lag until the first laryngeal elevation after the bolus head arrives to the intersecting point of the mandibular lower rim and the tongue base; (b) pharyngeal passing duration after the bolus head passes from the above-mentioned point to opening of the cricopharyngeal region; (c) criopharyngeal response time, during which the cricopharynx opens, then closes.