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Mucosal-cheek retractor to facilitate securing of mucosal grafts
Mucosal-cheek retractor to facilitate securing of mucosal grafts Richard G. Boudreau,” MARINA
MERCY
MEDICAL
Marina Del Rey, Calif. CENTER
T he cheek (buccal) mucosa is an effective
intraoral grafting material. An instrument and technique are described which facilitate removal of the mucosal graft when the buccal mucosa is the donor site. Application of the instrument in removing oral and facial lesions is also presented. The instrument (Fig. 1) consists of an extraoral and intraoral component. The extraoral component is a broad, concave surface that depresses the cheek surface medially, while an intraoral ring outlines a periphery and stabilizes the instrument. The thumbscrew can be adjusted to provide the desired pressure-tension. Once the retractor? is in -position (Fig. 2), the incision is made to outline the desired shape of the graft. The outline incision of the donor site can be made smaller than the surgical bed of the prepared recipient site, because of the elasticity of the mucosa. The parotid duct papillae may be included within the confines of the graft without adverse effects on Stenson’s duct or the recipient site. Removal of the graft is facilitated by elevating it above its periphery, via intradermal injection of saline solution. The saline solution is injected under the donor bed, through the incision. Blade and/or scissors can then be used to easily remove the graft. Excess adipose and muscle tissue is removed, and the graft is stored in sterile saline solution until it is ready for application to the recipient site. The peripheral pressure placed by the retractor and the submucosal hydraulic injection of saline solution provide effective control of bleeding at the operative site. The incision site is closed primarily. The described technique is effective in removing cheek mucosa with a minimum of surgical trauma to the patient. It is easy to perform, requires a minimum amount of operating time, and is well suited to the oral surgical office environment. Different sizes of the instrument make it adaptable to almost any anatomic variation. The instrument can also be used for removal of lesions of the oral mucosa, as well as
*In the private practice of oral and maxillofaciai surgery Oral and Maxillofacial Surgery, University of California tAvailable from E. A. Beck & Co.
10
and Lecturer and Clinical at Los Angeles.
0030.4220/78/0146-0010$00.20/0
Instructor,
Department
of
0 1978 The C. V. Mosby Co.
Volume 46
Retractorfor securingmucosalgrafts
Number1
Fig. 1. Side view of mucosal-cheek
Fig. 2. Retractor
in position.
Periphery
11
retractor.
of the donor
site is outlined
facial cutaneouslesionsof the cheek and surrounding area. When the instrument is to be used for removal of a facial lesion, it is simply reversed in position. The hemostasis, isolation, and elevation of the lesion provided by the instrument facilitate the surgical procedure. The usesof an extraoral/intraoral cheek retractor for mucosal and skin surgery have been presented. Reprint requests to: Richard G. Boudreau Marina Mercy Medical Center 4644 Lincoln Blvd., Suite 400 Marina Del Rey, Calif. 90291
MERCY
MEDICAL
Marina Del Rey, Calif. CENTER
T he cheek (buccal) mucosa is an effective
intraoral grafting material. An instrument and technique are described which facilitate removal of the mucosal graft when the buccal mucosa is the donor site. Application of the instrument in removing oral and facial lesions is also presented. The instrument (Fig. 1) consists of an extraoral and intraoral component. The extraoral component is a broad, concave surface that depresses the cheek surface medially, while an intraoral ring outlines a periphery and stabilizes the instrument. The thumbscrew can be adjusted to provide the desired pressure-tension. Once the retractor? is in -position (Fig. 2), the incision is made to outline the desired shape of the graft. The outline incision of the donor site can be made smaller than the surgical bed of the prepared recipient site, because of the elasticity of the mucosa. The parotid duct papillae may be included within the confines of the graft without adverse effects on Stenson’s duct or the recipient site. Removal of the graft is facilitated by elevating it above its periphery, via intradermal injection of saline solution. The saline solution is injected under the donor bed, through the incision. Blade and/or scissors can then be used to easily remove the graft. Excess adipose and muscle tissue is removed, and the graft is stored in sterile saline solution until it is ready for application to the recipient site. The peripheral pressure placed by the retractor and the submucosal hydraulic injection of saline solution provide effective control of bleeding at the operative site. The incision site is closed primarily. The described technique is effective in removing cheek mucosa with a minimum of surgical trauma to the patient. It is easy to perform, requires a minimum amount of operating time, and is well suited to the oral surgical office environment. Different sizes of the instrument make it adaptable to almost any anatomic variation. The instrument can also be used for removal of lesions of the oral mucosa, as well as
*In the private practice of oral and maxillofaciai surgery Oral and Maxillofacial Surgery, University of California tAvailable from E. A. Beck & Co.
10
and Lecturer and Clinical at Los Angeles.
0030.4220/78/0146-0010$00.20/0
Instructor,
Department
of
0 1978 The C. V. Mosby Co.
Volume 46
Retractorfor securingmucosalgrafts
Number1
Fig. 1. Side view of mucosal-cheek
Fig. 2. Retractor
in position.
Periphery
11
retractor.
of the donor
site is outlined
facial cutaneouslesionsof the cheek and surrounding area. When the instrument is to be used for removal of a facial lesion, it is simply reversed in position. The hemostasis, isolation, and elevation of the lesion provided by the instrument facilitate the surgical procedure. The usesof an extraoral/intraoral cheek retractor for mucosal and skin surgery have been presented. Reprint requests to: Richard G. Boudreau Marina Mercy Medical Center 4644 Lincoln Blvd., Suite 400 Marina Del Rey, Calif. 90291