Flap Design for Minor Oral Surgery


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Flap Design for Minor Oral Surgery

  1. 1. Flap Design for Minor Oral Surgery Presenter: R1 鄭瑋之 Instructor: VS 陳靜容醫師 2012/2/24
  2. 2. Stages of Operation <ul><li>Retraction </li></ul><ul><li>Incision </li></ul><ul><li>Reflection </li></ul><ul><li>Bone removal </li></ul><ul><ul><li>access </li></ul></ul><ul><ul><li>point of elevation </li></ul></ul><ul><ul><li>removal of obstruction </li></ul></ul><ul><li>Tooth section </li></ul><ul><li>Delivery </li></ul><ul><li>Clean-up </li></ul><ul><li>Sew-up </li></ul><ul><li>Check-up </li></ul><ul><li>Follow-up </li></ul><ul><li>Write-up </li></ul>
  3. 3. Principles of Flap Design <ul><li>Local flap </li></ul><ul><ul><li>outlined by a surgical incision </li></ul></ul><ul><ul><li>carries its own blood supply </li></ul></ul><ul><ul><li>allows surgical access to underlying tissues </li></ul></ul><ul><ul><li>can be replaced in the original position </li></ul></ul><ul><ul><li>can be maintained with sutures and is expected to heal </li></ul></ul><ul><ul><li>Used in oral surgical, periodontic, and endodontic procedures to gain access. </li></ul></ul>
  4. 4. Principles of Flap Design <ul><li>Complications </li></ul><ul><ul><li>Flap necrosis </li></ul></ul><ul><ul><li>Flap Dehiscence </li></ul></ul><ul><ul><li>Flap Tearing </li></ul></ul><ul><ul><li>Injury to Local Structures </li></ul></ul>
  5. 5. Principles of Flap Design <ul><li>Base > Free margin </li></ul><ul><ul><li>to preserve an adequate blood supply </li></ul></ul><ul><ul><li>unless a major artery is present in the base </li></ul></ul><ul><li>Width of Base > Length of Flap*2 </li></ul><ul><ul><li>less critical in oral cavity, but length < width </li></ul></ul><ul><ul><li>a long, straight incision with adequate flap reflection heals more rapidly than a short, torn incision. </li></ul></ul><ul><li>An axial blood supply in the base </li></ul><ul><li>Hold the flap with a retractor resting on intact bone to prevent tension. </li></ul>A. Flap necrosis
  6. 6. Principles of Flap Design <ul><li>The incisions must be made over intact bone </li></ul><ul><li>If the pathologic condition has eroded the buccocortical plate, the incision must be at least 6 or 8 mm away from it . </li></ul><ul><li>The incision is 6 to 8 mm away from the bony defect created by surgery. </li></ul><ul><li>Gently handle the flap's edges </li></ul><ul><li>Do not place the flap under tension </li></ul><ul><li>Do not cross bony prominences, ex: canine eminence </li></ul>B. Flap Dehiscence
  7. 7. Principles of Flap Design B. Flap Dehiscence
  8. 8. Principles of Flap Design <ul><li>Envelope flaps </li></ul><ul><ul><li>an incision around the necks of several teeth. </li></ul></ul><ul><ul><li>extends 2 teeth anterior and 1 tooth posterior . </li></ul></ul><ul><li>If not provide sufficient access… </li></ul><ul><li>Vertical (oblique) releasing incisions : </li></ul><ul><ul><li>extends 1 tooth anterior and 1 tooth posterior . </li></ul></ul><ul><ul><li>started at the line angle of a tooth. </li></ul></ul><ul><ul><li>carried obliquely apically into the unattached gingiva. </li></ul></ul><ul><ul><li>If cross the papilla  localized periodontal problems </li></ul></ul>C. Flap Tearing
  9. 9. Principles of Flap Design <ul><li>Mandible : lingual n. & mental n. </li></ul>D. Injury to Local Structures
  10. 10. Principles of Flap Design <ul><li>Maxilla : greater palatine a. & nasopalatine n./a. </li></ul>D. Injury to Local Structures
  11. 11. Principles of Flap Design Summary
  12. 12. Types of Mucoperiosteal Flaps <ul><li>Envelope/sulcular incision </li></ul><ul><li>Envelope with one releasing incision (three-corner flap) </li></ul><ul><li>Envelope with two releasing incisions (four-corner flap) </li></ul><ul><li>Semilunar incision </li></ul><ul><li>Y-incision </li></ul><ul><li>Pedicle flap </li></ul>Full-thickness mucoperiosteal flap
  13. 13. Types of Mucoperiosteal Flaps Edentulous: at the crest of the ridge  removal of a mandibular torus 2 teeth anterior 1 tooth posterior 1. Envelope/Sulcular flap
  14. 14. Types of Mucoperiosteal Flaps <ul><li>Greater access in an apical direction, especially in the posterior aspect of the mouth </li></ul>1 tooth anterior 1 tooth posterior 2. Three-corner flap
  15. 15. Types of Mucoperiosteal Flaps <ul><li>rarely indicated </li></ul>1 tooth anterior 1 tooth posterior 3. Four-corner flap
  16. 16. Types of Mucoperiosteal Flaps <ul><li>to approach the root apex </li></ul><ul><li>avoids trauma to the papillae and gingival margin </li></ul><ul><li>useful for periapical surgery of a limited extent. </li></ul><ul><li>should not cross major prominences, ex: canine eminence </li></ul>4. Semilunar incision
  17. 17. Types of Mucoperiosteal Flaps <ul><li>removal of a maxillary palatal torus </li></ul>5. Y-incision
  18. 18. Types of Mucoperiosteal Flaps <ul><li>mobilizes from one area and then rotates to fill a soft tissue defect in another area. </li></ul><ul><li>closure of oroantral communications </li></ul>6. Pedicle flap
  19. 19. Examples
  20. 20. Examples
  21. 21. Reference <ul><li>Contemporary Oral and Maxillofacial Surgery , 4th Edition, Larry J Peterson, DDS, MS, Edward Ellis, III, DDS, MS, James R Hupp, DMD, MD, JD, FACS and Myron R Tucker, DDS </li></ul><ul><li>Peterson's principles of oral and maxillofacial surgery , Michael Miloro,G. E. Ghali,Peter Larsen,Peter Waite </li></ul><ul><li>An atlas of minor oral surgery: principles and practice , David A. McGowan </li></ul><ul><li>Manual of minor oral surgery for the general dentist , Karl R. Koerner </li></ul>
  22. 22. Thanks for your attention!