The document discusses principles of flap design for minor oral surgery. It describes different types of flaps including envelope, three-corner, four-corner, semilunar, Y-incision, and pedicle flaps. Key considerations for flap design include ensuring an adequate blood supply to the base of the flap, minimizing tension on the flap, and avoiding injury to local structures like nerves and arteries. Complications of improper flap design can include flap necrosis, dehiscence, and tearing.

1. Flap Design for Minor Oral Surgery Presenter: R1 鄭瑋之 Instructor: VS 陳靜容醫師 2012/2/24

2. Stages of Operation Retraction Incision Reflection Bone removal access point of elevation removal of obstruction Tooth section Delivery Clean-up Sew-up Check-up Follow-up Write-up

3. Principles of Flap Design Local flap outlined by a surgical incision carries its own blood supply allows surgical access to underlying tissues can be replaced in the original position can be maintained with sutures and is expected to heal Used in oral surgical, periodontic, and endodontic procedures to gain access.

4. Principles of Flap Design Complications Flap necrosis Flap Dehiscence Flap Tearing Injury to Local Structures

5. Principles of Flap Design Base > Free margin to preserve an adequate blood supply unless a major artery is present in the base Width of Base > Length of Flap*2 less critical in oral cavity, but length < width a long, straight incision with adequate flap reflection heals more rapidly than a short, torn incision. An axial blood supply in the base Hold the flap with a retractor resting on intact bone to prevent tension. A. Flap necrosis

6. Principles of Flap Design The incisions must be made over intact bone If the pathologic condition has eroded the buccocortical plate, the incision must be at least 6 or 8 mm away from it . The incision is 6 to 8 mm away from the bony defect created by surgery. Gently handle the flap's edges Do not place the flap under tension Do not cross bony prominences, ex: canine eminence B. Flap Dehiscence

7. Principles of Flap Design B. Flap Dehiscence

8. Principles of Flap Design Envelope flaps an incision around the necks of several teeth. extends 2 teeth anterior and 1 tooth posterior . If not provide sufficient access… Vertical (oblique) releasing incisions : extends 1 tooth anterior and 1 tooth posterior . started at the line angle of a tooth. carried obliquely apically into the unattached gingiva. If cross the papilla  localized periodontal problems C. Flap Tearing

9. Principles of Flap Design Mandible : lingual n. & mental n. D. Injury to Local Structures

10. Principles of Flap Design Maxilla : greater palatine a. & nasopalatine n./a. D. Injury to Local Structures

11. Principles of Flap Design Summary

12. Types of Mucoperiosteal Flaps Envelope/sulcular incision Envelope with one releasing incision (three-corner flap) Envelope with two releasing incisions (four-corner flap) Semilunar incision Y-incision Pedicle flap Full-thickness mucoperiosteal flap

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. Types of Mucoperiosteal Flaps Greater access in an apical direction, especially in the posterior aspect of the mouth 1 tooth anterior 1 tooth posterior 2. Three-corner flap

15. Types of Mucoperiosteal Flaps rarely indicated 1 tooth anterior 1 tooth posterior 3. Four-corner flap

16. Types of Mucoperiosteal Flaps to approach the root apex avoids trauma to the papillae and gingival margin useful for periapical surgery of a limited extent. should not cross major prominences, ex: canine eminence 4. Semilunar incision

17. Types of Mucoperiosteal Flaps removal of a maxillary palatal torus 5. Y-incision

18. Types of Mucoperiosteal Flaps mobilizes from one area and then rotates to fill a soft tissue defect in another area. closure of oroantral communications 6. Pedicle flap

19. Examples

20. Examples

21. Reference 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 Peterson's principles of oral and maxillofacial surgery , Michael Miloro,G. E. Ghali,Peter Larsen,Peter Waite An atlas of minor oral surgery: principles and practice , David A. McGowan Manual of minor oral surgery for the general dentist , Karl R. Koerner

22. Thanks for your attention!