Alan Samit

Respiratory obstruction following vestibuloplasty and lowering of the floor of the mouth

Abstract A case of severe respiratory obstruction necessitating emergency tracheostomy following mandibular skin graft vestibuloplasty with lowering of the floor of the mouth is presented. The surgeon must be aware that extensive manipulation of these tissues can result in significant bleeding and edema. Careful technique and recognition of the potential problems help prevent such problems.

Mandibular vestibuloplasty: A clinical update

Abstract Ten modifications of the traditional mandibular skin graft vestibuloplasty have been reported. These include (1) omission of the surgical stent, (2) labial suturing of the skin graft, (3) fenestration of the graft, (4) cannulation of the submaxillary ducts, (5) intentional mental anesthesia, (6) infiltration of steroids into the floor of the mouth, (7) use of chromic submandibular sutures, (8) omission of prophylactic antibiotics, (9) donor site options, and (10) partial procedures. With the use of these modifications, mandibular labial and lingual vestibular extension can be consistently obtained with minimal morbidity and reduced anesthesia time (Fig. 6). Operating time with these techniques averages 1 hour and 15 minutes. Postoperative hospitalization is significantly shortened, with most patients discharged on the third postoperative day. Patient acceptance is high, and our results have been extremely satisfying.

Complications associated with skin graft vestibuloplasty: Experiences with 100 cases

The mandibular skin graft vestibuloplasty with lowering of the floor of the mouth is a relatively complex surgical procedure and can be accompanied by a large number of diverse complications. In our experience, these have ranged from minor inconveniences to a life-threatening emergency. Most could be easily prevented or simply managed. The complications encountered in a series of 100 consecutive skin graft vestibuloplasties are presented and discussed.

Atypical benign migratory glossitis: Report of a case with histologic and electron microscopic evaluations

A case of benign migratory glossitis atypically confined to only one side of the tongue is presented. The diagnosis was confirmed by repeated histopathologic evaluation. Electron microscopic studies revealed a striking intimacy between sensory nerve processes and the basal lamina of the lingual epithelium.

Cephalometric templates based on the Bolton standards

An accurate, simple, rapid method of cephalometric profile analysis is proposed. Templates, derived photographically from the 9-year through 18-year male-female Bolton standard tracings, are used to define the optimal locations for any selected hard or soft tissue dentofacial landmarks. Discrepancies between the ideal and actual positions of each landmark are immediately apparent and graphically reveal existing deformities. No tracing or measurements are required, as the analysis is performed directly on the patients cephalogram. The construction of the templates and their application to clinical cases are described.

Instrument-marking tapes: An unnecessary hazard

Instrument-marking tapes facilitate instrument preparation and packaging but can be responsible for increased surgical morbidity by fragmenting into the wound or harboring bacteria when old or damaged. Four cases of submandibular abscess formation and the potential failure of an oro-antral closure were directly attributed to the use of marking tapes.

Crestal ostectomy and lateral wall compression for management of the enlarged pneumatized tuberosity

The crestal ostectomy with lateral antral wall compression is a simple, predictable procedure to correct soft tissue and osseous hypertrophy in the pneumatized maxillary tuberosity. It offers certain advantages over other techniques: 1) simultaneous reduction of vertical and lateral aspects of the hyperplastic tuberosity; 2) simultaneous revision of hypertrophic or mobile mucosal tissue overlying the tuberosity; 3) avoidance of a horizontal scar band in the buccal vestibule, which may subsequently interfere with the denture flange; 4) negligible effect on the depth of the buccal vestibule; 5) fixation wires are not required; 6) rapid healing of the osteotomy site, since there is intimate bony contact; 7) expedient initiation of denture fabrication is possible because the palatal aspect of the tuberosity is not mobilized; and 8) no surgical stent is necessary.

Management of bilateral fractures three weeks after mandibular skin graft vestibuloplasty

Management of bilateral fractures of the atrophic mandible is a difficult problem. A recent skin graft vestibuloplasty with lowering of the floor of the mouth compromises the blood supply to the fractured segments and jeopardizes the changes for bony union. The viability of the skin graft and the stability of the vestibular extension are also at risk. The successful management of such a case is presented and discussed.