Episode 07 — Incisions : intraoral incisions скачать в хорошем качестве

Episode 07 — Incisions : intraoral incisions

🔹 Ward’s Incision – Type I 🔹 Ward’s Incision – Type II --- 🔹 Sulcular Incisions *Second Molar Sulcus Incision:* This incision begins on the ascending ramus, follows the center of the *third molar shelf* to the **distobuccal surface of the second molar**, and continues as a sulcular incision to its mesiobuccal corner. It is indicated for *transalveolar extraction* of **mesially inclined and superficial impactions**. *Second and First Molar Sulcus Incision:* This is an extended version of the previous incision, continuing forward to the **mesiobuccal surface of the first molar**, providing **better surgical exposure**. It is preferred when the third molar is positioned more **lingually**. --- 🔹 Bayonet and L Flaps *Second Molar Sulcus Incision with Vestibular Extension* — commonly known as the *Bayonet flap* — includes an oblique vestibular extension angled forward, offering *excellent buccal visibility* during surgery. The **L Flap**, or **paramarginal flap with vestibular extension**, is similar but placed a few millimeters away from the marginal gingiva. This design helps preserve *marginal attachment healing* around the second molar, making it a refined approach in delicate cases. --- 🔹 Lingual Flap Incision The lingual flap incision begins on the *ascending ramus**, continues along the **distal surface of the second molar**, and follows the **lingual sulcus* toward the **first molar region**. It is mainly indicated for the *lingual split technique* used in **transalveolar extraction of mandibular third molars**. --- 🔹 Semilunar Incision The semilunar, or half-moon incision, is made in the **alveolar mucosa**, avoiding the marginal and papillary gingiva. While it minimizes gingival trauma, it tends to cause **more bleeding, delayed healing**, and **mucosal scarring**. It also offers *limited access* to periradicular tissues and may violate surgical principles if the flap margins lie directly over a bony defect. *Indications:* Used for *apicectomy**, **apical curettage**, and **removal of fractured root tips* during transalveolar extractions. --- 🔹 Submarginal Incision The submarginal incision includes a **horizontal cut in the attached gingiva**, accompanied by vertical releases. It’s often scalloped to follow the contour of the gingiva and requires at least **4 millimeters of attached tissue**. Though it can cause bleeding into the surgical site, it is highly valued for **aesthetic zones**, especially around the **maxillary anterior teeth**, where gingival preservation is critical. --- 🔹 Degloving Incision The degloving incision is placed about **3 to 5 millimeters above the mucogingival junction**, leaving unattached mucosa on the alveolus to aid closure. It provides excellent access to the *pyriform aperture anteriorly* and the **zygomatic buttress posteriorly**. *Indications:* It is used in surgeries involving the **maxilla**, including **Caldwell–Luc procedures**, **Le Fort osteotomies**, **infraorbital nerve neurectomy**, **maxillectomy**, and **zygoma fracture fixation**. During closure, care must be taken to prevent *alar flaring* by applying an *alar cinch suture**. A **V–Y closure* can also be used to achieve lip lengthening when needed. --- 🔹 Curvilinear Incision This incision is commonly used in the **mandibular anterior region**, between the **mental foramina**. It extends into the labial mucosa while preserving *10 to 15 millimeters of attached mucosa* near the gingiva. Once the mucosa is incised, the *mentalis muscle* fibers are clearly visible and are sharply divided in an oblique approach toward the mandible. *Indications:* Used for *open reduction of symphysis and parasymphysis fractures**, and for **harvesting corticocancellous bone grafts* from the chin region. *Precautions:* Maintain adequate soft tissue on the bone for tension-free closure. In the canine area, avoid placing the incision too low to prevent injury to the **mental neurovascular bundle**. --- 🔹 Ginwalla’s Incision Ginwalla’s incision is placed along the *anterior border of the mandibular ramus**, extending both **buccally and lingually* to form a **Y-shaped configuration**. It provides excellent exposure of the **inferior alveolar nerve**. *Indication:* Used primarily for *inferior alveolar nerve neurectomy* in the management of **trigeminal neuralgia**.