Excision of redundant oral soft tissues

Vestibuloplasty: Goals and Main Techniques

Vestibuloplasty is a key stage of surgical preparation performed to increase the depth of the oral vestibule. A properly formed vestibule is essential for successful prosthetic treatment. In clinical practice, there are several main techniques for performing this procedure.

Submucosal vestibuloplasty according to Obwegeser is performed with the primary goal of radically increasing the depth of the oral vestibule. In contrast, the Edlan technique has its own distinctive features compared to the Kazanjian technique. During vestibuloplasty using a transposed labial mucosal flap according to Edlan, the periosteum is transposed with subsequent closure of the surgical wound directly on the lip.

Correction of frenula and scar contractures

The presence of scar contractures in the oral vestibule mucosa requires a specialized surgical approach. Various intervention options are considered to eliminate them, including techniques by Wassmund, Kazanjian, Edlan, and Obwegeser. The use of a silicone complex plays a special role in the treatment of scar deformities.

Limberg frenuloplasty deserves special attention. This procedure is used to correct a short labial frenulum. The intervention consists of the following steps:

• Making incisions with the formation of triangular flaps.
• Mutual transposition of the formed triangular flaps to redistribute tension.
• Completion of the procedure by primary wound closure (suturing tight).

Wound surface plasty and graft selection

Various materials can be used for the plasty (closure) of the extensive wound surface formed after deepening the vestibule:

• Palatal mucosal autograft.
• Skin autograft.
• Allogeneic skin graft.
• Silicone membrane.

When choosing a skin autograft for vestibuloplasty, a number of negative factors that may affect the treatment outcome must be considered. First, an aesthetic defect occurs because the transplanted tissue differs in color from the surrounding mucosa. Second, surgical morbidity increases due to an additional surgery in the donor site to harvest the material. Third, there is a risk of hair growth in the oral vestibule if hair follicles are preserved in the graft. Finally, the skin flap has a pronounced tendency to retract and can shrink in size during the postoperative period.

Fixation of Stent liners and silicone complexes

During skin transplantation surgery, it is extremely critical to position the tissues correctly on the fixation device. The autograft is placed on a special Stent liner with the wound surface facing outward. For reliability, sutures are placed specifically to secure the graft to the liner along its upper edge. The assembled structure itself (the liner with the autograft) is fixed in the recipient zone of the oral vestibule using sturdy circumferential mandibular sutures.

Alternatively, a prefabricated silicone complex is widely used in vestibuloplasty, being sutured during the operation with percutaneous sutures. The advantages of using a silicone complex include:

• Technological efficiency: the technique is convenient and fully standardized in execution.
• Predictability: the clinician achieves a predictable clinical outcome of the intervention.
• Outpatient feasibility: the ability to perform the surgery in an outpatient setting without hospitalization.
• Stability: reliable preservation of the shape and volume of the recreated vestibule.

Class and exam questions

What else to study on this topic

• Tooth-conserving procedures: hemisection and root amputation.
• Alveolectomy as a method of preparing the alveolar ridge for prosthetics.
• Materials for jaw augmentation (autogenous bone, allogenic bone, hydroxyapatite).
• Sandwich osteotomy of the atrophied alveolar process.
• Features of using a silicone membrane for wound surface plasty.

Other topics in "Chapter 16. Surgical Preparation of the Oral Cavity for Prosthetic Treatment (A.V. Shchipsky)"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.