lingual pouch 1
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LINGUAL POUCH
DR.SRIKANTH GUNTURU
INTRODUCTION
• Displacement of impacted teeth is a rarely reported complication
• The localization and retrieval of such a fragment is technically demanding and requires expertise.
Description of pouch
• Sublingual pouch is the space between the mandibular rami ventral to the tongue apparatus
• Evolutionarily it is significant as it forms a simple diverticulum in the floor of the mouth of birds.
ANATOMICAL CONSIDERATIONS
• The supple soft tissues in the sublingual space and below the mylohyoid muscle is filled with loose areolar tissue and acts as a pouch
• This region is in communication with adjacent tissue spaces
ANATOMICAL CONSIDERATIONS
• SUBLINGUAL • SUBMANDIBULAR • PTERYGOMANDIBULAR• LATERAL PHARYNGEAL SPACES
FACTORS INFLUENCING DISLODGEMENT
• DISTOLINGUAL ANGULATION • FENESTRATION OF LINGUAL CORTEX• FAULTY TECHNIQUE• EXCESSIVE UNCONTROLLED FORCE
LOCALIZATION OF DISLODGED TOOTH
• Plain radiographs• CT• ULTRASOUND• FLUOROSCOPY
WORTH RECOMMENDED 2 VIEWS AT RIGHT ANGLES TO EACH OTHER FOR 3 DIMENSIONAL LOCALIZATION
EARLY V/S LATE
EARLY INTERVENTION
• TO ADDRESS PATIENTS’ APPREHENSION
• TO PREVENT INFECTIONS
LATE INTERVENTION
• WAIT FOR 3-4 WEEKS• ALLOW FOREIGN BODY
REACTION• ENCAPSULATION WITH
FIBROUS TISSUE• STABLE DURING
RETRIEVAL
COMPLICATIONS
• INFECTIONS• THROMBOSIS OF INTERNAL JUGULAR VEIN• EROSION OF CAROTID ARTERY• INTERFERENCE WITH NERVE FUNCTIONS
TECHNIQUES OF RETRIEVAL
• PREVENTION IS ALWAYS BETTER. USE MALLEABLE RETRACTOR
• THUMB SHOULD BE PLACED UNDER THE LOWER BORDER OF MANDIBLETO MILK THE TOOTH BACK ALONG LINGUAL SURFACE
INTRAORAL VERSUS EXTRAORAL
SURGICAL TECHNIQUES
• REFLECT THE LINGUAL GINGIVA AS FAR AS PREMOLAR REGION
• INCISE THE MYLOHYOID MUSCLE TO ACCESS THE SUBMANDIBULAR SPACE
YEH TECHNIQUE• COMBINATION OF INTRAORAL AND LATERAL
NECK APPROACH• WOUND IS EXTENDED DISTAL OF FIRST MOLAR • 4MM SKIN INCISION IN SUBMANDIBULAR
REGION• STABILIZETHE TOOTH AND DELIVER IT OUT
A simple retrieval technique for accidentally displaced
mandibular third molars ;jomfs 2002;60;836
ESCODA TECHNIQUE
• TRANSCUTANEOUS APPROACH• RETRIEVED THE DISPLACED TOOTH VIA
TRANSCUTANEOUS APPROACH
Accedental displacement of a lower third molar into lateral cervical space. Ooo 1993: 76 159
ESEN
• DESCRIBED THE TECHNIQUE TO RETRIEVE FROM TONSILLAR FOSSA TRANSORALLY
Displacement of third molar into lateral pharyngeal space jomfs 2000;58;96
DISPLACED MAXILLARY THIRD MOLARS
• HIGHLY POSITIONED MAXILLARY THIRD MOLARS
• THIN LAYER OF BONE SEPERATES FROM INFRATEMPORAL SPACE
• VENOUS DRAINAGE FROM PTERYGOID PLEXUS MAKES IT DIFFICULT TO VISUALISE
• INTRAORAL APPROACH THROUGH A SAGITTAL SPLIT RAMUS OSTEOTOMY INCISION
• HEMICORONAL APPROACH• MANIPULATING VIA STRIGHT NEEDLE PLACED
CUTANEOUSLY IN AN INFERIOR DIRECTION DELIVERING IT INTRAORALLY
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