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