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[Development of the facial and periodontal approach to the maxillary sinus].

The nasal approach for operations of the maxillary sinus is becoming increasingly popular. The oral approach provides the best access for demonstration of the orbital floor, for ligation of the maxillary artery, for drainage of resistant rhinogenic sinusitis, and for removal of foreign bodies, tooth roots, dislocated teeth, odontogenic cysts and benign tumours of the maxillary sinus. Formerly the anterior wall of the maxillary sinus was removed, but nowadays procedures preserving the bone are chosen. The classical otorhinolaryngological incision lies in the limbus of the vestibule. Maxillofacial surgeons prefer an incision at the junction of the attached to the unattached gingiva because scars in the limbus of the vestibule create problems during later fitting of a denture. A follow-up of 40 patients shows that the gingival marginal incision causes no problems. This incision, introduced by Peter in 1930, is therefore preferred. The marginal incision does not leave any visible scars. It corresponds to an incision on the alveolar ridge in the edentulous patient.

Face↗

[Scorpionic tooth].

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Adolescent↗

Preprosthetic surgery.

Several of the abnormal conditions existing in the edentulous patient can be corrected surgically, prior to construction of dentures, to enable the patient to function more successfully following prosthetic restoration. The more common problems have been discussed which often require surgical correction. In some instances, articulated diagnostic models of the patient's mouth show that surgery can be avoided, or when surgery is necessary, these models help identify the exact locations of the tissue to be corrected. Alveolectomy has been presented with an eye toward conservatism since this procedure affects the quality of denture foundation and therefore denture stability. Alveolectomy should be performed only when there is a definite indication for the procedure. Correction of soft tissue abnormalities can substantially improve the patient's ability to function with dentures and solve many of the adjustment problems which confront the dentist. It is often better to correct the soft tissue abnormality rather than to circumvent the problem with an inferior prosthetic restoration. Since the introduction of resilient acrylics and tissue conditioning materials, the patient need no longer suffer the discomfort of denture withdrawal after surgery. Electrosurgery has emerged as a successful method of correcting many soft tissue abnormalities. Vestibuloplasty is receiving much emphasis as a possible treatment for atrophic ridges in which there is still enough alveolar bone from which to extend a sulcus. These sulcus extension procedures may offer some help in the future regarding the problem of resorbed ridges, but presently, more research is necessary before widespread use is recommended.

Alveoloplasty↗