Surgery Overview

GENERAL INFORMATION   The oral cavity vasculature promotes rapid healing and inhibits infection. Infection is common with oral surgery. Perioperative antibiotics should be considered on a case-by-case basis. Use atraumatic techniques to minimize tissue swelling and dehiscence, and to promote healing. Resect all diseased tissue. All oral masses should be submitted for histopathology. Use appositional suture patterns.     MOST COMMON COMPLICATIONS AND DIFFICULTY   Expect hemorrhaging and be prepared with direct pressure and ligation. Bleeding may be severe if the palate or bone is cut. Use cautery judiciously to avoid delayed healing. Avoid tension on the tissue edges when suturing as this may promote dehiscence (particularly in the palate).

Single-flap technique for fistula repair.  Debride the fistula and advance a buccal flap over the defect and create a hard palate rotational flap by debriding the fistula and rotating a mucoperiosteal hard palate flap over the defect.

"EXPERTS' ADVICE"
 

• Plan the closure prior to surgery. Mucosal and mucoperiosteal flaps can be used in the mouth following the same guidelines for flap creation as for the skin.
• Extensive reconstruction typically requires a feeding tube (gastrotomy or esophagotomy) during the healing phase. Consider placing the endotracheal tube through a pharyngostomy approach if the tube is in the way.

Use rapidly absorbing suture to minimize discomfort of sutures in the mouth. VICRYL RAPIDE* allows for more rapid absorbtion in sensitive areas. Alternately, use a soft (braided multifilament) suture such as VICRYL* PLUS. VICRYL* PLUS may be preferable to VICRYL* because of triclosan (IRGACARE MP*) in a contaminated environment. MONOCRYL* is also a good substitute for VICRYL* because of its monofilament configuration and rapid absorbtion.