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In immediate closure what does this diagram shows and also what that lower incision says
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This is from Chapter 32: Maxillary Sinus and its Implications (page 623), and the image contains two separate figures.
Upper Diagram - Fig. 32.7 A-C: Immediate Closure of Oroantral Fistula/Communication
This shows a 3-step technique for closing a small oroantral communication immediately after tooth extraction:
Panel A - Shows the surgical site planning:
- A black circle marks the oroantral fistula (the abnormal communication between the oral cavity and the maxillary sinus, typically occurring after upper molar/premolar extraction)
- A vertical line with an arrow indicates the releasing incision - a vertical cut made through the gingiva on either side of the defect to mobilize the buccal mucoperiosteal flap
- Dashed lines show the planned incision boundaries
Panel B - Shows the flaps being raised and reflected. The buccal flap is mobilized and elevated, creating tension-free tissue movement toward the fistula site.
Panel C - Shows the completed closure: the advanced tissue flap is sutured over the fistula site with interrupted sutures (shown as cross-hatches), sealing the oroantral communication.
Lower Diagram (unlabeled caption, likely a continuation figure)
This shows the Rehrmann's buccal advancement flap technique for closing a larger oroantral communication - seen in an occlusal/top-down view:
- Panel A: Occlusal view showing the large oroantral communication (dark oval opening in the alveolar ridge) with diverging buccal releasing incisions outlining the flap
- Panel B: The buccal flap is fully elevated and reflected, exposing the open socket leading into the sinus. The periosteum at the flap base is incised to allow stretch
- Panel C: The mobilized flap is advanced over the ridge and sutured to the stable palatal mucosa with interrupted sutures - achieving complete watertight closure
The Lower Incision Label
In Panel A of the upper diagram, the label reads "Releasing incision" - this is the vertical relieving cut made through the buccal mucosa/periosteum at the edges of the defect. Its purpose is to:
- Free the buccal flap from its base attachments
- Allow the flap to be advanced medially without tension
- Ensure the closure does not pull apart under normal oral function
This is a standard principle in oroantral closure: any flap used must be tension-free, which requires releasing the periosteum at the flap base.
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