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Lingual Pouch: DR - Srikanth Gunturu

The document discusses the sublingual pouch, which is the space between the mandibular rami below the tongue. Displaced teeth can become lodged in this pouch. Localizing and retrieving displaced teeth from the pouch can be technically challenging. Factors like tooth angulation, lingual bone fenestration, and excessive force can influence tooth dislodgement into the pouch. Imaging like radiographs and CT are used to locate displaced teeth. Various surgical techniques through intraoral and extraoral approaches can be used for retrieval. Early intervention is preferred to prevent infections, but later retrieval after encapsulation is also possible. Complications from displaced teeth include infections, thrombosis, and nerve damage.

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Srikanth Gunturu
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3K views18 pages

Lingual Pouch: DR - Srikanth Gunturu

The document discusses the sublingual pouch, which is the space between the mandibular rami below the tongue. Displaced teeth can become lodged in this pouch. Localizing and retrieving displaced teeth from the pouch can be technically challenging. Factors like tooth angulation, lingual bone fenestration, and excessive force can influence tooth dislodgement into the pouch. Imaging like radiographs and CT are used to locate displaced teeth. Various surgical techniques through intraoral and extraoral approaches can be used for retrieval. Early intervention is preferred to prevent infections, but later retrieval after encapsulation is also possible. Complications from displaced teeth include infections, thrombosis, and nerve damage.

Uploaded by

Srikanth Gunturu
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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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 LATE INTERVENTION

• WAIT FOR 3-4 WEEKS


• TO ADDRESS PATIENTS’ • ALLOW FOREIGN BODY
APPREHENSION REACTION
• TO PREVENT • ENCAPSULATION WITH
INFECTIONS 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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