The incision is usually placed approximately 3 to 5 mm superior to the mucogingival junction. Leaving unattached mucosa on the alveolus facilitates closure. This tissue has many elastic fibers and contracts following incision, although during closure, the tissue can be grasped and holds sutures well. The surgeon should not make the incision more superior in the anterior region because entrance into the piriform aperture, with puncture of the nasal mucosa, may result. Some individuals have extremely low piriform apertures, which makes this possibility a reality. Palpation of the inferior extent of the piriform aperture and/or anterior nasal spine ensures incision placement inferior to these structures. In the edentulous maxilla, where atrophy of the alveolar bone brings the alveolar crest and floor of the nose in close apposition, incision along the alveolar crest is an excellent choice.
The incision extends as far posteriorly as necessary to provide exposure, usually of the first molar tooth, and traverses mucosa, submucosa, facial muscles, and periosteum (Fig. 7-4). The mucosa retracts during incision, exposing underlying tissues.
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