Step 5 Closure

Closure is adequate in one layer, except in the anterior region. Closure may begin in the posterior areas with resorbable suture. The pass of the needle should grab mucosa, submucosa, cut edge of the facial muscles, and periosteum, if possible. A simple mucosal closure is inadequate as it allows retraction of the facial muscles, which will heal in an abnormally low position along the mandible. Closure continues anteriorly to the area of the cuspid tooth. At this point, the suture is tied (Fig. 812). It is imperative that the mentalis muscle be firmly reattached to its origin to prevent ptosis of the lip and chin. A minimum of three deep resorbable sutures are placed in the mentalis muscle to reapproximate the cut edges (see Fig. 8-12). Their placement is usually in a delayed fashion, allowing retraction to improve access for all three before tying. The mucosa from canine to canine is then closed with a running resorbable suture.

A suspension dressing, such as elastic tape, is useful for several days after the mandibular buccal vestibular approach to prevent hematoma and to maintain the position of the repositioned facial muscles.

FIGURE 8- 12 Closure of the posterior incision is performed in one layer. In the anterior region, delayed sutures are placed in the mentalis muscle before mucosal closure.

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