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