Buccal mucous membrane harvest
This is Richard Allen at the University of Iowa. This video demonstrates harvesting of a buccal mucosa graft. Prior to harvesting, Stenson’s duct is identified which is the duct of the parotid gland. It is usually adjacent to the upper third molar. The area has been anesthetized with lidocaine with epinephrine. The size of the graft needed has been determined and is outlined with the monopolar cautery. The monopolar cautery is used in this case to harvest the graft. There is some danger of thermal damage from the monopolar cautery and scissors can be used if one is concerned. The dissection plane is performed superficial to the buccinator muscle. Hemostasis is performed with the monopolar cautery. This procedure can be performed with the patient awake or asleep. Once the graft is harvested, the graft is thinned with Westcott scissors. A thinner graft is advantageous for reconstructions. The graft is set aside for the reconstruction. The area of the harvest can then be closed with a 5-0 chromic suture. This suture is placed in a running locking fashion. At the conclusion of the case, the patient will use Peridex mouth wash three times a day for a week. It is not uncommon for these closures to dehisce during the first week which does not seem to have an untoward effect on final outcome. The patient is instructed not to eat any hot foods or liquids for the first day. The mouth is then packed as the harvested graft is sutured into position.