title: Tissue resistance to soft tissue emphysema during minimally invasive periodontal surgery.
abstract: OBJECTIVE
  The aim of this study was to determine the pressure where oral soft tissue resistance will be overcome resulting in soft tissue emphysema and to measure the safety of an antifouling device for a videoscope used during minimally invasive periodontal surgery.
  
  
  METHODS
  Resistance was measured in vitro in porcine tissue. One study arm measured palatal tissue resistance to air applied through a needle. Another arm measured resistance in a surgical access for minimally invasive periodontal surgery (MIS). India ink was placed on the tissue,pressure at 0,3,10,15,20, and 25 pounds/square inch (psi)applied, and penetration of India ink into the tissue was measured. Three trials in three sites were performed at each pressure in both arms of the study.
  
  
  RESULTS
  Pressure applied to palatal tissue through a needle showed no significant penetration of India ink until 15 psi (0.90 ± 0.24 mm, p = 0.008). Penetration considered clinically significant was noted at 20 and 25 psi (4 to 6 mm, p ≤ 0.0001). No significant penetration was noted in minimally invasive incisions.
  
  
  CONCLUSIONS
  Within the test system, pressures of 15 psi or less seem unlikely to cause soft tissue emphysema. No evidence of tissue emphysema was noted with the video scope antifouling device.
  
  
  CONCLUSIONS
  The use of pressures greater than 15 pounds per square inch should be avoided during surgical procedures. The antifouling device for a videoscope appears safe for use during minimally invasive periodontal surgery.
authors: Department of Periodontology, Baylor College of Dentistry Texas, USA. skharrel@gmail.com
authors: Stephen K
authors: SK
authors: Harrel
authors: Celeste M
authors: CM
authors: Abraham
authors: Francisco
authors: F
authors: Rivera-Hidalgo
mesh_terms: D000388:Air; D000539:Alveolar Process / Q000503:physiopathology / Q000601:surgery; D000818:Animals; D002244:Carbon; D004396:Coloring Agents; D004867:Equipment Design; D005881:Gingiva / Q000503:physiopathology / Q000601:surgery; D007431:Intraoperative Complications / Q000517:prevention & control; D019060:Minimally Invasive Surgical Procedures; D009339:Needles; D055100:Optical Fibers; D019647:Oral Surgical Procedures / Q000009:adverse effects; D010159:Palate / Q000503:physiopathology / Q000601:surgery; D010513:Periodontal Ligament / Q000503:physiopathology / Q000601:surgery; D010519:Periodontium / Q000503:physiopathology / Q000601:surgery*; D011312:Pressure; D013352:Subcutaneous Emphysema / Q000209:etiology / Q000517:prevention & control*; D013552:Swine; D020535:Video-Assisted Surgery / Q000295:instrumentation
chemical_list: D004396:Coloring Agents; C028433:chinese ink; D002244:Carbon