Porcine: Surgical extraction of the mandibular tusk.

Extraction of a mandibular tusk in the pig is extremely challenging due to the long and curved reserve crown. The clinical crown of the mandibular tusk is present in the rostral mouth just behind the third incisor. The reserve crown courses through the mandible below the premolars and molars and then at the second or third molar the reserve crown diverges in a buccal direction to the radicular root. The radicular root is encapsulated with bone that is prominent just rostral to the masseter muscle.
A caudal releasing “J” flap is created by starting along the ventral mandible and moving dorsal along the rostral aspect the masseter muscle (this flap was first described through personal communication with Dr Jennifer Rawlinson). The incision is directed deep to the periosteum. In large overweight pigs there may be considerable subcutaneous tissue/fat to carefully dissect through to reach the periosteum. Additionally, careful dissection along the masseter muscle is indicated to avoid the facial vein/artery/nerve and parotid salivary duct. Once the flap is created, a periosteal elevator is used to elevate the flap over the encapsulated root and along the ventral mandible. Once the flap is created, a high-speed surgical drill with a carbide bur is used to remove buccal/cortical and alveolar bone to expose to apical portion of the tusk. Additional cortical bone may be removed by following the reserve crown in a coronal direction. With multiple sectioning of the reserve crown, the tusk is elevated and extracted in segments. The remaining ~2 cm of the coronal crown may be temporarily left in place to minimize oral contamination of the extraction site. Alternatively, oral extraction of the clinical crown utilizing a single releasing mucogingival flap may be performed. The large apical “J” flap is closed in three layers; the periosteum, the subcutaneous tissue/fat and the skin.