Chapter 87 - Part C: To Close or Not to Close: When Oral Wounds Should Heal Open

In this BoardsCast episode, we continue Tobias Chapter 87 – Soft Tissues of the Oral Cavity by challenging one of the biggest misconceptions in oral surgery:
Not all wounds in the mouth should be closed.
Some should heal open — and in many cases, closure actually makes things worse.

Oral soft tissue is elastic, mobile, contaminated, enzyme-rich, and highly vascular. These factors make it excellent at healing… but terrible at holding tension. This episode explains when closure helps, when it harms, and how to know the difference.

You’ll learn:

• Why some oral wounds fail when closed but succeed when left open
• The difference between mucosa, gingiva, and mucoperiosteum in wound management
• How blood supply, motion, and salivary contamination change closure strategy
• When primary closure is mandatory — and when it is a liability
• The physiologic basis of second-intention oral healing
• How to avoid tension, flap necrosis, and dehiscence
• Board-relevant patterns in oral trauma, extractions, tumor excisions & fistula repairs

If you’ve ever wondered, “Should I close this, or is nature going to do a better job?”, this episode gives you a rulebook straight from Tobias.

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Listen On: Spotify | Apple Podcasts | Amazon Music

Chapters

• 0:00 Introduction: The Dehiscence Nightmare
• 1:00 New Mental Model: Second Intention as a Primary Strategy
• 2:30 Analyzing Motion and Tension: When Suture is the Enemy
• 5:00 Drainage Dynamics: Why trapping bacteria in the mouth is fatal to repairs
• 8:15 The Golden Rule: Tension and Drainage Mandates
• 11:00 Case Studies: When "nothing" resulted in the best functional outcome
• 13:30 The Art of Not Using a Needle Driver