Treatment of cysts

Ram Yadav, Max Fac Surgeon, BPKIHS

1. 2 nd June 2016 Treatment of cyst

2. Reasons for treatment of cyst of the oral cavity Cyst tends to increase in size. Cysts tends to get infected Cysts weaken the jaw and cause pathological fractures. Some cysts can undergo changes and it is not possible to be certain about a cystic lesion unless the tissue is examined histologically. Cysts can prevent eruption

3. Operative procedures Marsupialization (decompression) Partsch I combined marsupialization and enucleation (Waldron) Marsupialization by opening into nose or antrum Enucleation Enucleation and packing Enucleation and primary closure ( Partsch II) Enucleation and primary closure with reconstruction/bone grafting

4. Marsupialization Principle

5. Indications

6. Advantages Simple procedure to perform Spares vital structures Allows eruption of teeth Prevents oronasal , oroantral fistula Prevents pathological fracture Reduces operating time Reduces blood loss Helps shrinkage of cystic lining Allows for endosteal bone formation to take place Alveolar ridge is preserved

7. Disadvantages Pathologic tissue is left in situ Histologic examination of entire cystic lining is not done Prolonged healing time Inconvenience to the patient Prolonged follow-up visits Periodic irrigation of cavity Regular adjustments of plug Periodic changing of pack Secondary surgery may be needed Formation of slit-like pockets that may harbor foodstuffs Risk of invagination and new cyst formation

8. Partsch I

9. Modifications of Marsupialization 2 stage technique: marupialization followed by enucleation Waldron’s Method

10. Indications

11. Advantages Development of a thickened cystic lining, which makes enucleation easier Spares adjacent vital structures Combined approach reduces morbidity Accelerated healing process Allows HPE of residual tissue

12. Disadvantages Patient has to undergo secondary surgery and the possible complications that are involved with any surgical procedure

13. Marsupialization by opening into nose or antrum Modifications of Marsupialization

14. Indications cysts that have destroyed a large portion of the maxilla and have encroached on the antrum or nasal cavity

15. Advantages Primary closure of oral wound Cystic cavity is opened into the maxillary sinus or nasal cavity, thereby reducing intra-cystic pressure Cystic cavity becomes lined with respiratory maxillary sinus or nasal cavity Adjacent structures are protected Restoration of the normal anatomy of the antral space and nose

16. Disadvantages Development of an oroantral or oronasal fistula, if there is breakdown of the wound

17. Surgical technique

18. Enucleation By definition , it means a shelling-out of the entire cystic lesion

19. Principle

20. Indications Treatment of odontogenic keratocysts Recurrence of cystic lesions of any type

21. After enucleation Packing Primary closure Primary closure with reconstruction/ bone grafting Where inferior border of mandible is non-salvageable Autogenous bone grafts- iliac , free fibula graft, or costochondral grafts

22. Advantages Primary closure of the wound Healing is rapid Postoperative care is reduced Thorough examination of the entire cystic lining can be done

23. Disadvantages After primary closure, it is not possible to directly observe healing of the cavity as with marsupialization In young persons, the unerupted teeth as in a dentigerous cyst will be removed with the lesion Removal of large cysts will weaken the mandible, making it prone to jaw fracture Damage to adjacent vital structures Pulpal necrosis

24. Follow-up Long-term follow-up, at least upto 8 years for keratocysts for early detection of dealing with any recurrence To check postoperative vitality of teeth Unerupted teeth that may require orthodontic assistance for eruption

25. THEME: RADICULAR CYSTS 1. In which sex are radicular cysts most prevalent? 2. In which age group do they most commonly occur? 3. How are they commonly discovered? 4. Which teeth do they commonly affect? 5. What is the most common cause? 6. What is the status of pulp in this condition? a Male b Female c Under 18 years d 30 – 50 years e Pain associated with tooth f Incidental finding g Maxillary wisdom teeth h Mandibular incisors i Maxillary incisors j Developmental k Congenital l Trauma m Vital n Non-vital

26. THEME: DENTIGEROUS CYSTS  1. Which sex is most commonly affected? 2. In which age group is a dentigerous cyst first noticed? 3. Which teeth are most commonly affected? 4 . Which epithelial residue is responsible for the formation of this cyst? 5 . From what is this epithelial residue derived? a Male b Female c Equally prevalent in both sexes d Under 18 years e 18 – 30 years f 30 – 50 years g Maxillary wisdom teeth h Mandibular wisdom teeth i Mandibular premolars j Root sheath of Hertwig k Rests of Malassez l REE m Enamel organ

27. THANK YOU

28. 1. Dentigerous cyst will rarely transform into what? a . ameloblastoma b. dentinoma c. odontogenic keratocyst d. none of the above

29. Treatment