3. DEFINITION
Killey and kay(1966) – cyst constitutes an
epithelium –lined sac filled with fluid or
semifluid material.
Fit for odontogenic and fissural cyst but wat
about SOLITARY BONE CYST OR
STAFNE’S CYST????????????
4. Killey and kay (1966) – revised definition”A
cyst is an abnormal cavity in hard or soft
tissue which is contains fluid, semifluid or
gas and is often encapsulated and lined by
epithelium.”
5. Kramer’s(1974) – A cyst is pathologic cavity
having fluid, semifluid, or gaseous contents
that are not created by the accumulation of
pus; frequently, but not always, is lined by
epithelium.
6. CLASSIFICATION
Various classifications have been given:
Robinson (1945)
Thoma-Robinson-Bernier (1960)
Kruger (1964)
WHO (1971)
Shear (1983)
7. According to shear’s -
Cyst of jaws
Cyst associated with maxillary antrum
Cyst of soft tissues of the mouth,face,neck
and salivary glands
8. cyst of jaws
Epithelial Non-epithelial
Developmental Inflammatory
Odontogenic Non-odontogenic
14. Cysts of the soft tissue of the mouth ,face and
neck –
Dermoid and epidermoid cyst
Branchial cyst
Thyroglossal duct cyst
Anterior median lingual cyst
Oral cyst with gastric or intestinal epithelium
Cystic hygroma
Nasopharyngeal cyst
Thymic cyst
Cyst of salivary glands
Hydatid cyst
15. PATHOGENESIS OF CYST FORMATION
Odontogenic cyst are derived from
odontogenic epithelium of stomodeum
Enamel organ
Reduced enamel epithelum
Remnants of dental lamina(cell rests of serrae)
Remnants of hertwig’s root sheath(cell rests of
malassez)
16.
17. PATHOGENESIS
Formation of cyst take place in generally three
stages :
Initiation
Cyst formation
Enlargement or expansion of cyst cavity
18. INITIATION
Initiation of cyst formation mostly from
odontogenic epithelium
Stimulus which initiates this process is
unknown
Factors involved
Proliferation of epithelial lining
I. Fluid accumulation in cystic cavity
II. Bone resorption
20. If a cleft produced by accumulation of a
purulent exudate in the form of a
microabscess involved one of the
proliferating strands of epithelium , then the
epithelial cells would be expected to line the
cleft.
21. Another mechanism- epithelial cells become
oriented in relation to their source of nutrition
and the adjacent connective tissue.
In normal situation they cover a surface and
finally desquamated
If the proliferating epitheliun beneath the
surface ,as in granuloma ,cells will migrate
inwards and desquamate in the center of
mass.
22. ENLARGEMENT
Basic mechanism for cyst enlargement is
similar but additional factors involved which
differ from type to type
Steps involved:
Attraction of fluid into cyst cavity
Retention of fluid in the cavity
Production of a raised internal hydrostatic
pressure
Resorption of surrounding bone with an
increase in size of bone cavity
23. Harris (1974) classified theories of cyst
enlargment:
Mural growth
a) Peripheral cell division
b) Accumulation of cellular content
Hydrostatic enlargement
a) Secretion
b) Transduation and exudation
Bone resorbing factor
24. CLINICAL EXAMINATION
Diagnostic features
Symptoms of cyst
Signs of cyst
Clinical stages of cysts
Secondary effects on jaw
Investigation
25. Diagnostic features :
Sign and symptoms of a cystic lesion depend
on
1. Dimension of lesion
2. Type of cyst
3. Location of cyst
4. Important structures adjacent to cyst
5. Presence of infection in the cyst
26. Symptoms of cyst :
1. Pain and swelling
2. Salty taste
3. Difficulty in mastication
4. Ill fitting denture
5. Displaced teeth
6. Space between the teeth
27. Signs of cyst :
1. Bone expansion
2. Fluctuant swelling under oral mucosa
3. Non vital tooth(if radicular cyst)
4. Missing tooth
5. Sinus formation with discharge
6. Large cyst distortion of adjacent structures
7. Hollow sound on percussion
28. Clinical stages of cyst :
1. Periosteal stimulation : curved enlargement
of bone
2. Tennis ball consistency:can be indented on
percussion
3. Egg shell crackling :micro cracks on cortical
plate
4. Fluctuation :complete resorption of bone
overlying the cyst
5. Sinus formation
6. Infection due to contamination from oral
cavity
29. Secondary effects on jaw due to cyst :
1. Numbness
2. Pathological fracture of jaw
3. Secondary infection
4. Malignant transformation
30. Investigation includes :
1. Radiographic examination/C.T. scan
2. Contrast studies
3. Aspiration
4. Vitality test
5. Biopsy
31. Radiograph for cyst
1. IOPA for small periapical cyst to see tooth
involvegd
2. Occlusal view to check lingual cortical
expansion
3. PNS view (occipitomental)to show relation to
maxillary antrum and nasal cavity
4. Lateral oblique (mandible)to check proximity to
lower border
5. PA view to check expansion of ramus of
mandible,survey of symphysis ,body and rami
of mandible
6. OPG (shows entire affected region.size and
site of the region can be assessed
32. Radiographic interpretations
Radiographs help to define site ,size,extent
and marginal outline of lesion
Characteristic appearance of a cyst is a
round or oval radiolucency surrounded by
sharp radioopaque line of condensed bone
(this line missing in an infected cyst or a very
large cyst that is growing rapidly.
Large cyst in mandible may displace inferior
nerve canal, clearly seen in radiograph
33. Contrast studies
To find out exact size and relation of the cyst
whose extent is doubtful.
Water soluble contrast solution can be
injected to cyst after removing cystic fluid
Avoid painful excess pressure in cystic cavity
After filling with radiopaque dye ,essential
radiographs are taken
Contrast medium removed by aspiration
carefully to avoid negative pressure in cystic
cavity
34. Aspiration
Cystic contents are aspirated using a wide
bore needle(18 guage) and syringe(5 ml)
Different types of aspirates obtained
Provisional diagnosis may be based on types
of aspirate
35. Types of Aspirate Diagnosis
Clear , pale , straw coloured fluid
with cholesterol crystals
Dentigerous cyst
Creamy white , thick aspirate Odontogenic cyst
Yellowish ,foul smelling fluid Infected cyst
Blood 1. Needle in blood vessel
2. Vascular lesion
Air 1. Maxillary antrum
2. Traumatic bone cyst
36. On biochemical evaluation of aspirated fluid
If total protein content >4gm/100 ml indicataed
radicular cyst or dentigerous cyst
If total protein content <4gm/100 ml indicated
odontogenic keratocyst
37. Vitality test :
Vitality test is done for tooth involved in the
cyst and those adjacent to it.
If tooth non-vital, it is most likely to be a
radicular cyst.
38. Biopsy
When type of cyst is not confirmed by
aspiration , a biopsy may be done to
categorise the cyst prior to treatment plan.
Gold standard to determining the cyst and to
differentiate from neoplasm.
39. Dentigerous Cyst
Term given by Paget in 1963
Cyst which enclose the crown of an
unerupted tooth by expansion of its follicle,
and attached to its neck – shears 1983
40. Etiology
Developmental in origin
Considered to arise by the accumulation of
fluid between reduced enamel epithelium
and the crown of an unerupted tooth or an
impacted tooth
The eruptive forces in the tooth cause
changes in the vascular hydrodynamics
which results in sepration of reduced enamel
epithelium from crown.
There is fluid accumulation between these
two.
41. Basis of observations at operation and
histologic examination distinguish two types :
1. Standard dentigerous cyst
2. Extrafollicular variety
42. Clinical features
Second most common cyst
Commonly seen in 1st and 3rd decade of
life
Males more affected than females
Capable to becoming aggressive lesion
43. Asymptomatic unless they develop into very
large cyst or get infected
Expansion of bone
Facial asymmetry
Displacement and root resorption of adjacent
teeth
Pain may occur if secondary infection
supervenes
44. Radiographic Features
Unilocular ,well defined radiolucency with
sclerotic margins around the crown of an
unerupted tooth
Three radiographic types
circumferential
lateral
paradental
45.
46. Cyst Contents
Yellowish straw coloured fluid rich in
cholestrol crystals
If cyst infected ,purulent material can be
obtained on aspiration
47. Histopathological features
Lined by stratified squamous epithelium
Lumen may contain fibrillar keratin
Presence of bilaminated eosinophilic
amorphous hyaline like Rushton bodies
Cholestrol crystals
48. Treatment
Marsuplization
Enucleation of cyst together with removal of
unerupted teeth
This permits decompression of a resulting
decrease in the size of bone defects.
49. ODONTOGENIC KERATOCYST
Odontogenic keratocyst term first coined by
philipsen in 1956
These cyst are quite aggressive and usually
extensive at the time of diagnosis
Very high recurrence rate
50. Pathogenesis –
Developmental anomaly
Arises from odontogenic epithelium
Dental lamina
Basal cells from overlying mucosa
Enamel organ-by degenration of stellate
reticulum
51. Clinical features
Most common in 2nd and 3rd decade of life
Males more commonly affectd
Mandible more affected than maxilla
Most common site is mandibular angle region
Greatest recurrence rate –as high as 60%
Asymtomatic usually until secondarily infected
52. Radiographic features –
Unilocular or multilocular radiolucency
In early stages ,unilocular radiolucency with
well defined sclerotic margin
It can arise in any part of jaw and is
independent of the teeth,it can mimic any of
the cyst radiographically e.g. dentigerous
cyst,primordial cyst,radicular cyst
As OKC expands it causes severe bone
destruction producing a multilocular
radiolucency and soap bubble appearance
radiographically
53. Cyst contents
Contains dirty white material
Cystic fluid has a large amount of exfoliated
keratin squamous
Smear can be stained and examined for
keratinized cells
When keratin content is high ,the fluid may
appear thick and can be mistaken for pus but
is odourless
Electrophoresis shows total protein content of
fluid to be 4g/dl
54. Histological features
Epithelium lining is usually parakeratinized
Epithelial lining is of uniform thickness ,5-8
layers of cells
Basal layer cell tall columnar and nuclei are
polarized giving tomb stone appearance
Connective tissue layer shows satellite cells or
daughter cyst which have a high rate of
invasiveness
55. Causes of high recuurence rate
Aggressive pecularity was first reported by
pindborg and Hansen (1963)
Tendency to multiplicity
Presence of satellite cyst
Cystic lining is very fragile and thin , making it
difficult to remove in one piece
Epithelial lining og keratocysts have an intrinsic
growth factor
Cyst can arise from basal cell of mucosa
56. Treatment
Bramley (1971/1974) had very rationally
outlined the surgical management of these
cyst as followes
Small single cyst with regular spherical
outline,enucleated from intra oral approach
Large or less accessible cyst with regular
spherical outline ,enucleated from extraoral
approach. Care should taken to ensure that
all fragments of extremly thin lining are
removed
57. Unilocular lesions with scalloped or
loculated periphery and small multilocular
lesions , treated by marginal resection
,while maintaining the continuity of
posterior and inferior border.
If cystic lining is found to be adherent to
overlying mucosa or muscle then it should
be excised along with marginal excision
Defect is closed primarily and can be left to
heal by secondary intention
Can be filled with hydroxyapatite crystals,
autogenous bone graft, corticocanellous
chips
58. Larger multilocular lesion with or
without cortical perforation,may require
resection of the involved bone followed
by primary or secondary reconstruction
with reconstruction plates or stainless
stell mesh or bone graft like iliac crest
graft,costochondral graft or allogenous
bone graft.
59. ERUPTION CYST
It is a dilatation of the normal folicular
space above the crown of the erupting
tooth caused by accumulation of tissue
fluid or blood
Smilar to dentigerous cyst which
developes during the eruption of tooth
when tooth is within the soft tissues
surrounding the bone.
Also known as eruption hematoma
60. Clinical features
Smooth , round soft tissue swelling over an
erupting tooth
Pink or bluish in colour
Not commonly seen as they undergo
spontaneous rupture or disappears from
masticatory trauma as the tooth enters the
oral cavity
61. Radiographic features –
Cyst in soft tissues, no significant radiographic
features are soon
63. GINGIVAL CYST OF INFANTS
Soft tissue cysts on the alveolar crest of the
gum pads of a newborn
Arise from remnants of dental lamina
64. Clinical features
Appears as pearly white nodules 2-3 mm in
diameter on the alveolar ridge
May be solitary or multiple
Cyst appears white in colour due to presence
of keratin within the cyst
Similar lesions on mid palatine raphe are called
epstein’s pearls
Similar lesions on lingual , buccal aspect of
alveolar ridge are called Bohn’s nodules
65. Pathology
Thin lining of stratified squamous cell
epithelium which may reveal
parakeratinization
Contain desquamated keratin
66. Treatment
No treatment as they rupture spontaneously on
eruption of underlying teeth
67. GINGIVAL CYST OF ADULTS
Soft tissue odontogenic developmental cyst
Location in gingival tissue
Etiology :
Remnants of dental lamina or cell rests of
serres
From enamel organ or epithelial islands of the
surface epithelium
As traumatic implantation cyst
68. Clinical features
No sex predilection
Occurs in 5th or 6th decade of life
Mandible is more frequently involved
Rarely seen in anterior part of jaw
Asymptomatic, painless, slow growing, Soft
and fluctuant
Seen in attached gingiva or the inter den tal
papilla on labial aspect, smooth surface
Adjacent teeth are normal
69. Hitopathology
Lined by stratified squamous cell epithelium
and contains fluid
Treatment
Surgical excision
No tendency to recurrence
70. LATERAL PERODONTAL CYST
First reported by standish and shafer in 1958
Cysts occur in the lateral peridontal position
Inflammatory etiology
71. Clinical features
Occurs in 4th to 7th decade of life
Males are affected more than females
Most frequent locations mandibular premolar
area,followed by anterior region of maxilla
Asymptomatic
Associated teeth vital
3rd molar most common and any infection can
cause spreading infection of submandibular
space
72. Radiographic features
Well defined radiolucency round or ovoid with
sclerotic margin
Lamina dura of the tooth destroyed
Smaller than 1cm in size and present between
the cervical margin and apex of the tooth
In case of 3rd molar seen to be present in the
bifurcation, buccal or lingual surface of roots
73. Pathogenesis
Reduced enamel epithelium
Remnants of dental lamina
Cell rests of malassez
Cystic contents
Serous caseous contents
74. Pathology
Lined by well formed , non keratinized stratified
squamous epithelial lining
Localized epithelium proliferation may be seen
Connective tissue wall may show inflammatory
cell infiltrate
Treatment plan
Enucleation
75. BOTRYOID ODONTOGENIC CYST
Weathers and Waldron 1973
Arises from odontogenic epithelial rests
Variant of lateral periodontal cyst
Gross appearance of large lesion resembling
a bunch of grapes ,hence the term botryoid
76. Clinical features
Occurs in 5th -7th decade of life
Most frequent location mandible in cuspid-premolar
region
Swelling may be present
Pain
Parasthesia
Discharge (rarely)
78. CEOC
First described by Gorlin in 1964
Shows features of cyst and tumour
Clinical features
Relatively rare cyst
Most often seen in second decade,no sex
predilection but more common in children
and young individuals
Mostly seen in anterior part of the jaw
79. Initially Symptomless
Swelling
Pain (rare)
Peripheral or intraosseous lesion may be seen
Later stages hard bony expansion
Some cyst arise close to periosteum and
produce a saucer shaped depression in bone
Pathogenesis
Remnants of dental lamina
Stellate Reticulum, Reduced enamel
epithelium
80. Radiographic features
Well defined lesions with sclerotic or diffuse
border
Small radiopaque flecks are seen in the cystic
cavity which is characterstic of this cyst
Some lesions are unilocular and some exhibit
multilocular radiolucency
Cortical perforation
May be associated with unerupted tooth
Resorption of the roots of adjacent teeth
81. Histological features
Basal layer is composed of cuboidal or
columnar cells with polarised nuclei
Most peculiar feature is presence of ghost
cells. these are eosinophilic ,pale,swollen
epithelial cells that have lost their nuclei
Treatment
Enucleation
82. GLANDULAR ODONTOGENIC CYST
Padayachee and Van wyk 1987
Same characteristic with lateral peridontal
cyst or botryoid cyst
Unilocular or multiloculat radiolucency
Cortical plare expansion
84. RADICULAR CYST
Also known as apical periodontal cyst
Associated with roots of non-vital teeth
Most common odontogenic cyst .in all cases
the pulp iis necrosed
Etiology-
Dental caries
Fractured tooth
Thermal /chemical injury to pulp
Iatrogenic pulp injury
87. Clinical features
Most common
Males affected more than females
Occurs in 3rd -4th decade of life
Incidence highest in anterior maxilla
Asymptomatic
Tooth must be non-vital
Pain if associated with suppuration
Temporary parasthesia
88. Radiological features
Round or pear shaped or oval shaped
radiolucency outlined by a narrow radio-opaque
margins
Treatment
Enucleation with primary closure
89. RESIDUAL CUST
Residual cyst ,that is overlooked after
causative tooth or root is extracted
An incomplete removed pariapical granuloma
An impacted tooth associated with a lateral
dentigerous cyst but cystic lesion
unrecognized and left in situ,residual cyst
persist and will enlarge
Cystic lesion developes on either a decidous
or retained tooth which either exfoliatesor is
extracted without knowledge of underlying
pathology
90. Mainly in middle aged and elderly patient
No sex predilection
Incidence greater in maxilla than mandible
Asymptomatic
Occasionally sign of pathologic fracture or
signs of encroachment
92. INFLAMMATORY PARADENTAL CYST
First reported by Main 1970
Associated with a lateral accessory root
canal of a non vital tooth
In 3rd decade of life
Male mostly affected
Mandibular 3rd molar mostly
93. Radiological features
Often superimposed on the buccal root face as
well demarcated radiolucencies,often with
corticated margin.
Periodontal ligament space not widened and
lamina dura is intact around the tooth
Treatment
Enucleation
94. NON-ODONTOGENIC CYST
Nasopalatine duct cyst
Derived from embryonic epithelial residues in
nasopalatine canal
Or from epithelium included in lines of fusion of
embryonic facial process
May be occur within the nasopalatine canal or
in soft tissues of the palate
At the opening of the canal – cyst of palatine
papiilla
95. Clinical features
Mostly 3rd to 6th decades of life
Higher ratio of man affected
Common symptom swelling
Also occurs in midline on labial aspect
May produce bulging of nose
Pain and discharge which is salty in taste
Displacement of teeth
96. Radiological features
Round or oval shape radiolucency some time
Heart shape radiolucency in between the
central incisors
Treatment
Surgical enucleation
97. Nasolabial cyst –
Occurs outside the bone in nasolabial folds
below the alae nasi
Arises from epithelium enclaved at the site of
fusion of the globular, lateral nasal and
maxillary process
It could develop from remnants of embryonic
nasolacrimal rod or duct
98. Wide age spread from 12-75 years
Women affected more
Swelling
Pain and difficulty in nasal breathing
Slow growing
Swelling of lip, fill out the nasolabial and lift the
alae nasai
Fluctuant
101. ANURYSMAL BONE CYST
Jaffe and Litchtenstein 1942
Often seen in lonf bones and spine
Aetiology
Trauma
Possible relationship with giant cell lesion
Variations in hemodynamics of area
Sudden venous occlusion
102. Clinical features
Very rare
Children and young adults mostly affected
Mandible affected more than maxilla
Firm swelling
Displacement of teeth
Egg shell crackling
Lesion not pulsatile
105. Aetiology
Trauma and haemorrhage with failure of
organization
Spontaneous atrophy of the tissue in a
central benign giant cell lesion
Abnormal calcium metabolism
Chronic low grade infection
106. Clinical features
Occurs in children and adolescent
Male predliction
Mandible affected more
Symptomless
Expansion of lingual cortex
107.
108. MANAGEMENT OF CYST OF THE JAWS
Removal of lining or enable the body to rearrange
position of abnormal tissue to eliminate from
within, and prevention of recurrence.
Minimum trauma to patient and maximum
conservation of tissue mainly of dental
components.
Preserve adjacent important structures
Achieve rapid healing; to minimize number of
visits
Restore the part to near normal and normal
function
Prevention of pathologic fracture
Facial esthetics.
109. Rationale behind treating a cyst
To avoid displacement and loosening of teeth
To avoid pathological fractures of the jaw due
to expanding lesion
To avoid displacement of the inferior alveolar
canal and destruction of other vital structure
around the cyst
To aim at removing the entire lining,
preserving the adjacent structures
111. Enucleation
Enucleation and packing
Enucleation and primary closure
Enucleation and primary closure with
reconstruction
Enucleation wth chemical cauterisation
Marsupialisation
Partsch I
Partsch II
Marsupialization by opening into nose or antrum
112. Marsupialisation or Partsch I operation
also known as cystotomy or decompression
Partsch 1892 described a type of
compression procedure
Principle :
Marsupialization or decompression refers to
creating a surgical window in the wall of cyst,
and evacuate cystic contents
113. Indication
Age - Young child with developing tooth buds
When development of the displaced teeth has
not progressed,and enucleation would
damage the tooth buds.
Proximity to vital structures – when proximity of
cyst to vital structures, could create an
oronasal ,oro antral fistula , injure
neurovascular structures or damage vital
teeth
114. Eruption of teeth – marsupialization permit the
eruption of unerupted teeth
Size of cyst – very large cyst where
enucleation could result in a pathological
fracture
Vitality of teeth- when apices of the many
adjacent teeth are involved with in the large
cyst
115. Advantages
Simple procedure to perform
Spares vital structures
Allows eruption of teeth
Prevents oro nasal oroantral fistula
Prevents pathological fracture
Reduces operating time
Reduces blood loss
Helps shrinkage of cystic lining
Allows for endosteal bone formation to take
place
116. Disadvantages
Pathologic tissue is left in situ
Histologic examination of entire lining is not
done
Prolonged healing time
Inconvenience to the patient
Prolonged follow up visits
Periodic irrigation of cavity
Regular adjustment of plug
Periodic changing of pack
Secondary surgery may be needed
117. SURGICAL TECHNIQUE
Anaesthesia
Aspiration
Incisions – circular
oval
eliptical
inverted ‘u’
Removal of bone
Removal of cystic lining specimen
Irrigation of cystic cavity
118. Suturing
Packing – white head’s varnish
tincture of benzoin
bismuth iodine paraffin
paste(BIPP)
Maintenance
Use of plug
Healing
119.
120. MODIFICATIONS OF MARSUPIALIZATION
Waldron’s method(1941)
Two stage technique
Combination of two standard technique
First marsupialization
Second enucleation,when the cavity
becomes smaller
121. Indications
When bone has covered the adjacent vital
structures
Adequate bone fill has strengthened the jaw to
prevent fracture during enucleation
Pt. finds difficult to clean cavity
For detection of any occult pathologic condition
122. Advantages
Development of a thickened cystic lining which
makes enucleation easier
Spares adjacent vital structures
Combined approach reduces morbidity
Accelerated healing process
Allows histopathological examination of
residual tissue
124. MARSUPIALIZATION BY OPENING INTO NOSE OR
ANTRUM
Cyst that have destroyed a large portion of of
the maxilla and have ancroached on the
antrum or nasal cavity
Technique
1. Anaesthesia
2. Incision – gingival curvilinear incision taken
along the involving teeth
3. Two releasing incision are made at 45°angle
and extending in to buccal sulcus
125. Mucoperiosteal flap is raised
Removal of bone(usually in large cysts ,an
opening already exist)
This stage a window is made by removing a
portion of cystic lining like partsch I technique
Second unroofing is performed by removing
antral lining presents between the cavities
126.
127. This allows the cyst cavity to become
lined with normal ciliated and mucous
secreting epithelium regenrating from
the respiratory mucosa other than a
squamous epithelium
Additionally intranasal antrostomy may
be performed .
Cavity packed with a ribbon gauze
soaked withtincture of benzoin or
antibiotic ointment
128. ENUCLEATION
Principle - surgical removal of entire
cystic lining
Shelling out of the entire cystic lining
without rupture
After enucleation of the cyst the
underlying space filled with blood
clot,which eventually organizes to form
normal bone
129. Indications
Treatment of OKC
Recurrence of cystic lesions of any cyst
type
Advantages-
Primary closure of wounds
Rapid healing
Postoperative care is reduced
Thorough examination of entire cystic
lining can be done
130. Disadvantages –
In young persons , the unerupted teeth in
dentigerous cyst will be removed with
the lesion
Removal of large cystic lesion in
mandible ,making it prone to fracture
When a cyst involves the apices of one or
more teeth in such a way that the blood
supply to the pulp passes through the
capsule of lesion,enucleation of cyst
could be result in pulpal necrosis
131. Enucleation with primary closure-
Anaesthesia
Incision- envelope flap
trapezoidal
Elevation of Mucoperiosteal flap
Bone removal
Exposure of cystic lining
Try to remove entire cyst lining in a single
piece
Irrigation of cavity and hemostasis ensured
suturing
132.
133.
134. Enucleation with open packing
large cyst which was previously infected
,closure may not be possible
the wound is packed with gauze
impregnated with bismuth idoform
parafin paste (BIPP) or whitehead’s
varnish.
Whitehead’s varnish contains Benzoin 10
gm, Storax 7.5 gm, Balsam of tolu 5gm,
iodoform 10 gm, solvent ether upto
100ml
135. Enucleation with bone curettage
After enucleation if there is a doubt that a
part of lining has been left behind, it can
be curetted out
A bone curett is used to scrap the bone
and remove any remaining lining
Enucleation with peripheral osteotomy
Instead of using a curett a large round
burr may be used to remove around 1-
2mm of bone around the entire
peripheral cavity
136. Enucleation with chemical cauterisation
Stoelinga has advocated the use of carnoy’s
solution
Mainly indicated in OKC.
Carnoy’s solution contains Glacial acetic acid,
Choloroform, Absolute alcohol, Ferric
chloride
137. Enucleation with bone grafting
Bone grafting with autogenous cancellous
bone grafts can be done in case of large
bony defects
Bone graft obliterates the cavity and
stimulates osteogenesis
There is , however , a risk of infection of
the bone graft which may lead to failure
138.
139. Segmental resection
Indicated when there is a large
odontogenic keratocyst with massive
bone destruction
Indicated when there is suspected
neoplastic transformation of the cyst
140. Procedure
Anaesthesia
Incision – a submandibular incision ,
which may at times be required to
extend into postramal region,is taken
1.5 – 2 cm below thr inferior border of
mandible
Incision extends ,through skin and
subcutaneous tissue,blunt and sharp
dissection carried out layerwise through
tissue planes e.g. superficial cervical
fascia ,platysma ,and deep cervical
141. Care is taken to marginal mandibular
nerve and facial artey and vein are
clamped and ligated
Small bleeders cauterized with diathermy
Pterygomassetric sling divided
,periosteum incised down to bone and
flap is raised superiorly to expose the
bone
Depending upon the extent of lesion
involvement to surrounding tissues
,enucleation or marginal resection done.
142. COMPLICATIONS OF CYSTIC LESION AND
MANAGEMENT
Risk of bone fracture (pathological)
If fracture occurs during surgery,after removal
of cyst bone plating should be done to
strength the mandible
Inferior dental nerve involvement
If cyst is in very close proximity with to
neurovascular bundle,possibility of damage
must be explained to pt.in advance
Management of teeth related to cyst
143. CONCLUSION
Diagnosis is always very important to decide
the treatment plan of the cyst
Care always should be done to prevent nearer
structure or tooth or tooth bud.
144. REFERENCES
A text book of cyst and management by
shears
Text book of minor oral surgical procedure by
jeffery L.hoe
Text book of oral surgery part II-by laskin
Text book of oral minor surgery by killey n
keys
Text book of oral pathology by shafers
Text book of oral maxillofacial surgery by
neelima malik