B9 cysts and shit Flashcards
basic surgical goals when managing b9 cysts
eradication of pathological condition
funcitonal rehab
what is imperative prior to definitive tx
histological diagnosis
PA cyst vs ameloblastoma…which would require more aggressive tx
tumor (ameloblastoma)
when should you plan reconstruction? what types of things should you plan for
plan while planning the excisions surgery
grafting, fixation, soft tissue, dental rehab, PATIENT PREPARATION
a true cyst….
contains an epithelial lining
types of inflammatory cyst (2)
periapical
residual
types of developmental cysts (5)
dentigerous OKC lateral periodontal glandular odontogenic cyst calcifying odontogenic cyst
4 strategies for managing cysts
- enucleation
- enucleation and curettage
- marsupialization
- staged marsupialization and enucleation
what is the decompression technique
staged marsup/enucleation
what is the treatment of choice for cystic lesions
enucleation
define enucleation
remove entire cystic lesions without rupture
what allows a cleavage plane between lesion and bony cavity during enucleation
fibrous connective tissue
indication for enucleation
any cyst that can be removed in entirety and safely without harming adjacent structures
how would you treat a dentigerous or PA cyst
enucleation
advantages of enuc
history examination of entire cystic wall
initial biopsy/treatment is curative in certain situations
disadvantages of enuc
possible pathologic fracture
devitalization of teeth
injury to nerve
enuc technique
access
aspirate
use largest curette
visualize bony cavity for soft tissue remnants
smooth bony margins/obtain water tight primary closure
what type of curette/how should you use curette for enuc
largest curette that defect will allow
cleavage plane
concave surface toward bone
post op for enuc
modify diet/activity
OHI
panorex every 6 mos
how long will it take for bony fill after enuc, will this bone recontour over time?
6-12 mos
yes it will recontour
E&C steps
enucleate cyst
remove 1-2 mm of bone with burs on entire periphery of cavity
is outcome better with mechanical (burs) or curette during e&c
you can use curette aggressively, but burs are more effective
e&c indications
aggressive cyst with high recurrence (OKC)
secondary surgery after recurrence when 1st surgery (enucleation) was deemed curative
advantage of e&c
gets rid of all epithelial remnants, decreasing chance of recurrence
disadvantage of e&C
damage to neurovascular bundle
dental pulps stripped
define marsupialization
open a cystic lesion and maintain latency to an adjacent cavity
decreases intracystic pressure (cyst shrinks, bone fills)
what are examples of spaces that you can leave patency to during marsup
oral cavity, max sinus, nasal cavity
is marsup a final treatment
not usually, normally have to enucleate later
marsup indications
adjacent vital structures at risk with enuc
difficult surgical access to all portions of cyst (increasing recurrence)
medical compromise
marsup advantages
simple to perform
spare vital structuers
either completely resolves lesion or makes it much smaller and easier to treat
marsup disadvantages
can’t histo examine the entire cystic wall (stuff you leave behind might be more aggressive)
patient inconvenience with home care
occasional secondary infections
marsup technique
aspirate
1 cm elliptical incision in soft tissue
create bony window
piece of cystic lining removed and submitted for path
cystic contents evacuated
keep window into cyst patent
marsup: thick cystic lining?
to keep window open, suture to oral mucosa
marsup: thin, friable cystic lining?
to keep window open, pack cavity for 10-14 days to prevent oral mucosa from healing over
post op for marsup
pt responsible for irrigating cystic cavity
cavity might get infection
routine follow up with radiographs
how long do you leave cavity open during marsup
until goals for choosing marsup have been met
why do you marsup before enucleation in some cases
allow time for bony coverage of vital structures
increases strength of jaw
indications for decompression
concern for injury to adjacent strucrures
size of lesion
marsup alone does not resolve
need to examine entire lesion histopatholgically
advantages of decompression
thickened cyst lining
reduces morbidity, accelerates complete healing
(all the other same as marsup alone)
disadvantages of decompression
same as marsup
periodical cyst tx
remove underlying process (RCT or ext)
enucleate +/- curettage
abx if needed
residual cyst tx
e&c
dentigerous cyst tx
ext of affected tooth
e&c
if larger, consider decompression
OKC tx
e&c with potential extraction
if large, consider decompression
lateral periodontal cyst tx
enucleation with preservation of tooth
glandular odontogenic cyst tx
e&c
some advocate resection
calcifying odontogenic cyst (gorlins) tx
e&c
epithelial jaw tumors (4)
ameloblastoma
adenomatoid odontogenic tumor
calcifying epithelial odontogenic (pindborg)
squamous odontogenic tumor
mixed jaw tumors (3)
ameloblastic fibroma
ameloblstic fibroma-odontoma
odontoma
ectomesenchymal jaw tumors (3)
odontogenic fibroma
odontogenic myxoma
cementoblastoma
which has poorer prognosis: tumor in mx or mn
maxilla due to undetected growth
t/f: tumors within bone have a better prognosis
true
indications for E&C jaw tumors
slow growing, non aggressive tumors
most odontogenic tumors
medically compromised
types of tumors tx with E&C
odontoma
ameloblstic fibroma/fibro-odontoma
AOT
cementoblastoma
odontogenic fibroma
indications for resection for tx of jaw tumors
aggressive lesions either by histopath/clinical behavior
tumors that would be difficult to remove in entirety/by e&c alone
types of jaw tumors indicated for resection
ameloblastoma
myxoma
CEOT
squamous odontogenic tumor
resection technique
lesion is removed with a 1 cm margin of uninvolved tissue
marginal resection
maintains continuity at inferior border
segmental resection
full thickness portion removed
total resection
remove entire jaw
