Management of cysts Flashcards
what is a cyst
pathological cavity having fluid or semi-fluid contents, which has not been created by the accumulation of pus
signs and symptoms of a cyst
- asymptomatic
- boney expansion
- fluctuant swelling
- missing teeth
- carious, discoloured, fractured teeth
- tilted/ displaced teeth
- discharge/ sinus
- loose teeth
- mental hypoaesthesia
- hollow perucssion note
- pain and swelling
- pathological fracture
investigations for cysts
- sensibility testing
- radiology
- aspiration of cyst contents
- biopsy
management aims
- to eradicate the pathology
- to minimise surgical damage
- to restore function quickly
treatment options
marsipulisation
enucleation
marsipulisation + enucleation
en bloc resection -jaw continuity maintained
partial resection - continuity lost
what is enucleation
complete removal of the cyst
what can happen following enucelation
closure can be primarily or secondary by packing the defect
when is primary or secondary closure contraindicated
if cyst is large, involving a number of vital teeth, in a difficult anatomical site or involving potentially useful unerupted tooth
why do we eliminate dead space
to reduce reactionary haemorrhage and to reduce post operative infection
how can we eliminate dead space
- procedure to collapse walls of the cavity
- use of biomaterials to fill the space
- use layered soft tissue closure or secondary intention
advantages of enucleation
complete removal of histology
cavity heals without complications
disadvantages of enucleation
infection
incomplete removal of lining
damages to adjacent teeth or antrum
weakening of bone
what is marsupulisation
this involves the creation of a window in the cyst lining, suturing the flap to the remaining lining to allow shrinkage of the lesion which may become self cleansing or be subsequently removed
when is marsupilsation the treatment of choice
in cases or eruption cysts involving potentially useful teeth
advantages of marsupialisation
avoids pathological fracture
treatment of medcially compromised patients
avoids damage to adjacent structures
allows potentially useful teeth to erupt
disadvantages of marsupialisation
orifice closes and cyst reforms
repeat visists
manual dexterity and compliance
complete lining not available for histology
what is decompression
- this reduces the pressure within the cyst cavity
- the opening into the cyst has to be kept open with a drain
- very similar to marsupialisation
what is an inflammatory cyst associated with a non vital tooth
radicular cyst
radicular cyst treatment
enucleation with either extraction of associated tooth or apicectomy following endodontic treatment
residual cyst treatment
enucleation or marsupialisation
examples of developmental cysts
dentigerous cyst
eruption
odontogenic keratocyst
lateral periodntal
gingival
dentigerous cyst treatment
enucleation with removal of associated teeth
marsupialisation if unerupted tooth is potentially function and can be aligned orthodontically
Keratocyst treatment
enucleation - particular attention to ensuring removal of an intact lining to reduce recurrence
long term radiographic follow up
en bloc resection
what is en bloc resection
cut out bit of bone that contains cyst
