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Oral Surgery III > Surgical Management of Odontogenic Cysts > Flashcards

Surgical Management of Odontogenic Cysts Flashcards

1
Q

What are the odontogenic cysts commonly treated in clinical practice

A
  • periapical cyst
  • residual cyst
  • dentigerous cyst
  • odontogenic keratocyst
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2
Q

what is a cyst

A

a benign pathologic cavity within bone or in soft tissues, generally formed by a connective tissue wall

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3
Q

what is the cystic cavity lined by

A

epithelium

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4
Q

what does the cysts lumen contain

A

fluids, keratin, or cellular debris

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5
Q

what is an odontogenic cyst

A

a cyst in which lining of lumen is derived from epithelium produced during tooth development

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6
Q

what is the classification of odontogenic cysts based on

A
  • histogenic classification (where cyst derived from)
  • inflammatory vs developmental
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7
Q

what are the histogenic classifications of odontogenic cysts and which cysts are in each category

A
  • cyst derived from rest of malassez: periapical cyst, residual cyst
  • cyst derived from reduced enamel epithelium: dentigerous cyst, eruption cyst
  • cyst derived from dental lamina (rest of serrae): odontogenic keratocyst, dental lamina cyst of new born, lateral peridontal, glandular cyst
  • unclassified: paradental cyst
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8
Q

what are the inflammatory cysts

A
  • radicular cyst
  • paradental cyst
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9
Q

what are the development cysts

A
  • dentigerous cyst
  • odontogenic keratocyst
  • developmental lateral periodontal cyst
  • glandular odontogenic cyst
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10
Q

what is done in the dx of odontogenic cysts

A
  • complete hx: pain, loose teeth, occlusion, swellings, delayed tooth eruption, dysesthesia and paresthesia
  • thorough clinical exam: inspection and palpation
  • plain radiographs: pano, occlusal, PA radiographs
  • CT scan/MRI: for larger lesions
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11
Q

what is aspiration used for in odontogenic syst diagnosis

A
  • to rule out vascular lesions, cystic lesions, solid tumors and inflammatory conditions
  • establish a DDX
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12
Q

how do you dx an odontogenic cyst

A
  • obtain tissue sample
  • incisional biopsy; larger lesions prior to definitive therapy
  • excisional biopsy: smaller cysts
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13
Q

what are the common surgical treatment options for odontogenic cysts

A
  • curettage
  • enucleation
  • marsupialization
  • marsupialization followed by cystectomy
  • enucleation followed by peripheral osteoctomy
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14
Q

what is curettage

A
  • a surgical scraping of the cyst from the bony walls of the maxilla or mandible with a special instrument called a curette that has a scoop at its tip
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15
Q

what is important in curettage

A

to create a bony window to expose the cyst in the maxilla or mandible

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16
Q

what is marsupialization

A

creating a surgical window in the wall of cyst and evacuation of cystic contents

17
Q

what does marsupialization do

A

decreases intracystic pressure and promotes shrinkage of cyst and bone fill (endosteal bone formation)

18
Q

use ____ to cover marsupialization site

A

acrylic plug

19
Q

what are the other management options for odontogenic keratocyst

A
  • enucleation followed by use of carnoys solution
  • enucleation followed by peripheral ostectomy and removal of overlying attached mucosa and use of carnoys solution
  • surgical resection for very large and recurrent lesions
20
Q

what is carnoys solution and what does it do

A
  • carnoy’s solution is a substance used as a complemetary treatment after the conservation excision of odontogenic keratocyst.
  • promotes superficial chemical necrosis and is intended to reduce recurrence rates
  • composed of 60% ethanol, 30% chloroform, and 10% acetic acid reduces the rate of KOT recurrence
21
Q

what are the indications for marsupialization

A
  • anatomical considerations: proximity of cyst to vital structures
  • surgical access: if access to all portions of cyst is difficult
  • assistance in eruption of teeth: in a young patient with a dentigerous cyst, it permits eruption of unerupted teeth
  • extent of surgery: marsupialization is preferred in an unhealthy or debilitated patient, because it is simple and less stressful for the patient
  • size of cyst: in a very large cyst, there is a risk of fracture of jaw during enucleation procedure
22
Q

what are the contraindications for marsupialization

A
  • recurrent odontogenic keratocyst
  • recurring cysts
  • smaller cysts (smaller than 2x2 cm)
23
Q

what are the advantages of marsupialization

A
  • simple procedure to perform
  • spares vital structures
  • even quit large cyst can be dealt under LA as anesthesia of deeper recesses is not essential
  • allows eruption of teeth
  • prevents oronasal, oroantral fistula in the maxilla
  • reduces operating time
  • prevents intraoperative fractures
  • reduces blood loss, helps in shrinkage of cystic lining
  • allows for endosteal bone formation to take place
  • alveolar ridge is preserved
24
Q

what are the disadvantages of marsupialization

A
  • pathologic tissue is left in situ
  • histologic examination of entire cystic lining is not done
  • the need for regular postoperative care occurs over a substantial period of time
  • unpleasant taste and smell may occur due to accumulation of stagnant saliva and food debris in cystic cavity
  • changing of pack and adjustment of plug
  • secondary surgery may be needed
  • longer healing time
25
Q

what is enucleation

A

shelling out the entire cystic lesion without rupture

26
Q

what is enucleation indicated for

A

removal of cyst that is not very large in size and has minimum risk of injury to vital anatomical structures during the surgical procedure

27
Q

enucleation allows for:

A

cystic cavity to be covered by a mucoperiosteal flap and space fills with blood clot, which will eventually organize and form normal bone

28
Q

what are the indications for enucleation

A
  • treatment of common types of odontogenic cysts
  • recurrence of cystic lesions of any cyst type
  • should be employed with any cyst of jaw that can be safely removed without unduly sacrificing the adjacent structures
29
Q

what are the contraindications to enucleation

A
  • dentigerous cyst associated with teeth other than the third molars that would erupt normally in the oral cavity and be functional
  • young patients with erupting teeth
  • medically compromised or debilitated patients who require extensive surgical procedure to treat the cyst
  • proximity to vital structures
  • very large cysts, may cause fracture of jaw
30
Q

what are the advantages of enucleation

A
  • entire pathological tissue is removed
  • tissue available for histopathological examination
  • chances of recurrence are less
  • healing time is reduced
  • enucleation with primary closure eliminates need for repeated appointments for packing, irrigation, adjustment of plug
31
Q

what are the disadvantages of enulceation

A
  • in young patients, the unerupted teeth in a dentigerous cyst will have to be removed with the lesion
  • removal of large cyst may make mandible more prone for fracture
  • damage to adjacent vital structures
  • adjacent tooth may be devitalized
32
Q

describe the combination of marsupialization and cystectomy

A
  • cystectomy after marsupialization (decompression) is a conservative technique that decreases the size of the cystic cavity and reduces the risk of intrabony defects which could be induced by primary enucleation
  • can save the adjacent anatomic structures as surgery is carried out in two stages
  • stage 1: marsupialization
  • stage 2: cystectomy
33
Q

describe stage 1 of combination of marsupialization and cystectomy

A
  • marsupialzation is performed usually on huge cystic lesions on the mandible
  • a decrease in the size of the lesion and the growth of normal oral tissues was observed, the size of the lesion decreased until the time of cystectomy
34
Q

describe stage 2 of combination of marsupialization and cystectomy

A
  • cystectomy is carried out later after the size of the cyst decreases considerably in size over a period of time and surgery could be performed under LA
35
Q

what is curretage followed by peripheral ostectomy

A
  • peripheral bone reduction with powered hand piece and rotary instruments done after enucleation of the cystic lesion

Oral Surgery III (11 decks)

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