Surgical Mgmnt of Odontogenic cysts Flashcards
What is the most common odontogenic cyst?
Periapical cyst
A benign pathologic cavity within bone or in soft tissues, generally formed by a
connective tissue wall.”
The cavity, within the oral regions, is almost always lined by epithelium. The lumen usually contains fluids, keratin or cellular debris.
cyst
Cyst derived from rest cell of Malassez
Periapical cyst
Cyst derived from reduced enamel epithelium
Dentigerous cyst
What is the most common inflammatory cyst in oral cavity?
radicular cyst
Cyst derived from dental lamina (Rest of Serrae)
OKC
Do cysts or tumors more commonly cause paresthesia/dystesia?
Tumors
To rule out vascular lesions, cystic Lesions, solid tumors and inflammatory conditions.
Aspiration
What size needle should be used for aspiriation?
18 gauge
_____ describes 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.
For this procedure, it is important to create a bony window to expose the cyst in the
maxilla or mandible.
Curettage
______ refers to creating a surgical window in the wall of cyst & evacuation
of cystic contents.
This process decreases intracystic pressure & promotes shrinkage of cyst & bone fill
(endosteal bone formation)
Marsupialization
________ is a substance used as a complementary treatment after the conservative excision of odontogenic
keratocyst. The application of this promotes a superficial chemical necrosis and is intended to reduce recurrence
rates. The application of this, a chemical solution composed of 60% ethanol, 30% chloroform, and 10% acetic
acid, in conjunction with surgery, is known to reduce the rate of KOT recurrence. An FDA ban in 2013 on the use of
chloroform for compounding led a number of surgeons to adopt a modified Carnoy’s solution in the use of Odontogenic
Keratocyst
Carnoy’s solution
Indications of ____
Anatomical considerations – Proximity of cyst to vital structures like maxillary sinus, Neurovascular bundle.
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 a unhealthy or debilitated patient , because it is simple & less stressful for patient.
Size of cyst – In a very large cyst, there is a risk of fracture of jaw during enucleation procedure.
Marsupialization
Contraindications for ____
Recurrent Odontogenic Keratocyst
Recurring Cysts
Smaller Cysts (< 2X2 cm)
Marsupialization
Adv of ____
Simple procedure to perform.
Spares vital structures eg. blood vessels, nerves
Even quite large cyst can be dealt under Local anesthesia as anesthesia of deeper recesses is not essential.
Allows eruption of teeth.
Prevents oronasal, oroantral fistulae 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.
Marsupialization
Dis adv of _____
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 & food debris in cystic cavity.
Changing of pack and adjustment of plug.
Secondary surgery may be needed.
Longer healing time.
Marsupialization
Indications for _____:
Treatment of Common types of odontogenic cysts
(odontogenic keratocysts, Radicular cysts, Dentigerous cyst etc.,)
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.
Enucleation
Contraindications for ______
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.
Enucleation
Adv of _____
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 etc.
Enucleation
Dis adv of _____
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.
Enucleation
means shelling out the entire cystic lesion without rupture.
This procedure is usually indicated for removal of cyst that is not very large in size
and has minimum risk of injury to vital anatomical structures during the surgical
procedure.
allows for cystic cavity to be covered by a mucoperiosteal flap & the
space fills with blood clot, which will eventually organize & form normal bone.
Enucleation
After a marsupialization is done and the cystic cavity persists, what should be done?
Cystectomy
Should marsupialization or cystectomy be done first in a 2 step approach?
Marsupialization
is defined as a peripheral bone. reduction with
powered hand-piece and rotary instruments, done after enucleation of the
cystic lesion.
Peripheral ostectomy
