2 cyst- treatment plan

CYSTCYSTTREATMENT PLANTREATMENT PLAN

Dr.V.RAMKUMAR

CONSULTANT DENTAL&FACIOMAXILAARY SURGEON

REG: NO 4118-TAMILNADU-INDIA(ASIA)

OBJECTIVES FOR TREATMENT OF CYSTSOBJECTIVES FOR TREATMENT OF CYSTS

Removal of lining or rearrangement of Removal of lining or rearrangement of position of the abnormal tissue to ensure position of the abnormal tissue to ensure its elimination from the jaw its elimination from the jaw

Conservation of the unerupted teeth that Conservation of the unerupted teeth that may eventually serve the functional role in may eventually serve the functional role in the arch the arch

Preservation of adjoining anatomical Preservation of adjoining anatomical structure and maintaining their integritystructure and maintaining their integrity

Restoration of the affected area to its Restoration of the affected area to its original form original form

OPERATIVE PROCEDURESOPERATIVE PROCEDURES

IN PRECISE …IN PRECISE …

MARSUPIALIZATION MARSUPIALIZATION (DECOMPRESSION) (DECOMPRESSION)

ENUCLEATIONENUCLEATION

WALDRON’S PROCEDUREWALDRON’S PROCEDURE

ENUCLEATION WITH BONE GRAFT / ENUCLEATION WITH BONE GRAFT / RECONSTRUCTION.RECONSTRUCTION.

MARSUPIALIZATIONMARSUPIALIZATION Technique:Technique:

Anaesthesia – LA. Anaesthesia – LA.

Mucoperiosteal flap is reflected to expose Mucoperiosteal flap is reflected to expose the cystic wall. (circular, oval or elliptical the cystic wall. (circular, oval or elliptical incision)incision)

Cutting of adequate window (fenestration) Cutting of adequate window (fenestration) in the outer wall of the cystin the outer wall of the cyst

Relief of intracystic pressure, decrease in Relief of intracystic pressure, decrease in size of the cystsize of the cyst

Cont….Cont….

Ideally, the aperture should be large but Ideally, the aperture should be large but compatible with the size of the cystcompatible with the size of the cyst

Packed with iodoform gauze coated with Packed with iodoform gauze coated with tincture of benzoin to prevent tincture of benzoin to prevent contamination of the cavity and providing contamination of the cavity and providing coverage of the wound marginscoverage of the wound margins

Patency of marsupialized cyst cavity is Patency of marsupialized cyst cavity is maintained using acrylic plugmaintained using acrylic plug

MARSUPIALIZAION

Indications Indications

In young children with developing tooth In young children with developing tooth germs, where enucleation would damage the germs, where enucleation would damage the tooth bud. tooth bud.

In elderly, debilitated patient, marsupialization In elderly, debilitated patient, marsupialization is less stressful and a reasonable alternativeis less stressful and a reasonable alternative

In very large cysts, enucleation will lead to In very large cysts, enucleation will lead to pathological fracturepathological fracture

When proximity to vital structures could injure When proximity to vital structures could injure neurovascular bundles, create oronasal and neurovascular bundles, create oronasal and oroantral fistulas.oroantral fistulas.

AdvantagesAdvantages

Relative simplicityRelative simplicity Conservation with respect to adjacent Conservation with respect to adjacent

important tissuesimportant tissues Allows eruption of toothAllows eruption of tooth No risk of creating oronasal or oroantral No risk of creating oronasal or oroantral

fistulafistula Reduces blood lossReduces blood loss Prevents pathological fracturesPrevents pathological fractures No risk of damaging an adjacent major No risk of damaging an adjacent major

neurovascular bundleneurovascular bundle

DisadvantagesDisadvantages

Prolonged healing timeProlonged healing timePathological tissue is left insituPathological tissue is left insituPeriodic changing of packPeriodic changing of packLarge cyst space takes considerable Large cyst space takes considerable

time to filltime to fillRisk of invagination and new cyst Risk of invagination and new cyst

formationformationPeriodic irrigation of cavity.Periodic irrigation of cavity.

ENUCLEATIONENUCLEATION

PRINCIPLE :PRINCIPLE :

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

Technique Technique Anesthesia – LA / Conscious sedation / GA.Anesthesia – LA / Conscious sedation / GA.

ENVELOPE INCISION / TRAPEZOIDAL FLAP –Releasing ENVELOPE INCISION / TRAPEZOIDAL FLAP –Releasing incisions.incisions.

Bone is removed – create a window.Bone is removed – create a window.

Complete removal of the cystic lining & contents.Complete removal of the cystic lining & contents.

After enucleation, the underlying space fills with blood clot, After enucleation, the underlying space fills with blood clot, which eventually organizes to form normal bonewhich eventually organizes to form normal bone

Primary closurePrimary closure

Radiographs of the area at regular intervals to observe the Radiographs of the area at regular intervals to observe the reparative processreparative process

Case -1 Case -1

Intra oral appearance Occlusal view

Cont….Cont….

Exposure Bone - window

Cont….Cont….

Removal of the cystic lining CYSTIC LINING

Cont…Cont…

Closure OPG – Pre op

Case - 2Case - 2

Occlusal view Incision

Cont….Cont….

Exposure Bone -window

Cont…..Cont…..

Cyst enucleation Bone cavity

Cont…Cont…

Closure Impacted tooth in cystic cavity

Case -3 (OKC)Case -3 (OKC)

FACIAL APPEARANCE OPG

Cont….Cont….

EXCISION /HEMIMANDIBULECTOMY SPECIMAN

Case -4 (OKC)Case -4 (OKC)

OPG ENUCLEATION under GA

DisadvantagesDisadvantages

A dentigerous cyst in a young person may A dentigerous cyst in a young person may prevent the involved tooth from assuming prevent the involved tooth from assuming its normal position in the archits normal position in the arch

The removal of large cystic lesion in the The removal of large cystic lesion in the mandible, might weaken the jawmandible, might weaken the jaw

Pulpal necrosis, following enucleation of a Pulpal necrosis, following enucleation of a cyst involving apices of one or more cyst involving apices of one or more healthy teeth, for which the blood supply healthy teeth, for which the blood supply to the pulp passes through the capsule of to the pulp passes through the capsule of the lesionthe lesion

WALDRON’S PROCEDUREWALDRON’S PROCEDURE

Two stage procedureTwo stage procedure

First stage – Cyst is marsupialized and it is First stage – Cyst is marsupialized and it is allowed to shrink in size deriving the benefit allowed to shrink in size deriving the benefit of decompression during the early phaseof decompression during the early phase

Second stage – The patient is taken up for Second stage – The patient is taken up for cyst enucleation, once the cyst shrinks to cyst enucleation, once the cyst shrinks to manageable size and the cyst is totally manageable size and the cyst is totally eliminatedeliminated

Indications Indications

Bone has covered the adjacent vital Bone has covered the adjacent vital structuresstructures

Adequate bone fill has strengthened Adequate bone fill has strengthened the jaw to prevent fracture during the jaw to prevent fracture during enucleationenucleation

Patient finds it difficult to cleanse the Patient finds it difficult to cleanse the cavitycavity

For detection of any occult For detection of any occult pathological condition.pathological condition.

Advantages Advantages

Development of thickened cystic Development of thickened cystic lining, which makes enucleation lining, which makes enucleation easiereasier

Spares adjacent vital structuresSpares adjacent vital structuresAccelerated healing periodAccelerated healing periodReduces morbidityReduces morbidity

Disadvantages Disadvantages

Patient has to undergo secondary Patient has to undergo secondary surgery and the possible surgery and the possible complications that are involved with complications that are involved with any surgical procedure.any surgical procedure.

THANK YOUTHANK YOU