Wilman: Good Afternoon guys, today we would like to present to you about Surgical Radicular Cysts, We consist

of Wilman R M as Presenter 1, Azizah as Presenter 2 and Adel as

Presenter 3, okay then let’s move to the first one, What is Radicular

Cysts?

What is Radicular Cysts

• Radicular (periapical) cysts are

pathological cavities, lined with epithelium,

and contain f luid or semi fluid material.

Clinical Presentation

• The majority of radicular cysts are asymptomatic,

• unless they are suppurated, whereupon pain as well as other symptoms occur.

Radiographic Examination

• Radicular cysts present as osteolytic or radiolucent lesions (round or oval in shape) with well-defined radiopaque borders,

• unless they have been infected, whereupon the radiopaque periphery does not exist.

• Wilman: The next one is Surgical Technique and it will present to you by Adel and Azizah

• Azizah: Hello guys, I’d like to present to you about Surgical Technique, (Masuk slide Surgical) Two techniques are employed in clinical practice for the surgical removal of cysts: Enucleation and marsupialization, I’ll present tou you about Enucleation Technique.

Surgical Technique

• Two techniques are employed in clinical practice for the surgical removal of cysts: Enucleation and marsupialization

enucleationThis technique involves complete removalof the cystic sac and healing of the wound byprimary intention. This is the most satisfactory methodof treatment of a cyst and is indicated in all caseswhere cysts are involved, whose wall may be removedwithout damaging adjacent teeth and other anatomicstructures.

Enucleation

The surgical procedure for treatment of a cyst with enucleation includes the following steps:•Reflection of a mucoperiosteal flap.•Removal of bone and exposure of part of the cyst. •Enucleation of the cystic sac.•Care of the wound and suturing.

After taking a radiograph to determine the exactlocalization and size of the lesion, a trapezoidal flap iscreated, whose extent must ensure adequate accessand visualization of the surgical field

After reflection of the mucoperiosteum, the bonecovering the lesion is evaluated, which, as mentionedabove, may be normal, thinned, or completely destroyed.In normal bone, a round bur is used to remove aportion of the buccal cortical plate covering the cyst,and, depending on its extent, a rongeur may be used to enlarge the osseous window created The osseous window must be large enough so that allparts of the cystic cavity may be accessed and removedwithout particular difficulty.

If the bony wall is thinned or perforated, it is removedperipherally with a rongeur, until it reachescompact bone. A curette is used for enucleation of small cysts, while for larger cysts, the broad end of a periosteal elevator is preferred, which is placed inside the cavity pressing gently between the cystic wall and bone, while the cyst is carefully grasped with forceps

After removal of the cysts, a curette is used to inspectthe cavity for the presence of remnants of thecyst, and copious irrigation with saline solution andsuturing of the flap follow

Azizah: then this is the picture of Enucleation Surgical Technique

gambar 1Removal of maxillary cyst, with labial access. Incision for creating a trapezoidal flap. a Diagrammaticillustration. b Clinical photograph

gambar 2

Reflection of flap and exposure of surgical field. a Diagrammatic illustration. b Clinical photograph

gambar 3Removal of bone at the labial aspect

respective to the lesion. a Diagrammatic illustration. b Clinical photograph

gambar 4Osseous window created to expose part of the lesion. a Diagrammatic illustration. b Clinical photograph

gambar 5Removal of cyst from bony cavity, using hemostat and curette. a Diagrammatic illustration. b Clinical photograph

gambar 6Surgical field after removal of lesion. a Diagrammatic illustration. b Clinical photograph

gambar 7Operation site after placement of sutures. a Diagrammatic illustration. b Clinical photograph

Azizah: The next one is Marsupilation Surgical Technique, and it will present to you by Azizah

Adel: Hello, I’d like to present to you about Marsupialization Surgical Technique

Marsupialization. This method is usually employed for the removal of large cysts and entails opening a surgical window at an appropriate site above the lesion

Marsupialization

• In order to create the surgical window, initially a circular incision is made, which includes the muco- periosteum, the underlying perforated (usually) bone, and the respective wall of the cystic sac

After this procedure, the contents of the cyst are evacuated, and interrupted sutures are placed around the periphery of the cyst, suturing the muco- periosteum and the cystic wall together

Afterwards, the cystic cavity is irrigated with saline solution and packed with iodoform gauze, which is removed a week later together with the sutures.

Adel: then this is the picture of Marsupialization Technique

gambar 1

Radiograph showing extensive mandibular cyst.The marsupialization method is indicated for its treatment

gambar 2Treatment of mandibular cyst with marsupializationmethod. Circular incision includes mucosa andperiosteum

gambar 3 Exposure of buccal cortical plate and removal ofportion of bone with round bur

gambar 4Enlargement of osseous window with rongeur

gambar 5

Exposure of cyst after removal of bone

gambar 6Suturing of wound margins with cystic wall

gambar 7

Packing of cystic cavity with iodoform gauze

gambar 8Cystic cavity after insertion of gauze

Wilman: Okay Friends, Thanks for your Attention, We open up the Answer and Question Section, please raise your hand if you want to Ask something about our topic