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Title: Dentistry - Surgical Treatment of Cysts
Description: BDS3/4 level excellent Oral Medicine Notes from a Distinction-level student at King's College London Dental Institute. Notes are colourful, well-structured with images, tables and diagrams throughout. Detail is summarised into bullet points and short sentences with key terms etc.
Description: BDS3/4 level excellent Oral Medicine Notes from a Distinction-level student at King's College London Dental Institute. Notes are colourful, well-structured with images, tables and diagrams throughout. Detail is summarised into bullet points and short sentences with key terms etc.
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0Surgical Treatment – Radicular Cysts, Dentigerous Cysts and Odontogenic Keratocyst
SURGICAL TREATMENT OF CYSTS
Learning Objectives
• Recognize the clinical signs of cysts
...
• To be familiar with the management of cysts; surgical treatment options are follow-up
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o Bony hard swelling that may be palpable (bilateral palpation)
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• Missing/displaced/loose teeth/resorption of roots
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• +/- discharge of pus
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Swelling
• Palpable/visible swelling when cyst has expanded beyond the normal anatomical boundaries of the
bone
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• First enlargement is bony hard but as cyst enlarges the bone thins – bone can become so thin ! ‘eggshell
cracking’
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Palpation of this area results in a feeling of cracking an eggshell
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• Maxilla – swelling buccal or palatal
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Pain & Infection
• Commonly stated that cysts remain asymptomatic unless infected
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o 21 out of 24 radicular cysts were described as containing pus
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Vier FV, Figueiredo JA
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Int Endod J
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- Infected cysts are painful and patient may present with a large facial swelling
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• Chance finding on routine radiograph?
• Check for associations:
•
o Radicular Cyst ! Necrotic tooth/carious tooth/root resorption
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Cone beam CT
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o 3D and aids with diagnosis
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o Greater detail of surrounding structures (e
...
ID nerve in mandible)
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o Around the crown of a tooth – likely to be a Dentigerous Cyst
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• Discoloured tooth/history of trauma/sinus/abscess
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• Endofrost (-50°C) Vs
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Electric pulp testing
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" Not normal, could indicate nerve is inflamed (hyperalgesic)
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• Fluid filled cavity rules out granuloma/tumour (solid) or maxillary sinus (air)
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• Creamy, viscous fluid – presence of Keratin Odontogenic Keratocyst
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• BUT pus is also creamy
...
Creamy fluid (pus) viscous (ODK) – Presence of Keratin in an
Odontogenic Keratocyst (ODK)
...
o May be useful if concerned lesion is a tumour or likely to recur (Odontogenic Keratocyst)
...
o i
...
cyst enucleation & specimen sent to histopathology for diagnostic assessment
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Marsupialisation
• +/- enucleation of cyst
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Marsupialisation
• +/- delayed enucleation/excision
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• +/- curettage
• +/- peripheral ostectomy
• +/- Carnoy’s Solution
• +/- liquid nitrogen
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• Wide local excision
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• +/- reconstructive surgery
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o Presence of infection
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o Mandible/maxilla
...
g
...
Enucleation
Completely removing the cyst from bone
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• Removal of complete cyst, including epithelial and capsular layers from the bony walls & cavity
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o Cyst ‘peeled’ off bony cavity, ideally in one piece
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o Specimen sent to histopathology for diagnosis
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• 3 sided mucoperiosteal flap being raised with Warwick
James
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• Scalpel placed onto bone to cut down to periosteum
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Decompression
• Aim of decompression is to reduce size of cyst prior to
enucleation by relieving the pressure within the cyst
...
• Subsequent enucleation is usually needed post-decompression
...
• Healing/reduction in size of cyst by bone deposition in the
base of the cavity
...
• Excision of a window of soft tissue overlying cyst
...
• Only small amount of specimen tissue (from excised window) is
sent for histopathological examination
...
Pogrel MA
...
J Oral Maxillofac Surg
...
Excision
• Wide local incision
o Remove lesion with a margin of surrounding
normal bone
...
g
...
Radicular Cyst
Root canal treatment of non-vital teeth will enable small, probable Radicular cysts to regress, non-surgically
...
• RCT + cyst enucleation
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• Extraction of non-vital tooth +/- enucleation of cyst
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• Monitor tooth for symptoms and apical swelling
...
CASE STUDY
Apicectomy, Retrograde Root
• 49 year old female
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Residual Cyst
• Enucleation, no recurrence
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• Excision of incisive nerve common during procedure
...
Eruption Cyst
• Usually disappear/burst by themselves
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• This allows tooth to erupt
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• 26 year old male
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ODONTOGENIC KERATOCYST
• Check for other signs of Basal Cell
Naevus Syndrome (BCNS)
...
• Difficult to enucleate from bone in one
piece due to epithelial outpouches &
small satellite cysts within fibrous
Kaczmarzyk et al
...
keratocystic odontogenic tumour in relation to treatment modalities
...
marsupialization
...
Other Rare Cysts
• Lateral Periodontal Cyst
o Curettage/Enucleation
...
• Botryoid Odontogenic Cyst
o Conservative surgical excision with curettage
...
• Gingival Cyst of Adult
o Conservative excision
...
• Fast growing – limited expansion of bone and
resorption of structures
...
• Resorption of adjacent structures
...
Guess the Cyst!
• 35 year old male, non-smoker, fit and well
...
• Pain > 6 months, swelling labial sulcus ~1 month
...
Cortication & radiolucency visible
...
Is vitality testing reliable on
crowned teeth?
- Excision under GA
- Large 3 sided mucoperiosteal flap
raised
...
- Large cavity flushed and sutured
Title: Dentistry - Surgical Treatment of Cysts
Description: BDS3/4 level excellent Oral Medicine Notes from a Distinction-level student at King's College London Dental Institute. Notes are colourful, well-structured with images, tables and diagrams throughout. Detail is summarised into bullet points and short sentences with key terms etc.
Description: BDS3/4 level excellent Oral Medicine Notes from a Distinction-level student at King's College London Dental Institute. Notes are colourful, well-structured with images, tables and diagrams throughout. Detail is summarised into bullet points and short sentences with key terms etc.