1 of 48

Cysts of the jaws

2 of 48

Cyst is a pathologic cavity or sac within hard or soft tissue that contain fluid,semi fliud or gas.It may be lined by epithelium ,fibrous tissue or occasionally even by a neoplastic tissue

3 of 48

4 of 48

5 of 48

DIAGNOSIS

  • CLINICAL PRESENTATION
  • 1.ABSENCE OF TOOTH – DENTIGEROUS CYST
  • 2.PRESENCE OF CARIOUS /FRACTURED TOOTH –APICAL PERIODONTAL CYST
  • 3.INFECTED CYST – SOME DEGREE OF NEUROPRAXIA OF NERVE.

​

6 of 48

VITALITY OF TOOTH

  • APICAL PERIODONTAL CYSTS – NON VITAL TOOTH

​

  • INFECTED CYST – TEMPORARY ABSENCE OF VITAL RESPONSE IN ADJACENT TEETH BECAUSE OF PRESSURE INTERFERENCE WITH SENSORY TRANSMISSION FROM PULP.

7 of 48

RADIOGRAPHIC EXAMINATION

  • PERIPAICAL X RAYS FOR SMALL CYSTIC LESION
  • OCCLUSAL FILM FOR PALATAL BONE DESTRUCTION

​

8 of 48

Occlusal view

9 of 48

OPG

  • FULL EXTENT OF CYSTIC LESION

10 of 48

11 of 48

CT SCAN

  • LARGE CYSTIC LESION & MULTICYSTIC LESION

12 of 48

RADIOPAQUE DYES

  • RADIOPAQUE DYE ie LIPIODAL ARE INJECTED .
  • X RAY TAKEN
  • SHOWS THE SIZE & RELATIONS OF CYST
  • REMOVE CONTRAST MEDIA BY ASPIRATION

13 of 48

ASPIRATION

  • ASPIATION USING 18 GUAGE NEEDLE

​

14 of 48

15 of 48

BIOPSY

  • VALUABLE DIAGNOSTIC AID
  • DONE UNDER LA
  • CARE TAKEN TO PLACE THE BIOPSY INCISION TO ALLOW PROPER CLOSURE & PREVENT INFECTION.

16 of 48

OPERATIVE PROCEDURES

  • 1.MARSUPIALIZATION(DECOMPRESSION)
  • PARTSCH 1
  • PARTSCH 2
  • MARSUPIALIZATION BY OPENING INTO NOSE OR ANTRUM

17 of 48

2.ENUCLEATION

​

​

​

  • ENUCLEATION & PRIMARY CLOSURE

​

  • ENUCLEATION & PRIMARY CLOSURE WITH

​

  • RECONSTRUCTION/BONE GRAFTING

​

18 of 48

MARSUPIALIZATION

  • CREATING A SURGICAL WINDOW IN THE WALL OF THE CYST & REMOVAL OF CYSTIC CONTENTS.

19 of 48

INDICATIONS

  • IN YOUNG CHILD WITH DEVOLPING TOOTH GERMS
  • PROXIMITY TO VITAL STRUCTURES
  • SIZE OF CYST—ENUCLEATION RESULTS IN FRACTURE
  • VITALITY OF TOOTH- EFFECT MANY ADJACENT TEETH

20 of 48

ADVANTAGES

  • SIMPLE
  • ALLOWS ERUPTION OF TOOTH
  • SPARES VITAL STRUCTURES
  • PREVENTS ORONASAL& OROANTRAL FISTULAE
  • PEVENTS PATHOLOGICAL FRACTURES
  • ALVEOLAR RIDGE IS PRESERVED

21 of 48

DISADVANTAGE

  • PATHOLOGIC TISSUE IS LEFT BEHIND
  • HISTOLOGIC EXAMINATION OF ENTIRE CYSTIC LINING IS NOT DONE
  • LONG HEALING TIME
  • PROLONGED FOLLOW UP
  • SECONDARY SURGERY MAY BE NEEDED

​

22 of 48

SURGICAL TECHNIQUE

  • ANAESTHESIA LA/GA
  • INCISION – U SHAPED INCISION WITH BROAD BASE
  • MUCOPERIOSTEAL FLAP IS RAISED

23 of 48

24 of 48

REMOVAL OF BONE

  • THIN BONE DUE TO EXPANSION-INCISION THROUGH MUCOPERIOSTEUM,BONE &CYSTIC LINING INTO THE CYSTIC CAVITY.

25 of 48

SUTURING OF CYSTIC LINING TO EDGE OF ORAL MUCOSA

PACKING

26 of 48

PACKING

  • RIBBON GUAZE WITH ANTIBIOTIC OINTMENT/WHITE HEAD VARNISH/IODOFORM PASTE.
  • PREVENTS CONTAMINATION OF CAVITY WITH FOOD DEBRIS
  • PACK NEEDS CHANGING AT REGULAR INTERVALS(7-14 DAYS)

27 of 48

USE OF PLUG

  • ACRYLIC PLUG TO PREVENT CONTAMINATION OF CYSTIC CAVITY.

​

  • HEALING –TAKES TIME

28 of 48

WALDRON’S METHOD OR PARTSCH 2

  • TWO STAGE TECHNIQUE
  • FIRST MARSUPIALIZATION
  • WHEN CAVITY IS SMALLER – ENUCLEATION& ENTIRE TISSUE IS EXAMINED HISTOPATHOLOGICALLY

29 of 48

  • ADVANTAGES
  • 1.DEVOLOPMENT OF THICKENED CYSTIC LINING WHICH MAKES ENNUCLEATION EASIER

​

  • 2.ALLOWS HITOPATHOLOGICAL EXAMINATION OF RESIDUAL TISSUE
  • DISADVANTAGE
  • PATIENT NEEDS SECONDARY SURGERY

30 of 48

MARSUPIALIZATION BY OPENING INTO NOSE OR ANTRUM

  • OPENING BUCCALLY THROUGH A BONY WINDOW
  • MARSUPIALIZATION/ENUCLEATION
  • UNROOFING BY REMOVAL OF ANTRAL LINING BETWEEN 2 CAVITIES

31 of 48

  • INTRANASAL ANTROSTOMY MAY BE DONE
  • CAVITY PACKED WITH RIBBON GUAZE SOAKED IN ANTIBIOTIC OINTMENT

​

32 of 48

ENUCLEATION

  • INDICATIONS

​

  • 1.TREATMENT OF ODOTOGENIC KERATOCYST
  • 2.RECURRENCE OF CYSTIC LESIONS

33 of 48

  • ADVANTAGE
  • PRIMARY CLOSURE
  • RAPID HEALING
  • HISTOPATHOLOGICAL EXAMINATION OF ENTIRE CYSTIC LINING CAN BE DONE
  • DISADVANTAGE
  • DAMAGE TO ADJACENT VITAL STRUCTURES
  • WEAKENS THE MANDIBLE IN LARGE CYST
  • UNERUPTED TEETH IN DENTIGEROUS CYST WILL BE REMOVED

34 of 48

PROCEDURE

  • SMALL CYSTIC LESION – INTRA ORAL
  • LA/GA
  • INCISION AROUND THE NECK OF TOOTH & RELEASING INCISION AT EITHER ENDS.
  • EDENTULOUS ON THE ALVEOLAR CREST
  • CYST REMOVED IN ONE PIECE

35 of 48

36 of 48

37 of 48

38 of 48

39 of 48

40 of 48

TREATMENT

  • KERATOCYST –ENUCLEATION& CAUTERIZATION WITH CARNOY’S SOLUTION WHICH REDUCES RECURRENCE.

​

  • DENTIGEROUS CYST –MARSUPIALIZATION IN CHILDREN WHICH ALLOWS TOOTH TO ERUPT INTO OCCLUSION./ENUCLEATION.

​

  • RADICULAR(PERIODONTAL) CYST –NON VITAL TOOTH EXTRACTION/RCT.USUALLY ENUCLEATION WITH PRIMARY CLOSURE

41 of 48

MUCOCELE

  • TWO TYPES
  • 1.TRUE RETENTION CYST –LINED BY EPITHELIUM
  • 2.MUCOUS EXTRAVASATION TYPE –BY POOLING OF MUCUS

42 of 48

ETIOLOGY

  • TRAUMA TO SALIVARY GLAND DUCT
  • SITE – MAINLY SEEN ON THE LOWER LIP

​

43 of 48

CLINICAL FEATURE

  • SMALL IN SIZE
  • PAINLESS,SUPERFICIAL,WELL CIRCUMSCIBED SWELLING OF MUCOSA.
  • MUCOCELE MAY RUPTURE SPONTANEOSLY WITH LIBERATION OF VISCOUS FLUID
  • WITHIN FEW DAYS TO WEEKS, FLUID ACCUMULATES & LESION APPEARS.

44 of 48

TREATMENT

  • ENUCLEATION RESULTS IN RECURRENCE.

​

​

  • BEST TREATMENT-SURGICAL EXCISION WITH MINOR SALIVARY GLAND& SUROUNDING CONNECTIVE TISSUE

45 of 48

RANULA

  • MUCOCELE PRESENT ON FLOOR OF MOUTH BENEATH THE TONGUE
  • RESEMBLANCE TO FROG’S BELLY,SO TERMED RANULA
  • 2 TYPES
  • 1.SUPERFICIAL
  • 2.PLUNGING

46 of 48

CAUSES

  • TRAUMA TO DUCTS OF SUBLINGUAL SALIVARY GLAND

​

​

  • PLUNGING TYPE ,EXTRAVASATED MUCUS PASSES THROUGH MYLOHYIOD MUSCLE & COLLECTS IN SUBMANDIBULAR REGION

​

47 of 48

CLINICAL FEATURE

  • DOME SHAPED BLUISH SWELLING IN FLOOR OF MOUTH.
  • TONGUE RAISED AS IT ENLARGES
  • IN PLUNGING TYPE,FLUCTUANT EXTRA ORAL SUBMANDIBULAR SWELLING SEEN.

48 of 48

TREATMENT

  • SURGICALLY REMOVE THE SUBLINGUAL GLAND