SEMINAR

SURGICAL MANAGEMENT OF ODONTOGENIC CYSTS

SUBMITTED BY YASMIN MOIDIN

2008 BatchAl Azhar Dental College

Principle of Treatment

1. local anesthesia.

2. Types of Flaps.

3. Surgical removal the of the

cyst .

Local anesthesia

Types of Flaps

1. Trapezoidal flap.

Advantage : Provides excellent

access, allows surgery to be

performed on more than two teeth,

produces no tension in the tissues

allows easy reapproximation of the

flap to its original position.

Disadvantages: Produces a

defect in the attachedgingiva

Types of Flaps

2. Triangular Flap.

Advantage : Ensures an

adequate blood supply, satisfactory

visualization, very good stability .

Disadvantages: Limited access

to long roots, tension is created

when the flap is held with a

retractor, and it causes a defect in

the attached gingiva.

Types of Flaps

3. Envelope Flap. Advantage : Avoidance of vertical

incision and easy reapproximation to original position

Disadvantages: Difficult reflection (mainly palatally), great tension with a risk of the ends tearing, limited visualization in apicoectomies, limited access, possibility of injury of palatal vessels and nerves, defect of attached gingiva

Types of Flaps

4. Semilunar Flap.

Advantage : Small incision and easy

reflection, no recession of gingivae

around the prosthetic restoration.

Disadvantages: The incision being

performed right over the bone lesion

due to miscalculation, scarring in the

anterior area, difficulty of

reapproximation , limited access and

visualization, tendency to tear.

Surgical removal the of the cyst

Enucleation: This technique involves complete

removal of the cystic sac and healing of the

wound by primary intention. This is the most

satisfactory method of treatment of a cyst and is

indicated in all cases where cysts are involved,

whose wall may be removed without damaging

adjacent teeth and other anatomic structures.

Surgical removal the of the cyst

The surgical procedure for treatment of a

cyst with enucleation includes the

following steps:

1. Reflection of a mucoperiosteal flap.

2. Removal of bone and exposure of part of the cyst.

3. Enucleation of the cystic sac.

4. Care of the wound and suturing.

Surgical removal the of the cyst

Panoramic radiograph showing an extensive radicularlesion at the region of teeth 22, 23, 24

Clinical photograph of case

Surgical removal the of the cyst

Removal of maxillary cyst, with labial access. Incision for creating a trapezoidal flap.

Reflection of flap and exposure of surgical field.

Surgical removal the of the cyst

Removal of bone at the labial aspect respective to the lesion.

Osseous window created to expose part of the lesion.

Surgical removal the of the cyst

Removal of cyst from bony cavity, using hemostat and curette.

Surgical field after removal of lesion.

Surgical removal the of the cyst

Operation site after placement of sutures.

Panoramic radiograph and clinical photograph taken 2 months after the surgical procedure.

Surgical removal the of the cyst

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. In order to

create the surgical window, initially a circular

incision is made, which includes the

mucoperiosteum, the underlying perforated

(usually) bone, and the respective wall of the

cystic sac

Surgical removal the of the cyst

Marsupialization: After this procedure, the contents of the

cyst are evacuated, and interrupted sutures are placed around

the periphery of the cyst, suturing the mucoperiosteum 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. During that period, the wound margins will have

healed, establishing permanent communication. Irrigation of

the cystic cavity is performed several times daily, keeping it

clean of food debris and avertinga potential infection.

Surgical removal the of the cyst

Marsupialization method. Circular incision includes mucosa and periosteum.

Exposure of buccal cortical plate and removal of portion of bone with round bur

Enlargement of osseous

window with

rongeur

Surgical removal the of the cyst

Exposure of cyst after removal of

bone

Suturing of wound

margins with cystic wall

Surgical removal the of the cyst

Packing of cystic cavity

with iodoform gauz

Cystic cavity after insertion

of gauze

Thank you