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PRESENTED BY:
FASAHAT AHMED BUTT
CYST
OBJECTIVES
What is cyst?Types of cystsa. Clinical featuresb. Radiographic
findingsc. Histology Diagnosis Treatment
A cyst is a pathological fluid filled cavity lined by
epithelium.
CYST
TYPES OF CYSTS
Gingival cyst Periodontal cyst
GINGIVAL CYST LOCATION: Lingual surface of mandibular canine and premolars. COLOR: Bluish gray. APPEARANCE: Nodular and resembles mucocele CONTOURLocalized enlargement. PAINLESS ATTACHED or MARGINAL GINGIVA
ORIGINDevelop from odontogenic epithelium or from surface or sulcular epithelium
RADIOGRAPHIC FINDINGS
No radiographic findings because the usually involve the soft tissues
HISTOLOGY
Gingival cyst cavity is lined by a thin , flattened
epithelium with or without localized areas of thickening.
Types of epithelium Non keratinized stratified squamous epithelium Keratinized stratified squamous epithelium Parakeratinized epithelium with palisading basal cells
PERIODONTAL CYST(Lateral Periodontal Cyst)
Uncommon lesion.Localized destruction of periodontal tissues.Lateral root surface. LOCATION Mandibular canine-premolar area.ORIGINDerived from rests of Malassez.CONTOURLocalized enlargementASYMPTOMATICPAINFUL
RADIOGRAPHIC FINDINGS
Interproximal periodontal cyst appears on the side of the root as a radiolucent area bordered by a radiopaque line.
Periodontal abscess is difficult to differentiate from periodontal cyst, radiographically
`
Cyst Abscess
Filled with fluid<1.5cmGingiva appears
bluish gray
Filled with puss 2-10cmGingiva appears
red
HISTOLOGY
Cystic lining may be a loosely arranged , thin, nonkeratinized epithelium, sometimes with thicker proliferating areas.
DIAGNOSIS
CLINICAL FINDINGSRADIOGRAPHBIOPSY
TREATMENT
Treatment is surgical excision and histopathologic examination for a conclusive diagnosis.
ENUCLEATIONMARSUPIALIZATIONCOMBINATION ENUCLEATION WITH CURETTAGE
ENUCLEATION
Enucleation means shelling out the entire cystic lesion without rupture.
INDICATION:Small cyst, which can be done when the vital
structures are not involved.
Local Anesthesia
Flap design is made
Incision made according to the
designTooth
extraction
Bur and forcep
Intraosseous window
Irrigation to clean the
cavity
Closure by suture (6-12
months)
MARSUPIALIZATIONMarsupialization refers to creating a surgical
window in the wall of the cyst, excavating the contents of the cyst and maintaining continuity between the cyst wall and the oral cavity.
This process decreases the pressure inside the cyst,
and promotes shrinkage of the cyst as well as bone fill.
INDICATIONS:If surgical access is difficultUnerupted tooth involved Small cyst
Prophylactic antibiotic
Anesthesia
Marsupialization
Others
Aspiration
Thin bone
Cavity
IncisionCircular or Eleptical
Large window
Thick bone Bur
SuturedPt instructed for cleansing
of cavity
Contents are evacuated
Irrigation via normal saline
COMBINATIONCombined approach morbidity and
complete healing of the defect. In this technique marsupialization is done
first and the enucleation is done at a later date.
The advantage is that as marsupialization is done first, it spares the vital structures. The size of the cystic cavity also becomes small and after healing the cystic lining becomes thick, making enucleation easier at this stage.
ENUCLEATION WITH CURETTAGE
After enucleation is done, a curette or bur is used to remove 1 to 2 millimeter of bone around the entire periphery of cystic cavity.
INDICATIONSFor cysts reported to have high recurrence rate, for
example odontogenic keratocyst
AdvantagesIf enucleation leaves any remnants, curettage may remove
them thereby decreasing the likelihood of recurrence.DisadvantageCurettage is more destructive to adjacent bone, blood
vessels and nerves therefore extreme care has to be taken to prevent this.
REFERRENCES
CARRANZAEOPGOOGLE