surgical management of odontogenic cysts
DESCRIPTION
ORAL AND MAXILLOFACIAL SURGERYTRANSCRIPT
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
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