Final stage of cystectomy and wound management
Before final closure of the surgical wound, the surgeon must perform retrograde filling of the root canals of the involved teeth. To stimulate tissue regeneration, the resulting intraosseous cavity is filled with osteoplastic materials. These include:
- Hydroxyapatite combined with collagen;
- "Ostim-100" — an ultra-high dispersion hydroxyapatite-based preparation;
- "Kergapiosteogel" — a composite material consisting of polyacrylamide gel and hydroxyapatite.
The mucoperiosteal flap is returned to its original position. The wound is sutured with silk, regular or chromic catgut. Important rule: a rubber drain must be left in the wound for 24 hours. Suture removal is scheduled for the 6th day.
Cystotomy: essence of the procedure and indications
During a cystotomy, only the outer (anterior) wall of the cyst is removed along with the adjacent bone. As a result, the intraosseous cavity connects with the oral vestibule, turning into an accessory oral cavity.
Main indications for the intervention:
- Large maxillary cysts that grow into the maxillary sinus and destroy the bone floor of the nasal cavity or the palatine plate.
- Extensive mandibular cysts causing severe bone thinning and creating a risk of pathological fracture.
- Mixed dentition period, when an attempt at complete enucleation of the capsule (radical cystectomy) can damage permanent tooth germs and disrupt occlusion.
Advantages and disadvantages of cystotomy
This method has its strengths and weaknesses.
Advantages:
- The surgery is technically simple and characterized by low invasiveness.
- The risk of damaging intact teeth, tooth germs (follicles), adjacent cavities, and neurovascular bundles is completely eliminated.
Disadvantages:
- The intervention is not radical.
- The oral cavity acquires accessory niches that require prolonged postoperative care.
- Open bone defects appear, worsening hygiene and promoting the development of inflammation.
- Postoperative jaw deformities are possible.
Cystotomy surgical technique
The intervention is performed under local anesthesia with preliminary premedication.
- Access: a semi-oval mucoperiosteal flap is outlined (with its base toward the transitional fold).
- Trepanation: the anterior wall of the jaw is removed, and a bone window is formed according to the size of the cyst.
- Working with the capsule: the outer wall of the cyst is excised, and sharp bone edges are smoothed with a bur.
- Flap placement: the mucoperiosteal flap is tucked directly inside the cystic cavity.
- Tamponade: the cavity is tightly tamponaded with a turunda containing Vishnevsky ointment or iodoform to press the flap down.
The first tampon replacement is done in a week. Overall, the course requires 3 to 5 replacements. In about 3–4 weeks, the cavity becomes epithelialized. (Note: in some classifications, the stages include flap elevation, bone trepanation, extirpation (complete removal) of the capsule, and flap return with suturing).
Oroantral cystectomy
This is a special modification of the surgery for cysts that have grown into the maxillary sinus.
Its principle is that the bone defect after cyst removal is combined with the sinus and an artificial communication with the inferior nasal meatus is created — a rinostomy is formed.
The surgery is indicated if the bone wall between the cyst and the sinus is very thin or already perforated. However, if the thickness of this separating bone partition is several millimeters or more, performing the intervention using this technique is strictly contraindicated.
Briefly: answers to topical questions
What are the types of odontogenic jaw cysts?
Odontogenic jaw cysts are classified into several types depending on their origin. The following main groups are distinguished:
- Dysembryogenetic cysts — developmental malformations, which include follicular (tooth-containing), lateral periodontal, eruption, gingival, odontogenic keratocyst (primordial), and glandular odontogenic cysts.
- Inflammatory cysts — acquired formations, including radicular (apical, lateral, residual) and paradental cysts.
- Subperiosteal cysts — singled out into a separate group by localization and origin.
What materials are used for retrograde root canal filling during a cystectomy?
For retrograde root canal filling, exclusively hard-setting materials are used, ensuring maximum adaptation to the canal walls. In surgical practice, the following are used:
- Silver amalgam — a traditional filling material.
- Glass ionomer cements — modern materials (e.g., "Fuji" or "Kemfil" preparations).
What intraoperative complications can occur during the enucleation of the cyst capsule?
During a cystectomy in the mixed dentition period, damage to permanent tooth germs is possible, which can lead to impaired formation of normal occlusion.
What surgical instruments are needed for jaw trepanation and cyst removal?
For working with bone tissue and trepanation, trephines, burs, and drills are indicated in the sources. For bone edge preparation, burs and bone rongeurs are used. For reflecting the mucoperiosteal flap, instruments for gum and periosteum detachment are used, including a raspatory; for tissue retraction — Langenbeck and Farabeuf retractors, spatulas, and Buyalsky spatula. Tweezers and clamps are also used.
CystECTOMY — complete removal (extirpation) of the capsule. CystOTOMY — creation of a window (only communication with the oral cavity).
Class and exam questions
What is done with the tooth in the treatment of a follicular cyst?
Causal teeth that served as the source for the development of such a neoplasm are subject to mandatory extraction.
On which postoperative day are sutures removed after closure of the cystic cavity?
Suture removal after surgery is performed on the 6th day.
In which cases is oroantral cystectomy contraindicated?
It is not performed if the thickness of the bone wall separating the cyst cavity from the maxillary sinus is several millimeters or more.
What else to study on this topic
- Osteoplastic materials: hydroxyapatite, "Ostim-100" and "Kergapiosteogel"
- Protocol for retrograde root canal filling in surgery
- Formation of a rinostomy: surgical nuances
- Method of tamponading accessory oral cavities with iodoform
Master the entire topic in the course "Surgical Dentistry"
This is a summary. The course covers everything tested in classes and exams.
- Complete textbook on "Cystectomy" and 866 more pages of the subject
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 28 video lessons on the subject
Other topics in "Chapter 7. Jaw Cysts (T.G. Faizov)"
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