Surgical Mgmnt of Odontogenic cysts

Question 1

What is the most common odontogenic cyst?

Answer 1

Periapical cyst

Question 2

A benign pathologic cavity within bone or in soft tissues, generally formed by a
connective tissue wall.”

The cavity, within the oral regions, is almost always lined by epithelium. 

The lumen usually contains fluids, keratin or cellular debris.

Answer 2

cyst

Question 3

Cyst derived from rest cell of Malassez

Answer 3

Periapical cyst

Question 4

Cyst derived from reduced enamel epithelium

Answer 4

Dentigerous cyst

Question 5

What is the most common inflammatory cyst in oral cavity?

Answer 5

radicular cyst

Question 6

Cyst derived from dental lamina (Rest of Serrae)

Answer 6

OKC

Question 7

Do cysts or tumors more commonly cause paresthesia/dystesia?

Answer 7

Tumors

Question 8

To rule out vascular lesions, cystic Lesions, solid tumors and inflammatory conditions.

Answer 8

Aspiration

Question 9

What size needle should be used for aspiriation?

Answer 9

18 gauge

Question 10

_____ describes a surgical scraping of the cyst from the bony walls of the maxilla
or mandible with a special instrument called a curette that has a scoop, at its tip.

 For this procedure, it is important to create a bony window to expose the cyst in the
maxilla or mandible.

Answer 10

Curettage

Question 11

______ refers to creating a surgical window in the wall of cyst & evacuation
of cystic contents.

 This process decreases intracystic pressure & promotes shrinkage of cyst & bone fill
(endosteal bone formation)

Answer 11

Marsupialization

Question 12

________ is a substance used as a complementary treatment after the conservative excision of odontogenic
keratocyst. The application of this promotes a superficial chemical necrosis and is intended to reduce recurrence
rates. The application of this, a chemical solution composed of 60% ethanol, 30% chloroform, and 10% acetic
acid, in conjunction with surgery, is known to reduce the rate of KOT recurrence. An FDA ban in 2013 on the use of
chloroform for compounding led a number of surgeons to adopt a modified Carnoy’s solution in the use of Odontogenic
Keratocyst

Answer 12

Carnoy’s solution

Question 13

Indications of ____
 Anatomical considerations – Proximity of cyst to vital structures like maxillary sinus, Neurovascular bundle.

 Surgical access – If access to all portions of cyst is difficult.

 Assistance in eruption of teeth – In a young patient with a dentigerous cyst, it permits eruption of unerupted teeth.

 Extent of surgery – Marsupialization is preferred in a unhealthy or debilitated patient , because it is simple & less stressful for patient.

 Size of cyst – In a very large cyst, there is a risk of fracture of jaw during enucleation procedure.

Answer 13

Marsupialization

Question 14

Contraindications for ____
Recurrent Odontogenic Keratocyst

Recurring Cysts

Smaller Cysts (< 2X2 cm)

Answer 14

Marsupialization

Question 15

Adv of ____
 Simple procedure to perform.

 Spares vital structures eg. blood vessels, nerves

 Even quite large cyst can be dealt under Local anesthesia as anesthesia of deeper recesses is not essential.

 Allows eruption of teeth.

 Prevents oronasal, oroantral fistulae in the maxilla
 Reduces operating time.

 Prevents intraoperative fractures.

 Reduces blood loss, helps in shrinkage of cystic lining.

 Allows for endosteal bone formation to take place.

 Alveolar ridge is preserved.

Answer 15

Marsupialization

Question 16

Dis adv of _____
 Pathologic tissue is left in situ.

 Histologic examination of entire cystic lining is not done.

 The need for regular postoperative care, occurs over a substantial period of time.

 Unpleasant taste and smell may occur due to accumulation of stagnant saliva & food debris in cystic cavity.

 Changing of pack and adjustment of plug.

 Secondary surgery may be needed.

 Longer healing time.

Answer 16

Marsupialization

Question 17

Indications for _____:
 Treatment of Common types of odontogenic cysts
(odontogenic keratocysts, Radicular cysts, Dentigerous cyst etc.,)

 Recurrence of cystic lesions of any cyst type.

 Should be employed with any cyst of jaw that can be safely removed without
unduly sacrificing the adjacent structures.

Answer 17

Enucleation

Question 18

Contraindications for ______
 Dentigerous cyst associated with teeth other than the third molars that would erupt
normally in the oral cavity and be functional.

 Young patients with erupting teeth.

 Medically compromised or debilitated patients who require extensive surgical
procedure to treat the cyst.

 Proximity to vital structures.

 Very large cysts, may cause fracture of jaw.

Answer 18

Enucleation

Question 19

Adv of _____
 Entire pathological tissue is removed.

 Tissue available for histopathological examination.

 Chances of recurrence are less.

 Healing time is reduced.

 Enucleation with primary closure eliminates need for repeated appointments for
packing, irrigation, adjustment of plug etc.

Answer 19

Enucleation

Question 20

Dis adv of _____
 In young patients, the unerupted teeth in a dentigerous cyst will have to be removed
with the lesion.

 Removal of large cyst may make mandible more prone for fracture.

 Damage to adjacent vital structures.

 Adjacent tooth may be devitalized.

Answer 20

Enucleation

Question 21

 means shelling out the entire cystic lesion without rupture.

 This procedure is usually indicated for removal of cyst that is not very large in size
and has minimum risk of injury to vital anatomical structures during the surgical
procedure.

 allows for cystic cavity to be covered by a mucoperiosteal flap & the
space fills with blood clot, which will eventually organize & form normal bone.

Answer 21

Enucleation

Question 22

After a marsupialization is done and the cystic cavity persists, what should be done?

Answer 22

Cystectomy

Question 23

Should marsupialization or cystectomy be done first in a 2 step approach?

Answer 23

Marsupialization

Question 24

is defined as a peripheral bone. reduction with
powered hand-piece and rotary instruments, done after enucleation of the
cystic lesion.

Answer 24

Peripheral ostectomy