Cyst & Preprosthetic Surgery PDF

NONODONTOGENOUS CYSTS NONODONTOGENOUS CYSTS It consists of ectodermal remnants (non- odontogenous) that do not have the potential to form teeth. 1-Nazopalatine duct cyst (incisive duct cyst) 2-Nazolabial cyst NONODONTOGENOUS CYSTS nasopalatine duct cyst (incisive du...

NONODONTOGENOUS CYSTS NONODONTOGENOUS CYSTS It consists of ectodermal remnants (non- odontogenous) that do not have the potential to form teeth. 1-Nazopalatine duct cyst (incisive duct cyst) 2-Nazolabial cyst NONODONTOGENOUS CYSTS nasopalatine duct cyst (incisive duct cyst) Develops from epithelial remnants of the nasopalatine duct in the embryo It is the most common in this group More common in the 5th decade The type that develops without bone involvement is 'incisive papilla cyst' Incisive duct cyst Does not reach large dimensions Swelling of the posterior mucosa of the central teeth Teeth vital It is often resisted, a sense of salty taste is taken. Incisive duct cyst Radiolucent area between central tooth roots Round or oval (sometimes heart- shaped) A large foramen insisivum may be difficult to distinguish from a small cyst (widest diameter of the foramen: 6mm) Nasolabial cyst (nasoalveolar cyst) It is thought to develop from epithelial remnants of the merger of the medial nasal and lateral nasal extensions or from epithelial remnants of the nasolacrimal duct It is a soft tissue cyst (does not appear on radiograph, sometimes it may show a depression area in the bone) F/E=3/1, 40-60 years old, occasionally bilateral INFLAMMATORY CYSTS INFLAMMATORY CYSTS Radicular cysts Apical Lateral Residual cysts INFLAMMATORY ODONTOGENIC CYSTS (2017) Radicular Cyst Collateral Inflammatory Cyst Radicular cyst In the apical or lateral relationship in the root of the erupted non-vital tooth Malessez epithelial remnants Radicular cyst Factors driving cyst development Proliferation of epithelium Hydrostatic pressure of the cyst fluid Resorption of the surrounding bone (prostoglandinII-I) Radicular cyst clinical The most common odontogenic cysts Between the ages of 20-60 Male/female=2/1 Mak./mand=3/1 Mak. Anteior, posterior, man.post., man., ant, Associated tooth non-vital Usually asymptomatic It shows symptoms when infected. Radicular cyst Radiology Round radiolucent at the apex of the tooth Fine radiopaque boundary in the environment Small lesions cannot be differentiated from periapical granuloma Root resorption can be seen in large sizes Radicular cyst differential diagnosis Periapical granuloma Periapical scar Periapical cemento-oseous dysplasia Radicular cyst histology Lined with multilayered squamous epithelium Hyperplastic connective tissue with multivessel wall PMN leucocytes, lymphocytes, plasma cells, russel bodies Cyst fluid contains collesterin crystals Radicular cyst treatment Apical resection + enucleation for small diameter and anterior teeth Tooth extraction + enucleation in large ones * Complete enucleation of the cyst prevents residual cyst formation  COLLATERAL INFLAMMATORY CYST Inflammatory cysts other than radicular cysts, heading COLLATERAL INFLAMMATORY CYSTS under the following categories. COLLATERAL INFLAMMATORY CYST Inflammatory cysts other than radicular cysts, COLLATERAL INFLAMMATORY It is grouped under the title of CYSTS. PARADENTAL CYSTS are cysts in the lower 20 age zone. COLLATERAL INFLAMMATORY CYST Cysts located on the buccal surface of erupted 1st and 2nd molars are called BUCHAL BIFURCAYON CYST. RESIDUAL CYST A cyst remaining at the site of a previously extracted tooth Differential diagnosis: haemangioma, Unicystic ameloblastoma Adenomatoid odontogenic tumour Neurilemma Treatment: enucleation Epithelioid jaw cysts (pseudocyst - false cyst) Epithelioid jaw cysts (pseudocyst - false cyst) Solitary bone cyst (traumatic bone cyst, simple bone cyst, haemorrhagic bone cyst) Stafne bone cyst Aneurysmal bone cyst TRAUMATISED BONE BONE as simple bone cyst, haemorrhagic bone cyst, extravasation cyst, solitary bone cyst is also known.  Traumatic bone cyst Although its occurrence is unknown, trauma at a level that does not cause fracture Usually asymptomatic Air in aspiration Radiolucent area between tooth roots Teeth vital, no resorption of tooth roots Treatment: ventilation TRAUMATISED BONE BONE It is not a real cyst. It is called by this name because it imitates real cysts very well. The cause of the lesion is unknown. However, it is discussed to be a response to trauma. It is known that it occurs when the clot formed by haemorrhage after trauma is organised and cannot be removed, resulting in the formation of a cavity in the area by liquefaction. ▪ It is usually painless and asymptomatic. Occasional pain or numbness may be present. The teeth in the affected area are vital, but nonvital teeth have also been reported. These are secondary devitalised teeth. ▪ Many lesions are discovered during routine radiographic examination. Needle aspiration yields no product; when something is obtained, it is usually a few millilitres of straw-coloured fluid. ▪ The cyst has no epithelium. The cavity is empty, sometimes with some blood clots. ▪ The lesion manifests radiographically as a well- demarcated radiolucency in young patients. The radiolucency penetrates between the roots but there is no loss of lamina dura in the teeth. ▪ A vague cortical extension may occur, most commonly in the buccal direction. However, it is generally said not to produce cortical expansion. ▪ No pathological fracture is seen. ▪ Treatment is to open and ventilate the cavity, the cavity is bled, washed and sutured. There are also those who say that it can be left untreated and disappear in advanced ages. ▪ Differential diagnosis; ▪ periapical cyst ▪ central giant cell granuloma, ▪ ameloblastoma ▪ odontogenic mixoma ▪ eosnophilic granuloma ▪ fibrous diplasia Stafne bone cyst Consists of salivary gland residues On the lingual surface of the mandible, localised under the inferior alveolar canal, anterior to the angulus It is asymptomatic. It is not a pathology. Well circumscribed, oval, radiolucent, as if pierced with a stapler It is seen in adults, there is no complaint. No treatment is necessary, it is monitored. Aneurysmal bone cyst Blood-filled cavity, surrounded by epithelium-free fibrous tissue Could it be the result of trauma or vascular malformation? In young adults Mandibular molar and ramus region  ANEURYSMAL BONE CYST It may cause swelling on the face due to enlargement of the bone cortex. There is usually a complaint of pain and the swelling area is tender on palpation. Although the cortex is thinned, it does not open and the periosteum is preserved. There may be paresthesia and pressure sensation. Aspiration in this lesion is a recommended practice before biopsy, venous blood comes. There may be crepitation on palpation.  Treatment is curettage. Soft tissue cysts around the mouth  Soft tissue cysts around the mouth Eruption, gingival, nasolabial cysts Dermoid cysts Thyroglossal cysts Branchial cysts Salivary gland cysts DERMOID CYSTS In the embryo, all elements of the skin (dermoid) or only the epidermis (epidermoid) are interposed between the tissues The cyst sac consists of skin folds The content is yellowish, sludge-like.  DERMOID CYSTS clinical It is localised on the cheek or under the chin (medially on the hyoid between m.genioglossus- m.geniohyoidus and under m.mylohyoidus). Unilocular Slow growth In children, occasionally after 40 years of age DERMOID CYSTS clinical Swelling inside the mouth and under the jaw Mobile if there is no bone adhesion Movement into the mouth or under the jaw in the direction of compression on bimanual examination Painless and rubbery when small Difficulty in swallowing and speech when it increases in size  DERMOID CYSTS treatment Extirpation through extra oral incision Difficult to remove by oral approach RG, CT and MRI with contrast medium to determine the boundaries of the lesion  Thyroglossal duct cysts and fistulas It is formed from the remnants of the ductus thyroglossus, which forms the median lobe of the thyroid gland, which disappears in the 6th week of intrauterine life Localised in the midline of the neck, between the foramen cecum of the tongue and the fork of the sternum Occasionally slightly to the side of the centre line Thyroglossal duct cysts and fistulas Present at birth A single mass Movement during swallowing Difficulty swallowing and swallowing when localised in the tongue Easily infected and painful Suppuration followed by fistula Then continuous discharge Thyroglossal duct cysts and fistulas treatment Surgical excision of the cyst and fistula Removal of part of the hyoid bone also prevents recurrence Care is taken not to remove thyroid tissue during the operation (myxoedema) Surgery can be performed at any age. BRANCHIATAL CYSTS It develops from the epithelium remaining from the branchial arches during the embryological period Below the angulus, along the anterior border of the sternocleidomastoid muscle Soft and fluctuant swelling Painless After an upper respiratory tract infection can become infected and pain begins Treatment is surgical SALIVARY GLAND CYSTS Mucous extravasation cyst - Mucocele - Ranula Mucous retention cyst MUKOSEL Small salivary gland ducts are easily traumatised under the mucosa and secretions accumulate under the mucosa. Over time, a pseudocyst develops in the soft tissue, which contains saliva. MUCOCEL: If the lesions are on the lower lip and cheek, it is called mucocele.  RANULA At the base of the mouth, it is called Ranula. MUKOSEL Occurs as a result of rupture of minor salivary gland ducts It is not surrounded by epithelium Often on the lower lip, under the tongue and cheek In children and young adults  RANULA Mucocele at the floor of the mouth Occurs as a result of rupture of the sublingual salivary gland duct At any age At the floor of the mouth, near the midline Blue coloured fluctuant swelling with abundant veins Restriction in tongue movements RANULA treatment Marsupialisation Removal together with the sublingual gland  MUCOUS RETENTION CYST Surrounded by epithelium (true cyst) Duct dilatation as a result of obstruction or cystic change of the duct epithelium Minor and major salivary gland ducts In adults Less frequent than mucoceles Treatment: removal of the cyst TREATMENT OF CYSTS Enucleation Advantages: The entire cyst can be examined microscopically Postop. continuous control is not required Disadvantages Infection of the clot in the cavity Recurrence when not completely removed Primary-secondary haemorrhage Trauma to neighbouring vital teeth, vascular-nerve bundle, sinus Jaw fracture Issues to be considered during the operation Flap shape and width: incision lines should be on intact bone Neighbouring anatomical structures should be protected Spontaneous filling of the cyst cavity with blood should be ensured Graft materials should be used when it is doubtful that the bone defect will heal spontaneously  Marsupialisation cystostomy Combining the cyst cavity and the oral cavity by opening a window along the equator above the cyst (the cyst epithelium is not completely removed). MARSUPIALISATION Indication: Conditions in which enucleation may damage neighbouring tissues Situations where teeth eruption is desired Very large cysts Elderly patients To avoid damage to jaw fractures or anatomical formations In cases of surgical transport difficulties Marsupialisation Disadvantages: The patient's continuous visit to the physician (tampon post.op. 1-2 weeks post.op. and 2-3 times at 3- week intervals until the wound cavity is closed) Microscopic examination of the whole cyst is not possible Keratocysts require a second surgical procedure to complete the treatment  Marsupialisation Disadvantages: The cyst epithelium disintegrates, difficult to suture. The window closes quickly. The patient should clean the cavity after each meal. Fenestration - opening a window Initiate bone regeneration, open the cyst and keep it open in order to reduce the size of the cyst Not definitive but auxiliary treatment Possible mandibular fracture can be prevented Neighbouring teeth and mandibular canal are preserved (by new bone formation) A second surgical procedure is required Follow-up after surgery for cysts Post-healing control in enucleation is performed after 6 months and until bone regeneration is complete. Keratocysts 6-10 years Fixed prosthesis should not be made before it is seen that bone healing has started The patient should be informed that the follow-up will be long