Preprosthetic Surgery Techniques PDF

PREPROSTHETIC SURGERY TECHNIQUES Dr. Dt. Erim Tandoğdu Maxilla and Mandibula Crest Expansion Procedures Procedures for Soft Tissue Procedures for Maxilla and Mandible Crest Expansion Submucous Vestibuloplasty Maxillary Vestibuloplasty with Clark's...

PREPROSTHETIC SURGERY TECHNIQUES Dr. Dt. Erim Tandoğdu Maxilla and Mandibula Crest Expansion Procedures Procedures for Soft Tissue Procedures for Maxilla and Mandible Crest Expansion Submucous Vestibuloplasty Maxillary Vestibuloplasty with Clark's Secondary Method Kazanjian Vestibuloplasty Epithelialisati Lip-switch Method (Transpositional on Methods Vestibuloplasty) Mandibular Vestibuloplasty and deepening of the floor of the mouth Soft Tissue Grafts Procedures for Soft Tissue Submucous Vestibuloplasty It is applied in the maxilla. It is applied if there is sufficient bone height. Vestibular sulcus should not be too shallow. Procedures for Soft Tissue Submucous Vestibuloplasty A straight vertical incision is made from the labial midline involving the mucosa The muscle and soft tissue connections between the periosteum and mucosa are dissected by entering under the mucosa. Procedures for Soft Tissue Submucous Vestibuloplasty The intervening tissue layer is excised or positioned upwards After the area is sutured, it is left with a temporary plate for 2 weeks. Procedures for Soft Tissue Maxillary Vestibuloplasty with Clark's Method Used when submucous vestibuloplasty is contraindicated A flap is lifted from the alveolar mucosa and transferred to the soft tissue side of the vestibule. The vestibular surface of the alveolar bone is left for secondary healing. Procedures for Soft Tissue Maxillary Vestibuloplasty with Clark's Method Laser can also be used in this process. Soft lined temporary prosthesis for the patient after the procedure can be utilised. Procedures for Soft Tissue Maxillary Vestibuloplasty with Clark's Method Procedures for Soft Tissue Maxillary Vestibuloplasty with Clark's Method Procedures for Soft Tissue Kazanjian Vestibuloplasty It can be considered as the opposite of the Clark method. The flap is lifted from the lower lip mucosa and transferred to the bone side in the deepened vestibule. The wound on the lip is left for secondary epithelialisation. Procedures for Soft Tissue Kazanjian Vestibuloplasty Procedures for Soft Tissue Kazanjian Vestibuloplasty Procedures for Soft Tissue Kazanjian Vestibuloplasty Procedures for Soft Tissue Kazanjian Vestibuloplasty Procedures for Soft Tissue Kazanjian Vestibuloplasty Procedures for Soft Tissue Lip-switch Method (Transpositional Vestibuloplasty) It is a modification of the Kazanjian vestibuloplasty. This time, the periosteum surrounded by the vestibule of the alveolar bone is tranposed on the secondary healing area on the lip. Procedures for Soft Tissue Lip-switch Method (Transpositional Vestibuloplasty) The mobilised mucosal flap is sutured to the deepest part of the vestibular sulcus. Procedures for Soft Tissue Lip-switch Method (Transpositional Vestibuloplasty) Procedures for Soft Tissue Lip-switch Method (Transpositional Vestibuloplasty) Secondary epithelialisation methods must have a bone height of at least 15 mm for successful results Relapse is observed in 30-50% after all secondary epithelialisation methods. Procedures for Soft Tissue Mandibular Vestibuloplasty and deepening of the floor of the mouth Deepening is performed in both labial and lingual areas. This eliminates the factors that cause displacement of the prosthesis. A stable soft tissue formation is achieved. Procedures for Soft Tissue Mandibular Vestibuloplasty and deepening of the floor of the mouth Procedures for Soft Tissue Mandibular Vestibuloplasty and deepening of the floor of the mouth Procedures for Soft Tissue Mandibular Vestibuloplasty and deepening of the floor of the mouth Procedures for Soft Tissue Soft Tissue Grafts Advantages: Reduced relapse at the recipient site Surgical defect is covered early Post-op complaints are reduced Recovery is accelerated Procedures for Soft Tissue Soft Tissue Grafts Skin Grafts Mucosa Grafts Alloplastic Materials Procedures for Soft Tissue Soft Tissue Grafts Skin Grafts: Half thickness (0.35mm) is taken from the hairless area with a dermatome. Procedures for Soft Tissue Soft Tissue Grafts Advantages of Skin Grafts: The graft can be taken in the desired size. It creates a suitable base for prosthesis.  Procedures for Soft Tissue Soft Tissue Grafts Disadvantages of Skin Grafts: 1. Colour difference with the mucosa 2. Unpleasant odour 3. Intraoral hair growth can be seen due to hair follicles 4. A hard scar line forms at the junction with the mucosa 5. The skin does not contain submucous glands, which has a negative effect on adhesion. This is especially important for the upper jaw. Therefore, skin grafts are not used in the upper jaw as much as possible. Procedures for Soft Tissue Soft Tissue Grafts Skin Grafts Procedures for Soft Tissue Soft Tissue Grafts Skin Grafts Procedures for Soft Tissue Soft Tissue Grafts Mucosa Grafts: Taken from the palate or cheek mucosa with a mucotome or scalpel. Procedures for Soft Tissue Soft Tissue Grafts Advantages of Mucosa Grafts: 1. Since the entire operation is performed inside the mouth, a second Wound one is not created outside the mouth. 2. Does not prevent adhesion. 3. It does not cause colour difference. 4. Does not cause unpleasant odour. 5. Intraoral hair growth is not seen. Procedures for Soft Tissue Soft Tissue Grafts Disadvantage of Mucosa Grafts: 1. Often the desired width of the graft cannot be obtained Procedures for Soft Tissue Soft Tissue Grafts Mucosa Grafts: Procedures for Soft Tissue Soft Tissue Grafts Mucosa Grafts Grafting from the cheek Procedures for Soft Tissue Soft Tissue Grafts Mucosa Grafts Grafting from the cheek Procedures for Soft Tissue Soft Tissue Grafts Mucosa Grafts Grafting from the cheek JAW CYSTS Dr. Dt. Erim Tandoğdu What is a Cyst? 'CYST' is, global and balloon- shaped, from the centre towards the environment expanding growing, epithelial furnished, bond liquid or semi-solid, surrounded by a capsule of tissue consistency with material filled with pathological structures.  Jaw and surrounding tissue cysts Odontogenic cysts Cysts due to developmental disorders Central (intraosseous) developmental odontogenic cysts Parosteal (peripheral) developmental cysts Inflammatory cysts Non-odontogenic cysts Pseudocysts (false) Soft tissue cysts  Classification of jaw cysts (epithelial) WHO,1992 Cysts due to developmental disorders Odontogenic Non-odontogenic Inflammatory cysts (I.R.H.Kramer,J.J.Pindborg,M.Shear:histological Typing of Odontogenic Tumours)  Cyst classification (WHO,1992) Developmental cysts Odontogenic cysts Keratocyst (primordial) cyst Dentigerous (follicular) cyst Eruption cyst * Lateral periodontal cyst Glandular odontogenic cyst Gingival cyst (Epstein's pearls)* Gingival cyst of an adult*  Cyst classification WHO,1992 Developmental cysts non-odontogenic cysts - nasopalatine (incisive) duct cyst - nasolabial (nasoalveolar) cyst Inflammatory cysts radicular cyst - apical and lateral - residual O D O N T O G E N I C CYSTS( WHO, 2017 ) DEVELOPMENTAL ODONTOGENIC CYSTS Dentigerous cyst Odontogenic keratocyst Lateral periodontal and botryoid odontogenic cyst Gingival cyst Glandular odontogenic cyst Calcified odontogenic cyst Orthokeratinized odontogenic cyst INFLAMMATORY ODONTOGENIC CYSTS Radicular cyst Collateral inflammatory cyst  Odontogenic cysts develop by differentiation of odontogenic epithelial remnants within the jaws. Differentiation is developmental or inflammatory. Odontogenic epithelial remnantsdevelop from the remnantsof the tooth-forming epithelium organ or from the enamel itself.  Remnant tissues from the epithelium forming the tooth Serres epithelial remnants (dental lamina) keratocyst (primordial), glandular, periodontal, gingival cysts Enamel epithelial remnants (enamel organ) dentigerous, eruption, paradental cysts Malessez epithelial remnants (Hertwig root sheath) radicular cyst  General symptoms of cysts Small cysts are asymptomatic As it grows, it first deforms the jaw and then the face First crepitation and then fluctuation on palpation Causes malposition of neighbouring teeth Vensan shows symptom When overgrown, it leads to pathological fractures Those in the upper jaw push and narrow the sinus Forms gerber protrusion consisting of the upper central When infected, they give all the symptoms of odontogenic infection. DENTIGEROUS CYST Dentigerous cyst follicular cyst It is an osteolytic central lesion surrounding the crown of an impacted or unerupted tooth. It is the most common developmental odontogenic cyst and the second most common odontogenic cyst. Dentigerous cyst etiology and histogenesis Pathogenesis is unclear It is formed by the accumulation of fluid between the reduced enamel epithelium and the dental crown after crown development. The cells forming the lesion are thought to be the 'thinned enamel epithelium' of the dental follicle. Dentigerous cyst clinical Adolescents and young adults More common in men Mandibular 3rd molar, maxillary molar, maxillary canine, respectively Aggressive development potential General symptoms of cyst during its development  Dentigerous cyst Radiology Meaningful but not specific Unilocular radiolucent around the unerupted tooth crown Thin sclerotic band around it Crown-radiolucent image relationship Central: encloses the crown Lateral: positioned lateral to the crown Circumferential: also includes the root part Impacted tooth relocates Root resorption may occur in neighbouring teeth Cyst(-) less than 0.5 cm around the crown Dentigerous cyst differential diagnosis Odontogenic keratocyst Adenomatoid odontogenic tumour Central mucoepidermoid carcinoma Unicystic ameloblastoma *Histological examination is necessary for definitive diagnosis Dentigerous cyst histology Several rows of nonkeratinized multilayered epithelium Occasionally ciliated Sometimes focal keratisation on the surface Cyst wall loose fibroconnective tissue Focal mucinous epithelium within the epithelium Sebaceous cells in connective tissue **Rarely epithelium shows neoplastic transformation and ameloblastoma, squamous cell Ca develops from this ground. Dentigerous cyst treatment Enucleation and curettage Marsupialisation Eruption cyst Dentigerous cyst in soft tissue Separation of the dental follicle and crown of the erupting tooth in the soft tissue of the alveolus Eruption cyst clinical Usually in children The erupting deciduous tooth, occasionally around the crown of the permanent tooth More common in mandibular molars and maxillary anterior teeth Soft, translucent swelling of the gingival mucosa 'eruption haematoma' due to accumulation of blood in the cyst in patients exposed to superficial trauma Eruption cyst treatment Usually no treatment is required Spontaneously ruptures If not, simple excision to allow the eruption of the tooth (roof to be opened) Lateral periodontal cyst Localised on the lateral surface of the erupted, vital tooth root (in the absence of trauma or caries resulting in pulp necrosis) 5th and 6th decade Male/female = 2/1 Between mandibular premolar-canine-cutter Sometimes it can cause swelling Lateral periodontal cyst aetiology and histogenesis Primordial cyst of a cavernous tooth Lateral dentigerous cyst (develops too slowly to allow the tooth to erupt) Malessez epithelial remnants Dental lamina Lateral periodontal cyst Radiology Radiolucent lateral to the tooth root Oval or round depending on size, rarely multilocular (Bortryoid odon. cyst) Usually sclerotic peripheral border Lateral periodontal cyst differential diagnosis Aggressive lesions should be differentiated from similar radiolucent lesions by histological examination as they have no clinical signs and symptoms. Unicystic ameloblastoma Eosinophilic granuloma Odontogenic keratocyst Primordial cyst of supernumerary tooth Lateral periodontal cyst histology Thin, nonkeratinized cuboidal or multilayered squamous epithelium Some of the epithelial cells have transparent nuclei The cyst wall is made of thin fibroconnective tissue There is no inflammation in the wall Lateral periodontal cyst treatment Enucleation of the cyst without tooth extraction when the pulp of the tooth is vital No recurrence when completely removed The botryoid one can relapse. GLANDULAR ODONTOGENIC CYST Radiologically, a multilocular and grape cluster-like RL lesion is usually observed, surrounded by a sclerotic line and may cause bone expansion. It is seen in the regions of the jaws with teeth, especially in the mandible in the region of central and lateral teeth. Those in the maxilla are also anteriorly located. GLANDULAR ODONTOGENIC CYST It is usually asymptomatic and can sometimes reach large sizes. It may destruct the cortical bone and form a fluctuant expansive lesion under the mucosa. GLANDULAR ODONTOGENIC CYST The cyst is lined with multilayered squamous epithelium and acidophilic, columnar, cuboidal and ciliated cells are present on the surface of the epithelium. These cells may form papillary bubbles towards the lumen. Mucin positive GOBLET cells and micro gland structures can be observed in the surface epithelium. GLANDULAR ODONTOGENIC CYST Enucleation is performed in the treatment. There are also those who recommend wide resection. The prognosis is good. It is rare. Relapse is common. Recurrence is common, especially in those that reach large sizes. Gingival cyst of infants dental lamina cyst of infants Parosteal (peripheral) cysts In the lamina propria of the palatal or alveolar mucosa Dental lamina residues (serre residues) Gingival cysts in infants Single or multiple In the mucosa covering the alveolar ridge or in the median ridge near the junction of the hard and soft palate Small, creamy white swelling Rapid recovery after spontaneous rupture Epstein's pearls:midpalatal rafe(nonodon.) Gingival cyst of adults Localised in the free and adherent gingiva and occasionally in the gingival papilla (parosteal) Histogenesis Ruins of Serre Traumatic implantation of the mucosal epithelium In your 40s Swelling less than 1cm on the buccal side Radiological signs are usually absent Enucleation, no recurrence ODONTOGENIC KERATOCYST ODONTOGENIC KERATOCYST In the 2017 classification, it was reclassified as a cyst. The definition of PRIMORDIAL CYST was also used previously. Since it is formed in the period before the development of the hard tissues of the tooth, cysts in the place where the germs of the teeth should be and without accompanying teeth are named in this way. Later, the term keratocyst was preferred because of its association with teeth, being lined with keratinized epithelium, aggressive behaviour and high recurrence rates. Odontogenic keratocyst The jaws are covered with thin, fragile, medium or parakeratised multilayered squamous epithelium with a creamy, caseous keratin lumen with the set full power plant destructive is a lesion. Other cysts According to more aggressive relaps Don't tendency too e much and (%5-60) Odontogenic keratocyst Features Aggressive clinic High recurrence Neoplastic potential It is also recognised as a tumour.  Odontogenic keratocyst aetiology and pathogenesis Dental lamina and its remnants, It originates from enlarged basal cells lining the oral epithelium.  Odontogenic keratocyst clinical It constitutes 10% of developmental odontogenic cysts Male/female=3/2 20-30, 50-70 years old Mand./mak=2/1 Posterior corpus and ramus Maxillary canine and 3rd molars  Odontogenic keratocyst clinical Asymptomatic until bone is expanded or infected More infected than others Less jaw expansion than expected from its volume (grows longitudinally) Can be multiple 'It may be associated with basal cell nevus syndrome.  Odontogenic keratocyst radiography Unilocular radiolucent, usually well circumscribed, with a thin sclerotic band around it Sometimes it may give a multilocular appearance May be associated with the crown of an unerupted tooth (25-40%) Resorption of the accompanying tooth roots is less common than other odontogenic cysts. Odontogenic keratocyst differential diagnosis Presence of keratin in the epithelium Protein content in cyst fluid High mitotic activity  Odontogenic keratocyst differential diagnosis Ameloblastoma Dentigerous cyst Central giant cell granuloma Odontogenic myxoma Aneurysmal bone cyst Traumatic bone cyst Residual cyst *exact diagnosis histopathological examination Odontogenic keratocyst microscopy Lined with 6-8 cells, fragile and loosely attached to the underlying connective tissue Fibrous wall is thin (fibre-poor collagen connective tissue) The basal cell layer is stained dark Odontogenic keratocyst microscopy Epithelial retepegs are smooth (in the absence of infection) Budding of the epithelium towards the cyst wall Satellite cysts and immature od.ep within the cyst wall. Odontogenic keratocyst microscopy The epithelium shows hyperparakeratosis (more aggressive) or hyperorthokeratosis. In parakeratotic type, there are bud-shaped structures on the cyst wall. These buds may show dysplastic and dyskeratotic features. The rate of satellite cysts is high in this type. Orthokeratogenised OCs are mononuclear. Odontogenic keratocyst cause of recurrence The cause of recurrence is incomplete removal of cyst epithelial remnants; Epithelium thin and delicate Satellite cysts in the fibrous wall of the cyst Epithelium has aggressive proliferative activity Odontogenic keratocyst treatment Enucleation Marsupialisation followed by curettage Chemical cauterisation (with Carnoy solution) and curettage Cryosurgery 6-8 years follow-up Recurrence is more common in parakeratised type ODONTOGENIC KERATOCYST Enucleation and curettage of surrounding tissues is the appropriate treatment for these cysts. Recurrence rate 5-60 Recurrence is more common in the posterior mandible and ramus due to difficulty in access. The possibility of recurrence increases after each recurrence. Prognosis is good, squamous epithelial cell carcinoma may rarely develop. The radiological and clinical appearance of multilocular and large keratocysts may resemble odontogenic tumours, especially ameloblastoma. Differential diagnosis of these lesions should be performed before the operation. ODONTOGENIC KERATOCYST Causes of recurrence in satellite cysts. keratocysts; De novo cysts formed by dental lamina remnants that are not associated with the initial cyst, Fragile cyst wall preventing easy enucleation of the cyst, The presence of  TREATMENT Primary treatment is enucleation and curettage. 5mm from the cyst border distant curettage. In large cysts and especially in young patients, marsupialisation followed by curettage. Chemical cauterisation and curettage (CARNOY SOLUSION) Basal cell nevus syndrome Gorlin-Goltz Syndrome Autosomal dominant hereditary More often in young people Associated with many anomalies 5-7% of patients diagnosed with OC are part of the syndrome  ODONTOGENIC KERATOCYST GORLIN SYNDROME with multiple keratocysts is an autosomal dominant disease in which the control of TGF on the epithelium is reduced (PTCH gene mutation). The skin shows numerous epidermal cysts, palmoplantar pits and pits and numerous skin tumours, especially basal cell carcinoma. Bifid ribs (3rd, 4th, 5th ribs), kyphoscoliosis, mental retardation, calcification of the falx in the brain, dysgenesis or agenesis of the corpus callosum, increased risk of medullablastoma, rhabdomyoma and ovarian fibroma, calcification of the tentorium of the cerebellum, bridging of the sella, decreased frontal sinus ventilation, asymmetry and dilatation of the brain ventricles. These patients have increased head diameter, protruding and wide forehead, ocular hypertelorism and large mandible. Anomalies seen in BCNS Neurological: mental retardation, hydrocephalus, medulloblastoma Ophthalmic: hypertelorism, congenital blindness Sexual: hypogonadism in men, ovarian tumours in women Dermal: dermoid cyst, basal cell carcinoma, small calcifications in the skin Skeletal: vertebral anomalies, bifid rib, kyphoscoliosis, metacarpal anomalies Dental: multilocular and multiple odontogenic keratocysts, mandibular prognathism 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