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CYSTS and TREATMENT OPTIONS - Coggle Diagram
CYSTS and TREATMENT OPTIONS
Pathological, epithelial lined cavities having fluid or semi-fluid contents
Pathogenesis
Epithelial remnants are present as a small ball of cells
Inflammatory processes trigger cells to proliferative
Proliferating cells exceed nutritional limit and the cells at the centre die/undergo apoptosis forming a fluid filled sac
Cyst slowly expands causing hydrostatic pressure on the adjacent bone
Bone undergoes osteoclastic stimulation resorbing bone
Expanding cyst can erode the overlying cortex, perforate mucosa and present in mouth as swelling
Becomes symptomatic when the hydrostatic pressure driving the cyst allows bacteria to enter
Signs and Symptoms
Asymptomatic, chance finding
Fluctuant Sweling
Bony expansion resulting in eggshell cracking of bone
Loose Teeth
Displaced/tilted teeth
Mental Hypoaesthesia
Discharging sinus
Hollow percussion to TTP
Pain and swelling if secondary infection
Discoloured, carious teeth
Pathological Fracture
Investigations
Vitality Testing
Allows differentiation between developmental (vital) and non-developmental (non-vital) cysts
Aspiration Cytology
if cyst contents clear, fluid with sparkles =
radicular cyst
Radiographs
Biopsy
Enucleation
Complete removal of the cyst lining followed by closure
Closure
Primary Closure - allow the cavity to fit with blood, which liquefies and is replaced with granulation tissue and eventually bone
Secondary Closure - pack the cavity with antiseptic dressing until granulation tissue replaces cavity
Elimination of dead space reduces reactionary haemorrhage and post-op infection
Advantages
Complete removal of cyst lining
Cavity heals without complications
Disadvantages
Possible incomplete removal
damage to adjacent teeth or antrum
infection
weakening of bone
Marsupulisation
Procedures where the cyst cavity is compressed in size to allow self-cleaning or removed at a later date
Indications
Eruption cysts involving potentially useful teeth
Large cysts adjacent to multiple teeth
Advantages
Avoids pathological fracture
Tx for medically comprmosied
Allows potentially useful teeth to erupt
avoids damage to adjacent structures
Disadvantages
complete lining not removed
requires manual dexterity and compliance
repeat visits
office closes and cyst reforms
En Bloc Resection
Whole cyst is removed along with adjacent normal tissue - requires reconstruction
Advantages
complete removal of cyst lining
Disadvantages
invasive
requires reconstruction
disfiguring for patient