Modern Surgical Methods of Treatment of Odontogenic Jaw Cysts (Literature Review and Own Data)

The purpose of the study was to analyze the data of modern domestic and foreign professional literature, which are devoted to new surgical methods of treatment of odontogenic cysts, to highlight the results of own clinical studies on the effectiveness of developed methods of cystectomy in jaw bones and their anesthesia. Materials and methods. Analytical and bibliosemantic methods were used in the research. The search for scientific information on medical topics for the period from 2010 to 2021 was carried out in the databases of electronic searching systems. Results and discussion. The use of standard techniques of conduction anesthesia of the trigeminal nerve is not always effective during cystectomy in the lateral parts of the mandible, due to the variability of branching of the trigeminal nerve, the possibility of additional innervation of the jaw branch from the superficial cervical plexus. Taking into account these anatomical factors, it is painless to perform a cystectomy of odontogenic cysts on the mandible. During oronasal cystectomy of odontogenic cysts that have grown into the nasal cavity it is advisable to block the nasopalatine nerve in the middle nasal passage. Modified methods of marsupialization can be used as an independent method of treatment of odontogenic cysts of large size, or be combined with radical removal of the cyst membrane. The use of ultrasound medical techniques reduces the risk of damage to adjacent soft tissues during enucleation of bone membranes in complex topographic and anatomical areas. The use of modern laser technologies and medical radiophysical equipment can increase the effectiveness of surgical treatment of odontogenic jaw cysts. The use of endovideosurgery techniques reduces the percentage of intraoperative complications. The introduction of computer spatial imaging of anatomical objects in dental practice has made it possible to develop new surgical technologies for precision-guided osteotomy and resection of the tips of the roots of masticatory teeth adjacent to the shells of radicular jaw cysts. Conclusion. In modern clinical practice, technical developments are used, which are based on the latest advances in laser optics, radio physics, bioacoustics, computer technology, which minimizes injuries during cystectomy operations, reduces the frequency of intraoperative complications. Individual-anatomical features of innervation of the maxillofacial area should be taken into account during local anesthesia, cystectomy and cystotomy operations in the jaw bones

CBCT report of three intresting cases of cysts and its radiographic presentations

Accurate diagnosis with imaging and treatment planning are key in the execution of any surgical procedure.Panoramic radiography has been routinely used in dentistry to assist in clinical diagnosis, treatment procedure but it has limitations such as overlapping of anatomical areas which are of interest in the diagnosis. The invention of computed tomography (CT) had revolutionized the digital imaging though their limitations like 2-dimensional imaging features such as distortion, magnification, and superimposition were present. Cone beam computed tomography (CBCT) is rapidly gaining Interest in the medical fraternity. it was designed with the aim to offset some of the limitations of panoramic and CT imaging .CBCT ever since its inception, it had been routinely used in dentistry for its numerous advantages such as 3-dimensional and multi-planar views. Linear, Curved and angular measurements could be performed along with area and volume calculation and density. All with less radiation exposure compared to conventional computed tomography (CT) scans. In this case series three cases of jaw cysts have been presented with varied radiographic features and the role of CBCT in these cases flooding us with enormous radiographic informations which paved the way for precise surgical management.

CBCT report of three intresting cases of cysts and its radiographic presentations

Accurate diagnosis with imaging and treatment planning are key in the execution of any surgical procedure.Panoramic radiography has been routinely used in dentistry to assist in clinical diagnosis, treatment procedure but it has limitations such as overlapping of anatomical areas which are of interest in the diagnosis. The invention of computed tomography (CT) had revolutionized the digital imaging though their limitations like 2-dimensional imaging features such as distortion, magnification, and superimposition were present. Cone beam computed tomography (CBCT) is rapidly gaining Interest in the medical fraternity. it was designed with the aim to offset some of the limitations of panoramic and CT imaging .CBCT ever since its inception, it had been routinely used in dentistry for its numerous advantages such as 3-dimensional and multi-planar views. Linear, Curved and angular measurements could be performed along with area and volume calculation and density. All with less radiation exposure compared to conventional computed tomography (CT) scans. In this case series three cases of jaw cysts have been presented with varied radiographic features and the role of CBCT in these cases flooding us with enormous radiographic informations which paved the way for precise surgical management.

Massive Dentigerous Cyst within the Anterior Part of The Mandible: A Case Report

Dentigerous cysts are the most common developmental odontogenic jaw cysts, associated with crowns of an Unerupted tooth. Usually, they occur in the second and third decade of life with a male predilection. They are frequently asymptomatic and mostly discovered incidentally on routine dental radiographic examination. Its growth is slow, and can reach a considerable size causing bone expansion and displacement of teeth. Mandibular lower third molars are the most frequently effected teeth; dentigerous cysts involving impacted mandibular canines are rarely reported. Surgical enucleation with extraction of the associated tooth is the standard treatment for dentigerous cyst, marsupialization is recommended for large lesions. We report a rare case of a large dentigerous cyst in a 62-year-old male patient, associated with impacted left mandibular canine, extending from the retro-molar area of left side crossing the midline to the 2nd premolar in the other side, that was successfully treated by marsupialization followed by enucleation and removal of the impacted tooth.

1537 Squamous Cell Carcinoma Arising in A Maxillary Odontogenic Keratocyst in Gorlin Goltz Syndrome - A Rare Case Report

Introduction Gorlin Goltz syndrome (GGS) is a rare, hereditary, AD condition with multiple BCCs, odontogenic keratocysts (Jaw cysts), calcification of falx cerebri, skeletal anomalies & a predisposition to neoplasms like medulloblastomas, fibromas and rhabdomyosarcomas. Aim We present a rare case of a Squamous cell carcinoma (SCC) developing in a Maxillary odontogenic keratocyst in a 32-year male with GGS. Discussion This patient was referred to the OMFS unit with a non-healing UL3 extraction socket and exophytic growth. Initial biopsies suggested an atypical squamo-proliferative lesion, however a repeat biopsy demonstrated an invasive SCC arising from a background odontogenic keratocyst of the maxilla. He was initially reluctant to undergo a staging CT scan to avoid risks of developing further BCCs due to IR exposure. This was eventually performed as per H&N MDT recommendation & showed a T4aN0M0 SCC of the left maxilla and bilateral multiple mandibular odontogenic keratocysts. He underwent a left maxillectomy, left neck dissection & reconstruction with a DCIA free flap, but did not want his mandibular keratocysts treated at the same time. Complete tumour clearance was achieved with no involved neck nodes & he remains disease-free at 4 months postoperatively. Although for a T4 tumour he would have needed postoperative radiotherapy, in view of the GGS, no adjuvant treatment was indicated. Conclusions SCC developing in a maxillary OKC is exceedingly rare with only two previous cases reported in GG syndrome. This is the first reported case of a GGS patient with oral SCC undergoing a complex free flap reconstruction.

Nasopalatine duct cyst with sebaceous differentiation: a rare case report with literature review

Background The aim of this study was to report a rare case of nasopalatine duct cyst with sebaceous differentiation. Further, a systematic search of the literature was performed to identify studies reporting patients with intraosseous jaw cysts with sebaceous differentiation. Case presentation A 55-year-old Korean man was referred to our hospital because of a cystic lesion of the anterior maxilla. Radiologic examination revealed a well-circumscribed radiolucent lesion in the anterior maxilla. Histology showed a respiratory columnar and cuboidal epithelium-lined cyst. Transition from the ciliated columnar epithelium to stratified squamous epithelium with sebaceous differentiation was observed. Based on these findings, the final diagnosis was nasopalatine duct cyst with sebaceous differentiation. A systematic search of the literature was performed to identify studies reporting patients with intraosseous jaw cysts with sebaceous differentiation. There were 24 cases of sebaceous differentiation in the epithelium of the cysts including 2 odontogenic keratocysts, 8 orthokeratinized odontogenic cysts, 8 dentigerous cysts, 1 radicular cyst, and 2 glandular odontogenic cysts. However, no case reports describing the occurrence of nasopalatine duct cysts with sebaceous differentiation have been reported. Conclusion This first case report of nasopalatine duct cysts with sebaceous differentiation could provide insight into the diagnostic process of cystic lesions with sebaceous differentiation.

Multiple Odontogenic Keratocysts in a Non-syndromic Young Patient: An Unusual Case Report

Odontogenic keratocyst (OKC) is a benign intraosseous lesion with invasive and aggressive behavior. It comprises approximately 2-21.8% of all jaw cysts. Odontogenic keratocysts (OKCs) are believed to arise from remnants of the dental lamina most common site in the molar ramus area. OKCs have a specific histopathologic appearance and are found to be locally aggressive and have a high recurrence rate, thus requires close long-term follow-up. OKCs are one component of the Gorlin-Goltz syndrome and all patients with multiple OKCs should be evaluated for this syndrome. In this paper, we present a case of a 13-year old non-syndromic female patient with multiple OKCs located at symphysis and bilateral mandibular angle region who was treated surgically with no obvious post-operative complications during follow-up period.

Dental pathologies in tumor patients with bone metastases or multiple myeloma scheduled for antiresorptive therapy

Background: Medication-related osteonecrosis of the jaw (MRONJ) is a potentially severe complication of mainly antiresorptive drugs. We evaluated the frequency of dentoalveolar pathologies in patients scheduled for antiresorptive therapy in a ‘real-world’ setting, also including patients with poor oral health potentially requiring tooth extractions and/or other dentoalveolar surgery. This approach is in contrast to the setting of recent randomized trials with restrictive exclusion criteria. Patients & methods: We prospectively included patients suffering from solid tumors with osseous metastases or multiple myeloma. Screening for dentoalveolar pathologies was done prior to initiation of antiresorptive therapy at the specialized MRONJ clinic of the University Hospital for Cranio-Maxillofacial and Oral Surgery, Innsbruck, Austria. Results: 119 subjects could be included. In 76 patients (63.9%), a dental focus was revealed including deep caries (24.4% of patients), chronic apical periodontitis (26.9%), periodontal disease (45.8%), root remnants (16%), jaw cysts (2.5%), partially impacted teeth (5.0%) and peri-implantitis (5.0%). Conclusion: Considering the high number of dentoalveolar pathologies (63.9%), systematic dental focus screening prior to initiation of antiresorptive therapy is of utmost importance to lower the risk for MRONJ.

Surgical Treatment of Large Cysts of the Jaws With the Use of Osteoplasty with Biocomposite Materials and the Method of Guided Tissue Regeneration

Improvement of methods of treatment of odontogenic cysts of the jaws continues to be an urgent problem in surgical dentistry and maxillofacial surgery. Currently, the most promising is the use of multicomponent osteoplastic materials in order to optimize reparative osteogenesis after cystectomy for extensive jaw cysts. The aim of the study is to improve the method of cystectomy in the surgical treatment of large cysts of the upper jaw with osteoplasty of the bone defect with biocomposite materials in combination with the method of directed tissue regeneration. Clinical, radiological, histological. During the period 2015-2019, 54 patients with odontogenic cysts of the jaws were under observation, of which 12 were diagnosed as extensive. After cystectomy, the bone cavity was filled with biocomposite material: hydroxylappatite granules (Polistom, RF) in combination with PRP, on top of an autoplasma membrane isolated from PRP and collagen membrane. The immediate and long-term periods of treatment were quite favorable. Control X-ray examination after 12 months showed complete recovery of the bone defect with an organotypic structure in all patients.