Classification of jaw cysts, their symptoms and treatment

Main types of jaw cysts

The tumor can appear on both the upper and lower jaw

The main types of cysts are presented in the table.

Table 1. Classification of jaw cysts:

Reasons for appearance

The following factors for the development of jaw cysts are identified:

• gum injury;
• penetration of infection into the dental tubules;
• tooth injury;
• sinusitis and other ENT pathologies;
• incorrect tooth development.

Varieties

Jaw cysts are divided into several types. They are classified depending on their location, mechanism of occurrence and structure.

Primordial

Their second name is keratocysts. They form in the area of ​​the third molars (chewing teeth) or in the corner of the lower jaw. Sometimes capsules may appear in place of the missing unit. Both single and multiple formations are noted. The latter are often multi-chamber.

A jaw cyst is a benign formation.

This species consists of thin fibrous tissue and odontogenic epithelium. It recurs frequently.

Follicular

Such neoplasms are also called “cysts of unerupted teeth,” which explains the mechanism of their appearance: they are formed in the place of ungrown or partially emerged units. The capsules are localized in the area of ​​the fangs, 2nd and 3rd molars, and the alveolar process of the jaw. They are covered with flat multilayered epithelium, which often becomes denser. Mucus formation may occur.

Radicular

The most common type - occurs in almost 80% of patients. Formations most often appear on the upper jaw (up to 70%). Their size is 0.5 – 2 cm in diameter, but sometimes it exceeds 3 cm.

Radicular capsules often become inflamed and suppurate. They are characterized by the appearance of network-like processes penetrating into the thickness of the wall. They can be located in the area of ​​any teeth. Large conglomerates lead to destructive lesions of bone tissue.

Important! Radicular cysts are often located next to the maxillary sinuses or penetrate into them. This contributes to the development of sinusitis.

Retromolar

Cysts are divided into several types.

Another type of eruption cyst. However, it develops with chronic periodontal inflammation that accompanies the appearance of teeth.

Associated symptoms

At the initial stage, the growth of the cyst is not accompanied by specific symptoms. Characteristic signs appear against the background of transformation of the neoplasm. The table presents the main symptoms of a mandibular cyst.

Table 2. Signs of cyst transformation:

Note! Such symptoms indicate the beginning of the process of suppuration. Treatment must be immediate.

Symptoms and complications

In the initial stages, the disease does not manifest itself. The patient has no complaints of discomfort or other subjective sensations. As the jaw cyst develops, symptoms :

1. A protruding, painless formation inside the oral cavity.
2. Severe pain during chewing and hyperemia of the mucous membranes during the purulent course of the disease.
3. Swelling of the gums.

Important! The formations may periodically open up on their own. In this case, there is an outflow of exudate through the fistula, sometimes the contents are poured into the maxillary sinuses. After a while, the capsules are filled with liquid again.

Cysts are benign formations. However, they can lead to significant complications :

• loss of one or more teeth;
• periostitis - inflammation of the periosteum;
• osteomyelitis – purulent lesion of bone tissue;
• sinusitis;
• pathological fracture of the jaw;
• sepsis - penetration of purulent contents into the bloodstream.

  The main way to detect the disease and its type is radiographic.

Types of salivary gland cysts

The appearance of pathological cavities is due to partial or complete inhibition of secretory outflow. The main types of salivary gland cysts are presented in the table.

Table 3. Types of salivary gland cysts:

Establishing a diagnosis

To clarify the diagnosis, the doctor refers the patient for a comprehensive examination. The main research methods are presented in the table.

Table 4. Diagnostic methods:

Diagnosis and treatment

The main way to detect the disease and its type is radiographic. Applicable:

• targeted images (film or performed by a radiophysiographer) – capture the area from 1 to 4 teeth;
• orthopantogram or panoramic photographs - give a complete picture of the structure of the jaw system, help to identify the extent and depth of the lesion;
• MRI – during the study, the skull is scanned with multiple images in different planes.

  An informative diagnostic method is a panoramic image.

Important! On the x-ray, cavities with clear contours will be visible. If a capsule of the follicular or retromolar type has formed, the image will show unerupted teeth embedded in the bone.

If a cyst occurs on the jaw, treatment is carried out surgically followed by therapy. Two types of surgery are used: cystectomy and cystotomy.

Cystectomy

It involves complete removal of the capsule, filling the cavity with biocomposite materials and suturing the wound. The factors for its purpose are:

1. Small formations located within 1 – 2 teeth. Their roots should be immersed in the capsule no more than a third of their length.
2. Extensive cyst of the lower or upper jaw.

If a cyst occurs on the jaw, treatment is carried out surgically followed by therapy.

The disadvantage of cystectomy is the frequent infection of the wound and, as a consequence, recurrence of the formation. Damage to intact (adjacent) units, the pulp (neurovascular bundle), and the maxillary or nasal sinuses is also possible.

Basic treatment methods

Specific treatment is required when the condition of the tumor changes

If the cyst in the jaw is 1 to 3 mm in size, then the therapeutic tactic is to monitor it.

If her condition changes, then treatment is as follows:

1. Rinse the root tubules . The specialist injects potent medications into the affected area. Then the tissue is cemented.
2. Surgical intervention . The type of surgery depends on the type of cyst.
3. Conducting antibacterial therapy . Antibiotics are prescribed during an acute purulent process. Medicines are administered by injection.

Note! Procedures for washing and cementing tissue are carried out only for radicular cysts.

Therapy

In cases where the formation is small in size (up to 3 mm), it is called granuloma. For some time, such formations should be under the supervision of a doctor. Treatment of a mandibular cyst is indicated only if the granuloma begins to increase in size. The main methods of treating cystic formations are the following.

1. Therapeutic manipulations. Specialists prescribe rinsing of the root canals, into which medications are then injected, and tissue cementation. Under the influence of drugs, the cystic formation thickens and is neutralized. Therapeutic treatment can only be used in cases where the cyst has a radicular shape and a size of no more than 0.8 cm.
2. All other methods involve surgery. Cystectomy is an operation to remove the infectious focus and adjacent tissues that have been affected.
3. Cystotomy is the most popular method of removing a mandibular cyst, which allows you to save the tooth. With cystomy, the anterior wall of the tumor is removed and all pathological contents are scraped out.
4. Plastic cystectomy is a procedure similar to simple cystectomy. The main difference is that the soft tissues are not sutured after removal of the tumor. This method of surgical intervention is used, as a rule, in advanced conditions accompanied by complications.
5. Two-phase surgery for mandibular cyst. It is a more complex procedure, which is prescribed exclusively in the most difficult cases. During the operation, the surgeon tries to preserve intact teeth and tissues as much as possible, while removing the infectious focus. A two-phase operation includes cystectomy and cystomy, which are performed in a specific order.
6. Removal of the cyst along with the tooth. This method is used mainly when the cyst is localized in the area of ​​the eighth molar.
7. If the pathology leads to the development of osteomyelitis, the patient is shown a more serious intervention, in which the infected area is opened and the destroyed tissue and pus are carefully scraped out.

Surgery

The main types of surgical intervention are presented in the table.

Table 5. Types of surgical treatment:

Note! Sometimes the surgeon removes the damaged tooth along with the cyst. This operation is performed if the jaw cyst is located next to the wisdom tooth.

Surgical treatment of minor salivary glands

The instructions for the doctor are as follows:

1. Infiltration anesthesia. The pain impulse is blocked in the sensitive receptor area.
2. Improving access to the cyst. This avoids severe blood loss.
3. Removal of the tumor. 2 small incisions are made over the cyst.
4. Removal of damaged lobules of the minor salivary gland.
5. Stitching. They are layer by layer.
6. Applying a compression bandage.

The duration of the operation depends on the type of cyst. Patients usually tolerate surgery well.

Other types of surgery

The table shows other types of surgical interventions.

Table 6. Other methods of operation:

If the growth of the cyst has led to the initial stage of osteomyelitis, the surgeon undertakes to open the affected area. The cavity is carefully scraped out.

This procedure involves removing pus and tissue that has been destroyed. After this, the patient is prescribed antibiotics.

Postoperative period

The duration of the postoperative period varies from 5 to 14 days

The plate provides information about returning to work after surgery.

Table 7. Return to work capacity:

Oral care after surgery should be thorough. The operated area and surrounding tissues should be treated with a piece of gauze soaked in a 5% hydrogen peroxide solution. This should be done after every meal and before going to bed.

After parotidectomy, stitches are placed. When they are removed, the operated area should be cleaned with mild soap and water.

Note! After surgery, you should not take aspirin. This drug causes bleeding.

If pain and swelling persist for longer than 2 weeks, you should contact the doctor performing the surgery again.

NONODONTOGENIC JAW CYSTS

Pathogenetically,
non-odontogenic cysts of the jaws are not associated either with teeth or with a disorder in the development of the dental epithelium. Their occurrence is associated with a violation of facial embryogenesis (embryonic dysplasia). These are so-called fissural (cleft) cysts. They develop in the embryonic period at the border of the embryonic facial processes. Localized on the upper jaw, they are rare (according to our data, in 2% of cases). Depending on the location, the following fissural cysts are distinguished: nasopalatine, globulomaxillary
and
nasoalveolar.
Nasopalatine cysts (incisive canal cysts) develop from the embryonic remains of the epithelium of the nasopalatine canal. The nasopalatine canal is an epithelialized

“tube” located in the bone incisive canal. The latter connects the bottom of the nasal cavity and the oral cavity. Cysts can occur in any part of this canal, but much more often they form in its lower parts.

Depending on the location of the development of the cyst, its pathological

structure. In the upper part of the canal (closer to the nasal cavity), the cysts are lined with columnar or ciliated epithelium, in the lower parts - with multilayered squamous epithelium.

Rice. 27.5.1. Radiographs of the upper jaw of patients with nasopalatine

(incisive canal) cysts (a, b, c).

Nasopalatine cysts are located between the central incisors. The growth of the cyst is slow and painless. After destruction of the palatine bone, a hemispherical protrusion with clear boundaries appears in the anterior part of the palate, behind the intact central incisors. When punctured, you can get a clear liquid with cholesterol crystals. Cysts may fester.

27. JAW CYSTS

Diagnosis

established on the basis of x-ray examination.
In the area where the incisive opening should be located, there is a focus of homogeneous rarefaction of bone tissue with clear boundaries {Fig.
27.5.1). This lesion has a round shape and is located strictly along the midline.
Intact tooth roots are projected onto it, preserving the periodontal fissure. Errors
in making a diagnosis occur in the presence of destroyed upper central incisors. On an x-ray, it is necessary to determine whether there is destruction of the periodontal fissure of the tooth, which is projected onto the cyst. The latter indicates an existing radicular cyst. The final diagnosis is established after pathohistological examination.

Globulomaxillary cysts (intramaxillary, spherical-maxillary) are located between the lateral incisor and the canine on the upper jaw. Formed from the epithelium at the site of fusion of two embryonic facial processes: frontal (processus globulahs)

and maxillary
{processus maxillaris).
These are nonodontogenic epithelial cysts of the jaw bones. Their shell is thin and lined with flat, cubic or columnar epithelium.

Cysts grow slowly and painlessly. They are often discovered by accident. Clinically, they manifest themselves as a painless protrusion in the vestibule of the oral cavity or palate. They can grow into the nasal cavity or maxillary sinus. The cyst is located in the area of ​​intact teeth. Suppuration of cysts is rare. During puncture, you can obtain a clear liquid with cholesterol crystals.

On the intraoral radiograph there is an area of ​​homogeneous rarefaction of bone tissue of a round shape with clear boundaries. The cyst is located between the intact lateral incisor and the canine (Fig. 27.5.2).

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Rice. 27.5.2. Radiographs of the upper jaw of patients with globulomaxillary cysts (a, b, c, d).

27.5. NON-ODONTOGENIC CYSTS OF THE JAWS

Divergence (divergence) of the roots of these teeth is noted, the periodontal fissure is preserved. The diagnosis becomes more complicated if the lateral incisor or canine is destroyed (periodontitis).

Nasoalveolar cysts (nasolabial cysts of the nasal vestibule) develop from the remains of the embryonic epithelium at the border of three embryonic processes: frontal, external nasal and maxillary. The cyst is lined with a membrane covered with flat, cubic, transitional or ciliated epithelium. They are located in the area of ​​the nasolabial furrow under the base of the wing of the nose.

Nasoalveolar cysts are located on the anterior wall of the maxillary bone in the vestibule of the oral cavity, in the projection of the roots of the lateral incisor and canine. They cause deformation (indentation) of the outer cortical plate. In the area of ​​the nasolabial groove under the base of the wing of the nose, there is a sedentary, elastic protrusion of a round shape with clear boundaries and not fused with the surrounding tissues. There may be a narrowing of the entrance to the nose. These cysts, localized on the maxillary bone, are located in the thickness of the soft tissues. When punctured, you can get a clear, yellowish, somewhat viscous liquid with cholesterol crystals. X-ray

the cyst does not manifest itself in any way; in some cases, there may be a small rounded clearing (due to deepening) of the bone tissue at the location of the cyst.
The teeth located in the cyst area are intact. The diagnosis is clarified
during surgery.

TREATMENT OF JAW CYSTS

Jaw cysts are treated surgically. There are two main surgical methods: cystectomy

and
cystotomy.
Cystectomy is a radical surgical treatment method, which consists of completely removing the cyst shell, followed by tightly suturing the surgical wound (applying a primary blind suture to the wound).

Cystotomy is a method of surgical treatment in which the outer (front) wall of the cyst is removed along with the adjacent bone and the existing intraosseous cavity is connected to the vestibule of the mouth, i.e. the cystic cavity is turned into an additional bay of the oral cavity.

Indications for istectomy

are odontogenic and non-odontogenic cysts of the jaws at any age.

Indications for istotomy

can be:

1. large cysts of the upper jaw, which grow into the maxillary sinus with destruction of the bone floor of the nasal cavity and palatine plate;

2. extensive cysts of the lower jaw with significant thinning of the bone walls of the jaw (in the event that complete removal of the cyst shell can significantly weaken the strength of the jaw and contribute to the occurrence of a pathological fracture);

3. the patient’s old age or the presence of severe concomitant diseases (cardiovascular, endocrine, cachexia, etc.);

4. hematological diseases (hemorrhagic diathesis, hemophilia, etc.);

5. in a mixed dentition, if an attempt to completely remove the cyst shell may damage the rudiments of permanent teeth, which will affect the formation of a normal occlusion.

The advantage of an istectomy

It must be assumed that the entire cyst shell is removed, which is subjected to pathomorphological examination, and reparative bone regeneration occurs in the resulting bone cavity, because The postoperative wound is sutured tightly.

Disadvantages and istectomies:

traumatic operation; the possibility of damage to nearby intact teeth; injury to the neurovascular bundle; the likelihood of opening the walls of the maxillary sinus or nasal cavity; the possibility of autolysis (decomposition) of a blood clot located in the bone cavity cannot be ruled out.

Advantages and istotomies:

low morbidity; the operation is easy to perform; There is no danger of damage to the follicles of permanent or intact teeth, as well as surrounding bone structures, cavities and neurovascular trunks.

Disadvantages and istotomies:

non-radicality of surgical intervention; the formation of additional bays (cavities) that require long-term postoperative care; the presence of postoperative jaw deformities; the resulting open postoperative jaw defects impair the cleansing of the oral cavity with oral fluid, which creates conditions for the proliferation of microorganisms.

Cystectomy surgery technique. Surgery is performed under local anesthesia. A trapezoidal (in the anterior) or angular (in the lateral) incision is made on the vestibular surface of the alveolar process of the jaw. A horizontal incision of the mucosa is made along the crest of the alveolar process in the absence of teeth or along the neck of the teeth. The incision is made down to the bone. Lateral incisions of soft tissues for peeling off the mucoperiosteal flap must be made so that they pass along

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27. JAW CYSTS

healthy bones, i.e. at a distance of at least 1 cm from the radiographic boundaries of the cyst. This should be done so that the suture lines do not coincide with the bone defect, which leads to the formation of fistulas leading into the postoperative bone cavity. The mucoperiosteal flap is peeled off with a rasp. Next, trepanation of the bone or expansion of the existing burr hole begins (Fig. 27.6.1).

Rice. 27.6.1. Stages of cystectomy: a - detachment of the mucoperiosteal flap, 6 - appearance of the bone wound after removal of the cystic membrane.

Fig.27.6.2. Radiographs of the lower jaw of a patient with a radicular cyst, and -before

Postoperative complications

The risk of complications arises due to the removal of the salivary gland. This is due to the possible connection of the neoplasm with the branches of the facial nerve.

Violation of its integrity leads to cessation of the functioning of facial muscles. As a result, the face is distorted.

After parotidectomy

The most serious complication after parotidectomy is airway swelling

After such surgery, the following complications may develop:

• numbness of the face;
• damage to the nerves that control the movements of the facial muscles;
• numbness of the ear;
• salivary drainage;
• Frey syndrome;
• the appearance of fistulas;
• swelling of the airways.

Older patients, people who smoke, people with diabetes and those with high blood pressure are at risk of heart attack. This can happen both during surgery and after it.

In order to prevent dangerous complications, you need to inform your doctor in detail about your health status.

After surgery on the upper jaw

Common complications are presented in the table.

Table 8. Complications after surgery on the upper jaw:

Home treatment

Further treatment is carried out at home. The main methods of “home” therapy include:

• use of folk remedies;
• oral care;
• compliance with dietary recommendations.

Folk remedies are used only under the supervision of a doctor.

The use of folk remedies

The most effective recipes are presented in the table.

Table 9. Treatment with folk remedies:

Note! These products can be used for compresses.

Dietary recommendations

It is recommended to diversify your diet with foods that contain vitamins and minerals. Particular attention should be paid to foods containing fluoride and calcium. You should also eat foods that stimulate saliva production.

Table 10. Dietary recommendations:

Preventive recommendations

A cyst on the jaw is easily prevented with the help of preventive procedures.

Table 11. Preventive recommendations:

All recommendations must be strictly followed. The cost of deviating from them can be very high.

Treatment during pregnancy

If a mandibular cyst forms during pregnancy, the woman should urgently consult a specialist. However, the situation is aggravated by the fact that to confirm the diagnosis it is necessary to take an x-ray. This procedure is dangerous for the fetus. Surgical interventions are indicated only in emergency cases, as they are performed under anesthesia.

When there is no serious inflammation, conservative therapy with medications is carried out. If severe pain and other symptoms are observed, you have to resort to surgery. Therefore, at the slightest discomfort in the oral cavity, you should consult a dentist and gynecologist. You should not use traditional methods, because delaying treatment can lead to severe complications in the lower jaw.

Prevention of the disease There are no specific measures that would completely eliminate the possibility of a jaw cyst. Prevention consists of regular oral hygiene, timely treatment of caries and its complications, as well as all kinds of infectious diseases. Plaque must be removed regularly to prevent it from hardening and turning into tartar.

It is important to visit the dental clinic at least once a year for a preventive examination. This will prevent the development of all kinds of dental diseases. You need to purchase only high-quality brushes and toothpastes, and regularly rinse with special dental elixirs. In case of jaw injuries, you should immediately contact a surgeon and subsequently be observed by him so that complications do not arise.

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