Follicular cyst of the tooth: causes, symptoms, treatment methods, reviews. Treatment of radicular, residual and follicular tooth cysts in the upper or lower jaw Cysts of the jaws treatment innovation

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Peri-root (radicular) cysts are the last stage of development chronic periodontitis... Usually patients do not complain of pain. Only with the development of relatively large peri-root cysts can patients complain of deformation of the alveolar process of the jaw, displacement of teeth.

Note that among patients admitted to dental hospitals, patients with peri-root cysts account for about 8%. About half of them (46%) are patients with festering jaw cysts. Moreover, radicular cysts are found more often in the upper (63%) and much less frequently in the lower (34%) jaw, equally often localized on the right and left sides of the jaw (Tatarintsev K.I., 1972).

An objective examination reveals a change in the color of the tooth crown and its destruction by a carious process, painless probing of the root canals of the tooth, in which a yellowish liquid can be released. Percussion of the "causal" tooth can be unpleasant, but is usually painless. In this case, deformation of the alveolar process and displacement of teeth adjacent to the "causal" one are possible. Palpation of the area of \u200b\u200bdeformation of the alveolar process reveals a symptom of "parchment crunch" (Runge-Dupuytren's symptom), or a symptom of a rubber or plastic toy (Vernadsky Yu.I., 1966), that is, the springiness of the wall. Electroodontometry of the "causal" tooth at least 100 μA. If the pulp of adjacent teeth has undergone necrosis, then their electromyography (EOM) is also within 100 μA. In the absence of pulp necrosis, their electrical excitability decreases due to compression of the neurovascular bundle (Tatarintsev K.I., 1972).

Speaking about the frequency of symptoms, we note that, according to the same author, the most frequent (21.8%) symptom of the clinical manifestation of a peri-root cyst is considered to be a symptom of elastic tension, i.e. sagging of the thinned bone wall at the site of cyst protrusion without signs of fluctuation and parchment crunch. The symptom of "parchment crunch" is observed in 5.8% of patients, that is, much less frequently than the symptom of fluctuation (18.3%). The symptom of deformity of the face with peri-root cysts is observed in 36.4% of patients.

Reaction of regional lymph nodes more often clinically manifested when localized in lower jaw and then, mainly, with their suppuration. It is with festering cysts that fistulas are usually observed, communicating the cavity of the cyst with the oral cavity - in 29.2% of cases.

At the same time, it is noted that the intensity of constant intoxication of the body with non-suppurative and suppurating peri-root cysts is practically the same, despite the significant clinically revealed differences in the intoxication syndrome in such patients and their different state of health according to subjective sensations.

On the roentgenogram, the peri-root cyst is projected in the form of a round or oval enlightenment focus with clear contours exceeding 5-10 mm in diameter. The focus of enlightenment always has a rim in the form of a thin strip of darkening bordering the contours of the cyst, the anatomical basis of which is the compacted bone tissue. When a cyst suppurates, the clarity of its contours is disturbed, they become "blurred".

Perioral cyst upper jaw ... Computer tomogram:
1 - cyst cavity; 2 - maxillary sinus; 3 - external nose; 4 - oral cavity

Morphologically, the cyst is an enclosed cavity, the inner surface of which is lined with a stratified squamous epithelium of the epidermal type, located in 4-12 rows. The epithelium often forms vegetation with the formation of a wide looped network. The underlying tissue consists of fibrous connective tissue with a concentric arrangement of fibers. The cyst cavity contains a clear yellowish liquid with cholesterol crystals. With suppuration, this fluid becomes cloudy and represents pus. The cyst capsule contains a significant amount of nerve fibers.

During the growth process, cysts can move up bottom wall a pear-shaped opening, causing the formation of a characteristic ridge at the bottom of the nasal cavity "Gerber's roller". When the cyst grows to the side maxillary sinus the bony wall of the sinus is usually resorbed and the cyst grows into the maxillary sinus (maxillary sinus). Sometimes, with the prevalence of bone opposition over resorption, it is possible to move the wall of the maxillary sinus away from the pressure of the shell of the cyst increasing in size. In this case, the sinus can decrease to the size of the gap (Verlotsky A.E., 1960). Therefore, depending on the relationship between the cyst and the maxillary sinus, the following types of cysts are distinguished: adjacent, pushing and penetrating cysts.

Peri-root cyst of the upper jaw to the right of the 15th tooth, deforming the wall of the maxillary sinus... Chronic right-sided sinusitis:
1 - upper jaw; 2 - left VChP (norm); 3 - right VChP; 4 - the cavity of the peri-root cyst; 5 - external nose

In the presence of adjacent cysts between the unchanged cortical lamina of the sinus and the cyst, the bone structure of the alveolar process is determined.

With pushing cysts, the cortical plate is displaced from the alveolar bay of the sinus upward, but its integrity is not compromised.

Penetrating cysts are detected on the roentgenogram in the form of a hemispherical shadow with a clear upper contour against the background of the maxillary sinus air, the cortical plate is interrupted in places or completely absent. In the case of penetrating cysts of the jaws, difficulties sometimes arise in their differential diagnosis with retention cysts of the mucous membrane of the maxillary sinus (Vorobiev D.I., 1989).

With the growth of cysts of the lower jaw, the latter changes the configuration of the alveolar process or the body only in advanced cases, when the cysts have existed for many years. At the first stages of its development, the cyst grows polarly in the thickness of the bone along the cortical plates, capturing only areas of the cancellous substance. In this case, the walls of the mandibular canal are usually resorbed, and the cyst membrane grows together with the neurovascular bundle. However, in such cases, no changes in sensitivity were observed in the zone of innervation of the mandibular nerve. In the course of surgical interventionit is usually possible to separate the cyst membrane from the neurovascular bundle without damaging it. Note that even with atraumatic removal of such cysts in postoperative period within 2-4 weeks. patients may notice a violation of the sensitivity of the lower lip from the corresponding side.

With the growth of the cyst along the alveolar arch, the cyst membrane squeezes the neurovascular bundles of the adjacent teeth, which causes atrophic changes in the pulp and is diagnosed during electroodontodiagnostics by increasing its indicators to 20 μA or more. Sometimes aseptic pulp necrosis occurs, which must be detected at the stage of preparing the patient for surgical treatment and endodontic treatment of such teeth.

About 30% of radicular cysts are residual and remain after tooth extraction or loss. The origin of the cyst in these cases is evidenced by its localization in close proximity to the hole of the missing tooth (Ryabukhina N.A., 1991).

Residual cyst of the lower jaw (photo print from a fragment of the orthopantomogram of the lower jaw of patient M., 60 years old)

Pericoronal (follicular) cysts are the result of a malformation of the tooth-forming epithelium, i.e., racemose degeneration of the follicle tissues. Therefore, as a rule, either an intact or a rudimentary or supernumerary tooth, which has completed or has not yet completed its formation, is always in close relationship with the follicular cyst. Usually such a tooth is located in the thickness of the bone and is not erupted.

Some authors (Al'banskaya T.I., 1936; Agapov N.I., 1953; Vernadsky Yu.I., 1983) also believe that follicular cysts can arise on the basis of inflammatory processes at the apex of the roots of milk teeth, when the focus of inflammation reaches the follicle permanent tooth, causing irritation with the subsequent development of a cyst.

E. Yu. Simanovskaya (1964) believes that follicular cysts develop for a rather long time, and in the clinical course of this pathology, some staging can be observed.

Stage I - latent development of a follicular cyst with no clinical symptoms. Examination reveals the absence of a permanent tooth or a delayed baby tooth (X-ray helps).

Stage II - the appearance of deformation of the alveolar process or the body of the jaw due to a dense painless or slightly painful swelling. With a thinning of the wall (large cyst), a parchment crunch and fluctuation appear. The duration of this stage is from several months to several years. It is at this stage that cysts can become infected.

Follicular cysts are diagnosed more often in adolescence (12-15 years) and adulthood, especially in the third decade of life.

The follicular cyst is a single-chamber cavity located in the jaw and delimited from bone tissue membrane (connective tissue capsule with stratified squamous epithelium lining the inner surface of the cyst), which is easily separated from the jaw bone when the cyst is removed).

Follicular cysts are localized more often in the upper jaw, respectively, to molars and canines. Sometimes follicular cysts can be located in the lower edge of the orbit, in the nose or in the maxillary sinus, completely filling it (Migunov BI, 1963).

Accordingly, the localization of the cyst is a thickening of the jaw, often with deformation of the face.

Follicular cysts are characterized by x-ray picture: a sharply delineated oval or round bone defect, immersion of the crown part of an unerupted tooth into this defect, or even the complete location of the tooth in the zone of the detected defect. The largest observed size of such a cyst is about the size of a chicken egg.

Follicular cyst of the lower jaw

During the puncture, a clear yellow liquid is determined, opalescent in the light, with an admixture of cholesterol crystals.

In infected cysts, their lumen contains a cloudy liquid with a large number of leukocytes.

Due to the fact, according to what period, there is a violation of the normal development of the dental follicle, the following can be diagnosed: 1) follicular cyst without teeth; 2) a follicular cyst containing a formed tooth or teeth (Braitsev V.R., 1928).

Treatment of follicular cysts is surgical. The volume of surgery should be planned individually and depends on the nature of the cyst, its location, the presence of suppuration, the prospects for the eruption of an impacted tooth, as well as the size of the cyst, the degree of damage to the jaw bone and the possibility of reparative osteogenesis.

With tooth-containing cysts, it is advisable to carry out cystectomy as a method that provides for the complete removal of the cyst shell (Dmitrieva V.S., Pogosov V.S., Savitsky V.A., 1968). In this case, the included teeth are removed.

Note that when performing a cystectomy, it is necessary to completely remove the membrane with its epithelial lining to prevent the occurrence of relapses. In some cases, especially with festering cysts, it is possible to use the cystotomy method.

In children, plastic cystotomy surgery is often shown (Vernadsky Yu.I., 1983), since it enables the final development, movement and correct eruption of the impacted tooth, around which a cyst has arisen.

With follicular cysts of inflammatory origin, both cystectomy and cystotomy can be used with equal success.

The two-stage cystectomy technique may be the treatment of choice for patients with large follicular cysts in the mandible. In this case, it is sometimes advisable prophylactically (in order to avoid a pathological fracture of the lower jaw) to apply VS Vasiliev's splints to the dentition in the preoperative period, or to make and fit gingival splints (mouthguards) from Weber's or Frigof's type plastic.

Retromolar cysts can be attributed to a variety of eruption cysts. They arise in connection with a chronic inflammatory process in the periodontal tissues, caused by difficult teething, more often wisdom. Sometimes, due to the cystic transformation of the integumentary epithelium under the "hood" above the retromolar cyst, it can be fused to the crown of an erupting tooth and is localized in the corner of the mandible, immediately behind the coronal part of the lower third molar.

Retromolar fossa cyst

The diagnosis of a retromolar cyst is confirmed by x-ray. However, such a diagnosis is rarely made by dentists. For example, during clinical and radiological examination of a large number of people with difficult teething of wisdom teeth, A.V. Kanopkene (1966) never noted the presence of retromolar cysts in them. Surgical treatment (cystectomy, cystotomy).

Primary cyst (keratocyst). Keratocysts arise from odontogenic epithelium, usually in those places where there are teeth, but they have no connection with the latter.

For the first time described the clinical and histological picture of keratocysts in 1956 by Philipsen. He also introduced the term "odontogenic keratocyst" and noted the possibility of this neoplasm to frequent recurrence and malignant transformation. In our country, E. Ya.Gubaidulina, L.N. Tsegelnik, R.A. Bashinova, Z.D. Komkova (1986), D. Yu. Toplyaninova and Yu. V. Davydova (1994) and other According to W. Lund (1985), keratocysts account for 11% of odontogenic cysts. Keratocysts are found mainly in the lower jaw at the level of the molars and, like follicular cysts, clinically may not appear for a long time and increase in size imperceptibly for the patient. Clinical symptoms keratocysts are similar to the main symptoms of other jaw cysts. They are diagnosed accidentally by X-ray examination for other dental diseases or in case of infection and suppuration. If keratocysts are found, it is necessary to exclude the presence of a basal cell nevus (Gorlin-Goltz syndrome), for which all family members should be examined.

Keratocysts, like radicular cysts, increase in size along the body of the jaw and lead it to deformation years after their appearance.

An X-ray examination, puncture or biopsy usually helps to direct the doctor to the idea that the patient has a keratocyst.

On the roentgenogram, the keratocyst looks like a focus of bone tissue rarefaction or a polycystic focus with clear polycyclic contours. Due to uneven bone resorption, the impression of multi-chamber is created, which requires a differential diagnosis with adamantinoma. The contours of the periodontal gap in the teeth located in the cyst cavity are initially preserved, and then not traced. Resorption of the tops of their roots is possible (Vorobiev Yu. I., 1989). Sometimes keratocysts are located next to impacted teeth or tooth buds. During the puncture, it is sometimes possible to obtain a thick, dirty gray mass with an unpleasant odor.

With a biopsy, which can simultaneously be the first stage of surgical treatment, it is possible to macroscopically determine a cavity covered with a membrane, which protrudes into the bone tissue with bay-like protrusions and contains keratin masses. During the histological examination of the operating material, a thin connective tissue capsule is determined, lined with a stratified squamous epithelium with pronounced keratinization phenomena. In the epithelial lining of the keratocyst, more high rates mitoses than in the epithelial layer of radicular cysts (Main M. Q., 1970; Toller R. A., 1971).

E. Ya. Gubaidulina, L. N. Tsegelnik, R. A. Bashilova and Z.D. Komkova (1986) identified some of the features of the clinical and radiological picture, in aggregate, the most characteristic of an odontogenic primary cyst:

1. anamnestic and clinical data do not reveal a connection between the occurrence of a cyst and dental pathology;
2. the cyst is localized mainly on the lower jaw in the area of \u200b\u200bthe body, according to the molars, angle and branch of the jaw;
3. despite the extensive intraosseous lesion, there is no pronounced deformation of the jaw, which, apparently, is explained by the spread of the process along the length of the bone in the form of a single cavity;
4. radiographically determined, as a rule, bone tissue rarefaction with clear boundaries, often with a polycyclic contour. A sharp swelling of the cortical plate is not detected, although the lesion covers a large area of \u200b\u200bthe jaw. The periodontal gap of the tooth roots in the cyst projection is most often preserved.

For surgical treatment, cystectomy is the treatment of choice. However, given that keratocysts are capable of recurrence and malignancy, some authors recommend using a two-stage operation technique if cystectomy is impossible (Gubaidulina E. Ya., Tsegelnik LN, 1990). This method of treating keratocysts gives a good result when used on an outpatient basis (Toplyaninova D. Yu., Davydova Yu. V., 1994). At the same time, N.A. Ryabukhina (1991) notes that the recurrence rate when removing keratocysts varies from 13 to 45%.

Cyst of the nasopalatine canal (incisal foramen) is epithelial non-odontogenic, arises from the remnants of the epithelium of the nasopalatine duct, split off in the embryonic period in the nasopalatine canal and among the "gap" cysts is the most common. According to W. Petrietall (1985), occurs in 1% of people. It is usually located in the area of \u200b\u200bformation of the alveolar arch above the incisors of the upper jaw, because of which it can be mistaken for a peri-root cyst. Increasing in size, leads to resorption of the palatine process of the upper jaw.

When examining the oral cavity in the anterior part of the palate in its middle, a painless, rounded formation with clear boundaries is determined. On palpation, "swelling" is noted. The central incisors of the jaw, as a rule, are intact, the electrical excitability of the pulp is within normal limits. In the diagnosis of cysts of the nasopalatine canal, an X-ray examination is of decisive importance, in which a rarefaction of bone tissue of a round shape in the area of \u200b\u200bthe incisal opening is detected. The contours of the periodontal gap of the central incisors are preserved.

When diagnosing cysts of the nasopalatine canal, a cystectomy is performed by access from the palatal surface of the alveolar arch of the upper jaw. If a cyst is significantly detected on the eve of the oral cavity, it is removed from the vestibular side of the alveolar arch of the upper jaw.

Cholesteatoma of the jaw - a tumor-like cyst-like formation, the shell of which is lined with the epidermis, and the contents have the appearance of a mushy mass, including horny masses and cholesterol crystals. In punctate, up to 160-180 mg% cholesterol can be determined (Vernadsky Yu.I., 1983). It is because of the presence of cholesterol that this tumor-like neoplasm often has a greasy or stearic tint, which is the reason for its name (Muller, 1938).

Cholesteatomas in the jaw area are found in two types: 1) in the form of an epidermoid cyst that does not contain a tooth; 2) in the form of a periodontal (follicular) cyst with special contents surrounding the crown of an unerupted tooth (Kyandsky A.A., 1938). The upper jaw is more often affected.

It is important to note that inside the cholesteatoma cavity there is always a mushy mass that has a pearly (nacreous) hue, which quickly disappears after the cholesteatoma is opened and the latter takes on a greasy appearance. The pearly luster is due to the presence of concentrically layered particles of decay of cell clusters from the keratinized epithelium in the cholesteatomic masses, which gave Cruvielhier (1829) a reason to call the cholesteatoma a "pearl tumor".

The clinical picture of the cholesteatoma of the jaws is most often generally similar to clinical picture cysts of the jaws, less often - a cystic form of adamantinoma, which has a two- or three-chambered structure. Usually, an accurate diagnosis of cholesteatoma is established during a histological examination or, more often, during an operation and is already confirmed by a histological examination of the operating material.

When diagnosing cholesteatoma, it is removed by cystectomy, less often by cystotomy.

Traumatic cysts of the jaws are rare. They are referred to as non-epithelial cysts. Such cysts are found in the lower jaw, in initial stages are asymptomatic and are diagnosed accidentally on the roentgenogram in the form of a clearly delimited cavity with sclerosed bony edges in the lateral part of the jaw body, not associated with the teeth. The pathogenesis of such cysts is unknown. Histologically, the cyst has no epithelial lining. Its bone walls are covered with a thin fibrous tissue, which contains multinucleated giant cells and hemosiderin grains (Gubaidulina E. Ya., Tsegelnik L.N., 1990). Traumatic cysts may be empty or filled with hemorrhagic fluid.

Some experts consider the cyst to be the result of intensive bone growth, in which the cancellous bone substance does not have time to rebuild, and bony cavities are formed. Similar cysts are found in the epophysis tubular bones... However, it is believed that traumatic cysts are the result of hemorrhage in the central parts of the jaw. Hemorrhages into the thickness of the spongy substance can lead to the formation of intraosseous cavities, lined with a capsule of connective tissue, in the formation of which the endosteum takes part. With suppuration, a fistula may form, which is a way for the vegetation of the epithelium of the gingival mucosa deep into the jaw, followed by the lining of the cyst membrane completely or, more often, partially. The pulp of the teeth bordering on the traumatic cysts of the jaws, as a rule, remains viable (Kyandsky A.A., 1938). Removal of traumatic cysts of the jaws is performed by exfoliation or cystotomy, which depends on the size of the pathological formation.

Aneurysmal bone cysts referred to as non-epithelial cysts. Etiopathogenesis is practically not studied. For many years this type of cyst was considered as a cystic form of osteoblastoclastoma (Kasparova N.N., 1991). It usually occurs in the area of \u200b\u200bintact teeth on the lower jaw in prepubertal and pubertal age (Roginsky V.V., 1987). The lesion is a cavity, sometimes a multi-cavity lesion, filled with blood, hemorrhagic fluid, or may not have any liquid content at all. The bony cavity of the cyst is usually lined with a sheath of fibrous tissue, devoid of epithelium, and contains osteoblasts and osteoclasts.

The name "aneurysmal" cyst means only one of the late symptoms of this pathology - deformation ("swelling") of the lower jaw.

In the early stages of the development of an aneurysmal bone cyst, patients do not present complaints. Radiographically, a focus of bone enlightenment with clear boundaries in the form of one or more cysts is diagnosed, thinning of the cortical plate is often noted, in the later stages - deformation of the jaw in the form of swelling.

When diagnosing this type of cyst, surgical treatment is performed, which consists in scraping the cyst shell.

Globular-maxillary (in the bone of the upper jaw between the lateral incisor and the canine) and nasolabial, or nasoalveolar cyst (on the anterior surface of the upper jaw in the projection of the apex of the root of the lateral incisor and canine), a globular-maxillary cyst can also occur. In this case, the latter causes only an impression of the outer compact plate of the jaw and is not radiologically determined, but can be detected only after the introduction of a contrast agent into its cavity.

Maxillary spherical and nasoalveolar cysts arise from the epithelium at the junction of the intermaxillary bone with the upper jaw. They contain a yellowish liquid without cholesterol (Roginsky V.V., 1987).

X-ray diagnostics helps in the diagnosis of a spherical-maxillary cyst. On the roentgenogram, bone rarefaction is usually determined in shape, resembling an inverted pear with clear boundaries. The roots of the lateral incisor and canine are usually moved apart, while the contours of the periodontal gap are preserved.

The spherical-maxillary and nasoalveolar cysts are removed by cystectomy by access from the vestibule of the oral cavity.


"Diseases, injuries and tumors of the maxillofacial region"
ed. A.K. Iordanishvili

A jaw cyst is a common pathology in which a cavity filled with fluid forms in the jaw tissue. The neoplasm occurs due to a dental disease or is formed from the follicular membrane. A distinctive feature of the disease is accelerated growth and a destructive effect on the jawbone. When symptoms appear, timely diagnosis and treatment are required, which implies surgical intervention.

Common forms of cysts

There are seven types of disease in total:

After removal of the cyst, relapses are possible due to tissue disorders. Treatment of the disease will entirely depend on the type of pathology.

Causes of cysts

Many pathogenic microorganisms are present in the oral cavity. Lack of hygiene leads to an increase in the number of microbes. The development of the disease may be associated with a decrease in the protective functions of the body. Human immunity is reduced by such factors as: insomnia, severe stress, overwork, unhealthy diet. Other factors in the onset of the disease include:

• Trauma oral cavity (gums or tooth). These include minor injuries - a cut solid food or a burn from a hot drink.
• Infectious contamination. Infection can enter the canal in case of periodontitis or periodontitis. Infection of soft tissue occurs due to untimely or improper treatment of diseases of the oral cavity (caries).
• The infection can be provoked by multiple ENT diseases (for example, sinusitis).
• Poor development and teething.

The cyst blocks the exit path for bacteria, which provokes rupture or suppuration. Inflammatory processes can provoke unpleasant consequences:

• inflammation and enlargement of the lymph nodes;
• swelling of the face or jaw area;
• inflammation of the gums;
• difficulty in curing the disease;
• inflammation of soft tissue or bone marrow.

Timely treatment will help avoid negative consequences.

Disease symptoms

At an early stage of the disease, no symptoms are found. A person may notice a small pouch on the gum, visible to the eye and uncomfortable when talking or chewing food. The cyst can be detected on an X-ray, during a preventive examination at the dentist.

The further stage of the course of the cyst is accompanied by suppuration and sharp symptoms:

• acute pain in the area of \u200b\u200blocalization of the cyst and the affected bone;
• increased body temperature up to 39-40 degrees;
• deterioration in general health;
• chills;
• migraine;
• nausea or vomiting;
• redness of soft tissues;
• strong swelling of the site of localization.

Untimely treatment can lead to damage to nearby tissues and organs.

Maxillary cyst

This type of disease occurs in most cases. The upper jaw is a paired bone of the cranial region. It contains a soft substance that predominates in quantity over other components. Due to the soft structure of the bone, the cyst spreads quickly. Each person has an individual structure of the maxillary sinus: cavities are different, and the roots of molars or premolars are covered with a membrane or pass into the sinus of the jaw.

The cyst of the upper jaw differs depending on the benign and malignant causes occurrence. The first of the reasons may be the spread of pathogenic microbes through the roots of the teeth or periodontal pockets. A symptom of this type of cyst can be edema, saccular formation, fever, pain when chewing, increased fatigue, migraine. A neoplasm is detected using an X-ray, where the cyst is a darkened area. Radicular formation is localized in the place of the central teeth.

The cyst can be found on x-ray

Mandibular cyst

Pathology with a hollow formation - a cyst of the lower jaw. Untimely treatment leads to the accumulation of fluid in the cavity. A sick person does not feel changes in the state of health, there is no jaw defect. The disease progresses, but it can only be detected with an X-ray examination.

The lower jaw is a paired bone that contains a cancellous substance. The cyst of the lower jaw damages the nerve that lies between the fourth and fifth teeth. Injury to the nerve leads to increased pain. Swelling and redness can be symptoms of the formation. Untimely access to the dentist can lead to a pathological fracture, fistula formation or osteomyelitis.

Neoplasm treatment with cystectomy

Removal of the cyst is carried out exclusively by a surgical method using modern equipment. With suppuration of the cyst, the contents are immediately drained out with the help of drains. There are also uncomplicated diseases that do not lead to surgical intervention.

The main types of surgery are: cystectomy and cystotomy. The first intervention is the excision of the cyst with overlapping of the damaged area. Indications for this surgical intervention:

• small volumes of education, which is located in the area from the first to the third intact tooth;
• pathology of the upper jaw, which does not affect the sinus and does not have teeth at the site of localization;
• pathology of the lower jaw in the place of the absence of teeth and the presence of the necessary amount of bone tissue to prevent fracture.

The main purpose surgical treatment - cystectomy is the preservation of infected teeth and teeth in the vicinity of a developed cyst. The causal teeth will be filled by specialists and the material will be removed over the root apex.

Surgery to preserve teeth - root apex resection. The teeth in the cyst cavity fall out after the operation, so it is pointless to save them. Teeth with complex structure the root system is often subject to removal due to the difficult passage of the root canals. During the operation, impacted teeth are removed if they are the root cause of the development of a cyst. For this, there is electrodontometry. If the tooth does not respond to an electric current, and an X-ray examination does not reveal an expansion of the periodontal space, the dentist will fill the tooth before the operation.

The cystectomy operation is performed under anesthesia: conduction or infiltration. The incision is made according to the size of the cyst. A trapezoid-shaped periosteal and mucous flap is formed and removed.

With the help of special surgical instruments, the cyst is removed along with the root surface. To prevent recurrence, the cyst membrane must be removed. After excision of the cyst, the roots of the near teeth are exposed, which provokes the cutting off of their tops. The next stage is the revision of the tooth cavity, which is covered with a blood clot. Antibiotics or antiseptics are not used. Osteogenic medications are injected into the open wound. Then a flap is applied, which is fixed with catgut sutures. Prescribed to take antihistamines, painkillers and anti-inflammatory drugs. Mouth rinses or baths with chamomile or sage infusions are shown. After the operation, a sick leave is issued.

Treatment of neoplasms with cystotomy

A cystotomy is performed to create a connection between the jaw cyst and the oral cavity. As in the first case, anesthesia is performed, an incision is made in the area of \u200b\u200blocalization of the cyst, the flap is removed and the wall is trepanned. The walls of the cyst and the outer membrane of the periosteum are removed with surgical scissors, and the cyst is cleaned out. The fluid in the cyst capsule is eliminated with a dental pump or soaked in cotton swabs. The flap is placed on the cyst wall, and the cavity is filled with strips of iodoform gauze. The adjacent teeth are subject to filling. With the healing process, the cavity is filled with a smaller cotton pad. Complete healing of the cavity takes six to twelve months. Dressings should be carried out within 2 months, constantly rinse the oral cavity (especially after eating) with boiled water and antiseptic solutions.

A timely visit to a specialist will help to avoid unpleasant consequences, including surgical intervention.

The jaw cyst is one of the variants of benign bone neoplasms and is a cavity filled with serous fluid.

Classification

Cystic formations of this localization are classified in connection with the origin:

1. Odontogenic - have a direct connection with the tooth or a violation of the correct laying of the tooth-forming epithelium. These cysts include radicular (apical, lateral, subperiosteal, residual), follicular, paradental and epidermoid.
2. Neodontogenic, or true jaw cysts - not associated with tooth tissues. They are subdivided into nasopalatine (incisal canal), globulomaxillary (spherical-maxillary) and nasoalveolar (nasolabial).

The cyst of the upper jaw occurs only in 2% of cases, and the cyst of the lower jaw is often a combination of odontogenic and non-odontogenic formations due to rapid growth and increase in the area of \u200b\u200bthe lesion.

Description

Neodontogenic cystic neoplasms have some common characteristics:

1. The pathogenesis is based on a violation of facial embryogenesis (embryonic dysplasia). It is formed on the border of the embryonic facial processes, that is, the main cause of the disease is congenital.
2. They have a cavity, which is delimited by a wall of fibrous tissue from the surrounding space (clearly seen in the photo).
3. The cavity is filled with aseptic fluid. It is prone to suppuration, in this case it is filled with purulent contents and increases significantly (a tendency to melt tissue). With injuries, the fluid can become hemorrhagic due to hemorrhage into the cavity.
4. The pathology is isolated and has no communication with the surrounding structures (localization exactly in the bone of the lower or upper jaw). Exceptions are neglected cases, in which inflammation switches (contact path) to neighboring organs (teeth, sinuses).

In each individual case, cystic formations can have significant differences, which somewhat complicates the diagnosis.

Diagnostics is based on X-ray images (ultrasound has no value, CT / MRI only during differential diagnosis in unclear cases).

The main treatment option is surgery to remove the cyst from the jaw tissue (cystotomy, cystectomy).

Symptoms

Symptoms of cysts in the jaw will depend on the specific type and degree of involvement of nearby tissues.

	Features:
Nasopalatine (incisal canal)	They develop from the embryonic remnants of the epithelium of the nasopalatine canal (connects the nasal and oral cavity). Most often occur in the lower parts of the canal. Localized between the central incisors.	Slow growth explains the long absence of clinical manifestations. 1. Virtually painless (slight pulling or aching sensations in the upper or lower jaw). 2. When the palatine bone is destroyed (the anterior part of the palate behind the incisors), a hemispherical protrusion appears in the oral cavity. 3. When puncture of education receive a serous transparent liquid. 4. Difficulty in nasal breathing (the lower nasal passage is often involved). 5. Violation of sensitivity (numbness, twitching) when the nerve bundles are compressed. With suppuration, typical signs of abscesses appear: Sharp throbbing pain; Suppuration is relatively infrequent.
Globulomaxillary (intramaxillary, spherical - maxillary)	Localized between the lateral incisor and the canine on the upper jaw. They arise with improper fusion of the frontal and maxillary embryonic layers.	The slow growth explains the long absence of symptoms. 1. Painless protrusion on the eve of the mouth and palate. 2. Difficulty breathing when invading the nasal cavity. 3. Development of the phenomena of sinusitis during germination in the maxillary sinus. 4. During puncture, a clear liquid with cholesterol inclusions is obtained. 5. Suppuration is extremely rare. Since the cysts are located between the roots of the teeth, odontogenic cysts (paradental cyst) can often form.
Nosoalveolar (nasolabial cysts of the vestibule of the nose)	Localized on the anterior wall of the maxillary bone on the eve of the oral cavity, in the projection of the roots of the lateral incisor and canine. They arise when the fusion of the frontal, external nasal and maxillary embryonic sheets is disturbed.	Clinical manifestations: 1. In the area of \u200b\u200bthe nasolabial groove there is a protrusion of a rounded shape. On palpation painless, mobile. 2. Difficulty breathing due to narrowing of the nasal passages. 3. Deformation of the facial skeleton occurs due to the localization of the cyst in soft tissues, and not just intraosseous location. 4. Headaches due to irritation of the nerve endings. 5. Suppuration occurs relatively rarely. At puncture, a transparent, somewhat viscous liquid is obtained.

Epidermal cyst

As an example, consider a cystic formation, which is odontogenic in origin, but clinically more reminiscent of non-odontogenic formations - an epidermal cyst.

Features and clinical manifestations:

1. It occurs in the area of \u200b\u200bthe lower jaw.
2. They have an asymptomatic course, since they grow extremely slowly, and are often an accidental finding in the images.
3. The cavity of the cyst contains both intact teeth and those that were involved in the pathological process (mixed genesis of the disease).
4. The cavity is filled not with liquid, but with mushy contents (a dangerous differential symptom, which is also characteristic of some malignant tumors).

In this case, the cyst is conventionally a precancerous condition.

Treatment

Treatment for jaw cysts is mainly limited to surgery, and although there are conservative methodsbut they are less effective and have a high risk of relapse.

Surgical removal

The following types of operations are carried out:

1. Cystectomy... Refers to radical methods, which is associated with excision of a hollow formation with all its membranes and suturing the edges of the wound.
2. Cystotomy... It is only a partial excision of the cystic cavity and surrounding bone tissue (removal of the anterior wall). In this case, all the contents leave the cavity, and the resulting void serves as an additional bay in the oral cavity. The wound is not sutured, but tamponized (the dentist rinses the mouth 2 times a week and changes the turunda until healed completely).
3. Plastic cystectomy... A variant in which the two above methods are combined. The cystic formation is removed completely, but the wound is not sutured, but tamponed with a muco-periosteal flap, which is held in the wound with an iodoform tampon.

The features of the methods are presented in the table.

	Indications	Advantages and disadvantages
Cystectomy	Used for all types of neoplasms (odontogenic and non-odontogenic)	Positive sides: · Radical removal (reliability of the method); · low risk the occurrence of infection (the wound is sutured tightly). Negative sides: · A large volume of intervention and, as a result, high trauma; Involvement of healthy teeth in the intraoperative or postoperative period); · Possible damage to the neurovascular bundle; · The possibility of injury to the sinuses.
Cystotomy.	1. For large cystic lesions. 2. When growing into the sinus cavity. 3. When the bone plate is destroyed (with the risk of pathological fractures). 4. Elderly people with multiple concomitant diseases. 5. In persons with a violation of the blood coagulation system (hemophilia). 6. In children for the preservation of tooth germs.	Positive sides: · Low invasiveness; · Fast and simple execution technique; · Low risk of damage to nerves, blood vessels and teeth. Negative sides: Incomplete excision (risk of recurrence); · The appearance of additional cavities; · High risk of secondary infection with open wound management.
Plastic cystectomy.	1. Defect of the mucoperiosteal flap. 2. Divergence of the wound edges due to suppuration.	It is used extremely rarely. It is performed in two stages: first, a classical cystotomy, and after 1-2 years, a classical cystectomy is performed.

With suppurative processes in the cystic formations of the jaw, treatment is carried out using the same techniques, but only after the inflammatory process subsides. This means that in the first place is the drainage and cleaning of the cavity (excision of the cystic cavity is the second stage).

With the involvement of the sinuses, fistulas are formed to create a single natural system for the drainage of cystic formation (gradually epithelializes on its own and the fistula closes).

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A cyst is a tissue formation covered with epithelium, the cavity of which contains fluid. It can appear in various internal organs.

The cyst also forms in the bone of the upper and (or) lower jaw, and it quite often affects this area, has characteristic symptoms and signs.

Characteristics of pathology

The jaw cyst is a cavity, the inner surface of which is lined with epithelium, and the outer wall is formed by fibrous tissue. Liquid contents - exudate - accumulate inside the cyst. Its dimensions can range from 5 mm to several cm.

Cystic formation is classified as benign tumors - they do not spread to the surrounding tissue and internal organs... But this does not mean that this tumor is harmless: if treatment is not started on time, the cyst accumulates pus in the jaw and grows in size. Its development is dangerous by intoxication of the body and such a serious complication as sepsis.

Cystic formations may not show up in specific symptoms for a long time. In such cases, they are identified during the conduct.

Experts believe that cysts in the jaw are a congenital pathology. Nevertheless, it has been proven that neoplasms can form as a result of tissue inflammation, with advanced pathological processes in the oral cavity, as the body's response to infection.

The cavity can become inflamed and thereby provoke the development of a purulent process, which is accompanied by severe pain and swelling of the gums.

The only way to treat a cyst of the jaw is surgical exfoliation ().

Lower jaw cyst on x-ray

Provoking reasons

A cyst in both the upper and lower jaw teeth is formed due to several factors. These include:

Such cavities can form in a patient of any age.

Modern classification - important to distinguish

Depending on the cause of the appearance, as well as the predominant signs, the following types of jaw cysts are distinguished:

1. Primordialalso known as primary or keratocyst. It is formed in the zone of the so-called "" or in the angular areas of the lower jaw. A tumor neoplasm can be single or multi-chambered. The cavity contains dense contents. The surgical method of eliminating keratocysts does not guarantee the absence of relapse: very often, after surgery, repeated suppuration is observed, the risk of tumor growth is not excluded.
2. , or root a cyst usually forms in the upper jaw. The tumor develops when the tissues that are close to the tooth root are inflamed. Capsule formation is a response to the inflammatory process. A characteristic feature of this type of education is the ability to grow into the jawbone. Basal cysts often fester. They can penetrate maxillary sinus, which creates the risk of developing sinusitis.
3. Follicular... A cyst of this type is formed from the enamel tissue of unerupted teeth. In its cavity, in addition to the liquid contents, there are rudimentary teeth, and sometimes already fully formed ones.
4. Traumatic... Most often localized in the lower jaw, occurs after a strong blow.
5. Aneurysmal... Such a cyst forms in the area of \u200b\u200bthe lower jaw, next to completely healthy teeth. The inside contains blood or liquid that resembles it in color. The main reason for this phenomenon is considered to be puberty.

Different types of formations cause different symptoms, which become noticeable only when the cyst reaches a certain size.

Keratocyst to the wisdom tooth area

Typical symptoms

With the formation of a jaw cyst with a large diameter, a round protrusion forms on the patient's face. In the inflammatory process, which almost always accompanies the development of education, the following symptoms are observed:

Methods for detecting education and features of its treatment

The main way to detect cysts in the jaw area is. The largest amount of information required provides.

With its help, the specialist determines the localization of the tumor, the degree of its growth, the level of influence on the teeth located next to it. Also, for diagnostic purposes, magnetic resonance imaging is performed.

The cyst is treated surgically. The main task of a specialist is to preserve the integrity of the teeth located next to the formation, as well as restore their functioning. For this purpose, the following manipulations are performed:

• if the patient is diagnosed with a radicular cyst with a diameter of no more than 8 mm, the root canal is washed, a drug is injected into it, which neutralizes inflammation and infection, and then cemented;
• an incision is made in the gum area, removing a small tumor together with the tops of the roots of the teeth, the canals are subsequently treated and the removed tissues are replaced with artificial materials;
• remove the tumor together with the tooth, if the neoplasm has formed near "";
• if the tumor has grown and provoked a purulent inflammation of the jawbone, a large-scale surgical intervention, after elimination of the tumor, the affected tissues are scraped out.

After the operation, the patient is shown long-term treatmentbased on taking antibiotics.

Hidden and obvious dangers

Even with treatment, there is no guarantee that the cyst will not reappear. But this does not mean that it does not make sense to deal with this problem: if the necessary therapeutic measures are not carried out on time, there is a significant risk of suppuration and subsequent penetration of purulent masses into the blood, which is fraught with the development of sepsis.

In addition, a benign neoplasm can transform into a malignant one and provoke the development of oncological disease.

Another consequence of untreated cysts is loosening of the teeth and their loss. You can fix this in the future only with the help of.

Preventive measures

Given the long asymptomatic period of cyst development, experts recommend regularly undergoing X-ray examination to control this process.

If there is a jaw injury (bruise), then it is necessary to immediately take an X-ray, and a month after the start of treatment - another.

After the operation to remove the cyst, you should avoid eating too hot or cold food, regularly rinse your mouth with antiseptic solutions. The diet should include as many cereals as possible. Vitamin complexes should be taken to strengthen local and general immunity.

After completing each meal, you need to thoroughly rinse your mouth with water, but in general it is desirable after each meal to be fully.