Intraoral approach for cystectomy of jawbone

Treatment of diseases: jaw cysts Indication Jaw cysts are divided into two types: odontogenic cysts and non-dental cysts. The intraoral route for the removal of the jaw cyst is suitable for small and medium-sized cysts of the mandible and large and medium-sized cysts of the maxilla. It is especially suitable for cases in which the teeth need to be removed at the same time. However, the diameter of the cyst is less than 1cm and the teeth can be retained. It is not necessary to rush to surgery. It can be treated with root canal treatment. It is expected that the cyst will gradually become ossified and disappear. Preoperative preparation Detailed clinical examination and X-ray examination (including dental piece, occlusal piece and jaw piece) should be performed before operation. If necessary, a puncture and aspiration test can also be performed to confirm the diagnosis, the location of the cyst and the extent of the lesion, and the cyst. Relationship with important anatomical structures such as the maxillary sinus, nasal cavity and mandibular canal. The lesions of the apical cyst and the teeth involved in the cyst should be treated with root canal before surgery. However, if the root and alveolar bone are absorbed more or the tooth is loose, it should be removed before or during surgery. When the jaw cyst is combined with acute inflammation, surgery should be performed after the inflammation is controlled. Surgical procedure Incision Generally, small cysts can be used as curved incisions, but large and medium-sized cysts, especially those requiring surgery to remove the teeth at the same time, should adopt a trapezoidal incision. Regardless of which incision is used, the pedicle should be designed in the vestibular mucosa of the oral cavity, and the base of the periosteal flap should be wider than the free edge of the valve to ensure adequate blood supply. In addition, the incision should also be designed in the normal bone outside the scope of the cyst, generally more than 0.5cm from the edge of the cyst. When making an arcuate incision, the midpoint of the arcuate incision should be 0.5 cm from the gingival margin, and the ends of the incision are close to the vestibular mucosal folds of the oral cavity. If the maxillary cyst is located on the temporal or temporal side of the bone plate, the incision can also be made on the temporal side. The temporal incision should be performed along the iliac crest, and no periosteal incision should be made. 2. Flap After the mucosal periosteum was cut according to the design of the incision, the small periosteum stripper was used to peel off and the mucoperiosteal flap was turned over. At this time, attention should be paid to the presence or absence of bone coverage on the surface of the cyst. If the bone is absorbed and the wall of the capsule adheres to the periosteal flap, the scalpel should be used for careful separation to prevent residual cysts, resulting in postoperative recurrence. 3. Open the window If the bone wall of the cyst surface is thick, you need to use a small bone to open a small window, and then use a rongeur to enlarge the opening; if the bone wall is very thin or worn, you can directly use the rongeur to bite the bone of the cyst surface. Wall to reveal cysts. The extent of bone wall removal on the surface of the cyst is such that it can reveal cysts and facilitate the removal of cysts. Avoid bone damage when bone is removed, and avoid breaking the wall. 4. Stripping cysts The wall of the capsule was carefully separated by a small periosteal stripper between the wall of the capsule and the wall of the bone. When peeling off, try to avoid breaking through the wall and try to peel it off as much as possible. At the same time, avoid damage to its adjacent anatomical structures such as the nasal vascular bundle, the inferior alveolar vascular bundle, etc., and also prevent the nasal passage, maxillary sinus, etc. . If the cyst has destroyed the posterior wall of the maxillary sinus, the wall should be removed with special care. Be careful not to exceed the posterior wall so as not to damage the important anatomical structures in the infraorbital fossa such as the internal maxillary artery and the pterygoid plexus, resulting in severe bleeding. When the ankle bone is damaged, it is necessary to prevent the perforation of the mucosa. If the cyst has worn through the upper wall of the maxillary sinus, it is also necessary to prevent the passage through the bottom. After the cyst is peeled off, it is necessary to carefully check the presence or absence of residual cyst wall, especially the back of the apex, the adhesion between the wall of the capsule and the bone wall, the deep part of the cyst, the site of the wall of the capsule, and the fenestration of the surface of the capsule. All around, you must carefully check and completely remove the residual wall. If necessary, 50% zinc chloride can be used to cauterize the bone wall, otherwise it can cause recurrence after surgery. It should also be pointed out that if the maxillary cyst is large in scope, it is connected with the maxillary sinus during operation and there is chronic inflammation of the maxillary sinus. At the same time, maxillary sinus radical surgery should be performed at the same time, and the lower nasal passage should be opened; if the maxillary sinus is connected with the upper jaw during operation In the case of sinus-free inflammation, only the cyst is removed together with the maxillary sinus floor mucosa, and then the lower nasal passage is opened, without the need for maxillary sinus radical surgery. In addition, when the cyst is large, a part of the cyst fluid can be withdrawn by a syringe before the wall of the capsule is peeled off, thereby reducing the tension to reduce the chance of peeling off the capsule wall. 5. Dental treatment If the root of the tooth is exposed to the cavity and the tooth can be retained, the apical resection should be performed. The bone can be used to remove 2 to 3 mm, but the root canal should be treated before surgery. The teeth in the tooth cyst should be removed together with the cyst. 6. Wound treatment Trim the edges of the irregular lumen wall, remove the bone residue, rinse the bone cavity, and then tightly suture the wound. If the bone cavity is large, antibiotic powder should be placed, and the cancellous bone and bone marrow can be placed. When the bone cavity is connected with the maxillary sinus or the maxillary sinus radical surgery is performed at the same time, the iodoform gauze should be filled in the bone cavity, and the nasal passage is taken out from the nostril through the lower nasal passage, and then the wound is tightly sutured. If the wound is large in the mouth after tooth extraction and can not be tightly sutured, part of the alveolar bone can be removed, and then the suture type and intermittent suture can be used. The face can be lightly bandaged with a four-tailed belt. complication The main complication of intraoral route for the removal of jaw cysts is postoperative infection. To this end, it should be noted that: 1 correctly handle the teeth associated with the cyst; 2 reasonable design of the incision, and should be tightly sutured in the mouth to prevent the wound from splitting, fistula formation; 3 can be placed in the bone cavity antibiotic powder; 4 postoperative selection antibiotic. In addition, it is generally believed that smaller cysts, after the cysts are removed, allow the blood to fill the bone cavity, put antibiotic powder, and then tightly suture the wound; however, larger cysts should not be used, but blood clots should be completely removed.

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