Follicular cysts of the jaws in children. Jaw cyst classification - causes and treatment methods

The date: 26.06.2020

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Periradicular (radicular) cystsare the last stage in the development of chronic periodontitis. Usually patients do not complain of pain. Only with the development of periradicular cysts of relatively large sizes, patients can complain about the deformation of the alveolar process of the jaw, the displacement of the teeth.

Note that among patients admitted to dental hospitals, patients with periradicular cysts make up about 8%. About half of them (46%) are patients with festering cysts of the jaws. Moreover, radicular cysts are more common 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 crown of the tooth and its destruction by a carious process, painless probing of the canals of the roots of the tooth, during which a yellowish liquid may be released. Percussion of the "causal" tooth may be uncomfortable, but is usually painless. In this case, deformation of the alveolar process and displacement of the teeth adjacent to the “causal” are possible. Palpation of the area of deformation 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), i.e. springiness of the wall. Electroodontometry of the "causal" tooth is not less than 100 μA. If the pulp of neighboring 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 common (21.8%) sign of the clinical manifestation of a periradicular cyst is considered a symptom of elastic tension, i.e., bending of the thinned bone wall at the site of the protrusion of the cyst without signs of fluctuation and parchment crunch. The symptom of "parchment crunch" is observed in 5.8% of patients, i.e., much less frequently than the symptom of fluctuation (18.3%). The symptom of facial deformity with periradicular cysts is observed in 36.4% of patients.

The reaction of regional lymph nodes is more often clinically manifested with localization in the lower jaw, and then, mainly, with their suppuration. It is with festering cysts that fistulas are usually observed, communicating the cyst cavity 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-suppurating and festering periradicular cysts is almost the same, despite significant clinically identified differences in the intoxication syndrome in such patients and their different state of health according to subjective sensations.

On the radiograph, the periradicular cyst is projected as a focus of enlightenment, round or oval in shape 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 compacted bone tissue. With suppuration of the cyst, the clarity of its contours is violated, they become "blurred".

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

Morphologically, the cyst is an encysted cavity, the inner surface of which is lined with stratified squamous epithelium of the epidermal type, located in 4-12 rows. The epithelium often forms vegetations 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. When suppurated, this fluid becomes cloudy and is pus. The cyst capsule contains a significant amount of nerve fibers.

In the process of growth, cysts can push up the lower wall of the piriform opening, causing the formation of a characteristic roller at the bottom of the nasal cavity "Gerber's roller". When the cyst grows towards the maxillary sinus, the bone wall of the sinus, as a rule, is resorbed and the cyst grows into the maxillary sinus (MS). Sometimes, when the phenomena of bone opposition prevail over resorption, it is possible to move the wall of the maxillary sinus away from the pressure of the membrane 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.

Periradicular 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 (normal); 3 - right VChP; 4 - cavity of the periradicular cyst; 5 - external nose

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

With pushing cysts, there is a displacement of the cortical plate from the alveolar bay of the sinus upward, but its integrity is not broken.

Penetrating cysts are detected on the x-ray as a hemispherical shadow with a clear upper contour against the background of the air of the maxillary sinus, the cortical plate is interrupted in places or completely absent. In the case of penetrating cysts of the jaws, sometimes there are difficulties 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 body only in advanced cases, when cysts exist 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 spongy substance. In this case, the walls of the mandibular canal are usually resorbed, and the cyst membrane fuses with the neurovascular bundle. However, in such cases, changes in sensitivity in the zone of innervation of the mandibular nerve were never observed. During the same surgical intervention, as a rule, it is possible to separate the cyst membrane from the neurovascular bundle without damaging it. Note that even with atraumatic removal of such cysts in the postoperative period for 2-4 weeks. patients may note a violation of the sensitivity of the lower lip on the corresponding side.

With the growth of the cyst along the alveolar arch, the cyst shell compresses the neurovascular bundles of adjacent teeth, which causes atrophic changes in the pulp and is diagnosed by electroodontodiagnostics by an increase in its parameters to 20 μA or more. Sometimes aseptic necrosis of the pulp occurs, which must be identified at the stage of preparing the patient for surgical treatment and endodontic treatment of such teeth should be carried out.

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

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

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

Some authors (Albanskaya T. I., 1936; Agapov N. I., 1953; Vernadsky Yu. I., 1983) also believe that follicular cysts can occur on the basis of inflammatory processes at the tops of the roots of milk teeth, when the focus of inflammation reaches the follicle permanent tooth, causing its irritation with the subsequent development of a cyst.

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

Stage I - the latent development of a follicular cyst with no clinical symptoms. On examination, the absence of a permanent tooth or a delayed milk tooth is detected (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 thinning of the wall (a 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 infection of the cysts can be observed.

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 the bone tissue by a membrane (a connective tissue capsule with stratified squamous epithelium lining the inner surface of the cyst), which is easily separated from the jaw bone tissue when the cyst is removed).

Follicular cysts are localized more often in the upper jaw, respectively, 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 B.I., 1963).

According to the localization of the cyst, thickening of the jaw occurs, often with facial deformity.

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

Follicular cyst of the mandible

Puncture revealed a clear yellow liquid, opalescent in the light, with an admixture of cholesterol crystals.

Infected cysts in their lumen contain a cloudy fluid, 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, it can be diagnosed: 1) a follicular cyst without teeth; 2) a follicular cyst containing a formed tooth or teeth (Braytsev VR, 1928).

Treatment of follicular cysts is surgical. The volume of surgical intervention should be planned individually and depends on the nature of the cyst, its localization, the presence of suppuration, the prospects for eruption of the 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 perform cystectomy as a method that involves the complete removal of the cyst membrane (Dmitrieva V.S., Pogosov V.S., Savitsky V.A., 1968). The included teeth are removed.

It should be noted that when performing 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, the operation of plastic cystotomy is often shown (Vernadsky Yu. I., 1983), as it allows the final development, movement and correct eruption of the impacted tooth around which the cyst has arisen.

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

The technique of two-stage cystectomy may be the method of choice in the treatment of patients with large follicular cysts in the lower jaw. At the same time, it is sometimes advisable prophylactically (in order to avoid a pathological fracture of the lower jaw) to apply V. S. Vasiliev’s splints on the dentition in the preoperative period or to make and fit tooth-gingival splints (kappas) from plastic such as Weber or Frigof.

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

Retromolar fossa cyst

The diagnosis of a retromolar cyst is confirmed by X-ray examination. However, such a diagnosis is rarely made by dentists. For example, during a clinical and radiological examination of a large number of people with difficult eruption 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 the odontogenic epithelium, usually in those places where there are teeth, but they have no connection with the latter.

First described the clinical and histological picture of keratocysts in 1956 Philipsen. He also introduced the term "odontogenic keratocyst" and noted the possibility of this neoplasm to frequent recurrence and malignant degeneration. 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 etc. According to W. Lund (1985), keratocysts make up 11% of odontogenic cysts. Keratocysts are found mainly in the lower jaw at the level of the molars and, like follicular cysts, they may not be clinically manifested for a long time and increase in size unnoticed by the patient. The clinical symptoms of keratocysts are similar to the main symptoms of other jaw cysts. They are diagnosed by chance during an X-ray examination for other dental diseases or in case of infection and suppuration. If a keratocyst is detected, 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 cause it to deform years after their appearance.

To direct the doctor to the idea that the patient has keratocysts usually helps x-ray examination, puncture or biopsy.

On the radiograph, the keratocyst looks like a focus of rarefaction of bone tissue or a polycystic focus with clear polycyclic contours. Due to uneven bone resorption, an impression of multi-chamberity is created, which requires a differential diagnosis with adamantinoma. The contours of the periodontal gap in the teeth located in the cavity of the cyst 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 rudiments of teeth. During the puncture, it is sometimes possible to obtain a thick mass of a dirty gray color with an unpleasant odor.

With a biopsy, which can simultaneously be the first stage of surgical treatment, macroscopically it is possible to determine a cavity covered with a membrane, which protrudes into the bone tissue with bay-like protrusions and contains keratin masses. Histological examination of the surgical material determines a thin connective tissue capsule lined with stratified squamous epithelium with pronounced keratinization phenomena. In the epithelial lining of keratocysts, higher rates of mitosis are noted 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 features of the clinical and radiological picture, which together are most characteristic of an odontogenic primary cyst:

anamnestic and clinical data do not reveal a relationship between the occurrence of a cyst and dental pathology;
the cyst is localized mainly on the lower jaw in the area of the body, respectively, the molars, angle and branch of the jaw;
despite the extensive intraosseous lesion, no pronounced deformation of the jaw is noted, which, apparently, is explained by the spread of the process along the length of the bone in the form of a single cavity;
X-ray is determined, as a rule, rarefaction of bone tissue with clear boundaries, often with a polycyclic contour. A sharp swelling of the cortical plate is not detected, although the lesion captures a large area of the jaw. The periodontal gap of the roots of the teeth in the projection of the cyst is most often preserved.

In 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 if cystectomy is not possible (Gubaidulina E. Ya., Tsegelnik L. N., 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 frequency of recurrences during removal of a keratocyst varies from 13 to 45%.

Cyst of the nasopalatine canal (incisive foramen)is an 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 is the most common among the "slit" cysts. According to W. Petrietall (1985), it occurs in 1% of people. It is usually located in the area of formation of the alveolar arch above the incisors of the upper jaw, which can be mistaken for a periradicular 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, a painless rounded formation with clear boundaries is determined in its middle. On palpation, "ripple" is noted. The central incisors of the jaw are usually intact, the electrical excitability of the pulp is within the normal range. In the diagnosis of cysts of the nasopalatine canal, X-ray examination is of decisive importance, in which rarefaction of the bone tissue of a rounded shape in the region of the incisive foramen 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 with access from the palatine surface of the alveolar arch of the upper jaw. With a significant detection of a cyst in the vestibule 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 look like a mushy mass, including horny masses and cholesterol crystals. In punctate, up to 160-180 mg% of 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 hue, which was the reason for its name (Muller, 1938).

Cholesteatomas in the jaw area occur in two forms: 1) in the form of an epidermoid cyst that does not contain a tooth; 2) in the form of a peridental (follicular) cyst with special contents surrounding the crown of an unerupted tooth (Kyandsky A.A., 1938). The upper jaw is most commonly affected.

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

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

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

Traumatic jaw cystsare rare. They are classified as non-epithelial cysts. Such cysts are found in the lower jaw, in the initial stages they are asymptomatic and are diagnosed incidentally on the radiograph in the form of a clearly demarcated cavity with sclerotic bone edges in the lateral part of the jaw body, not associated with teeth. The pathogenesis of these cysts is unknown. Histologically, the cyst has no epithelial lining. Its bone walls are covered with thin fibrous tissue, which contains multinucleated giant cells and hemosiderin grains (Gubaidulina E. Ya., Tsegelnik L. N., 1990). Traumatic cysts may have no fluid content or may be filled with hemorrhagic fluid.

Some experts believe that the cyst is the result of intensive bone growth, in which the cancellous bone does not have time to rebuild, and bone cavities form. Similar cysts are found in the epiphyses of tubular bones. However, there is an opinion 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 can form, which is the path for the vegetation of the epithelium of the gum 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 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 cystsreferred 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 intact teeth in the lower jaw in prepubertal and pubertal age (Roginsky V.V., 1987). The lesion is a cavity, sometimes a multicavitary lesion, filled with blood, hemorrhagic fluid, or may not have liquid contents at all. The bone cavity of the cyst is usually lined with fibrous tissue, devoid of epithelium, and contains osteoblasts and osteoclasts.

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

In the early stages of the development of an aneurysmal bone cyst, patients do not complain. Radiographically, a focus of bone enlightenment is diagnosed with clear boundaries in the form of one or more cysts, thinning of the cortical plate is often noted, and 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.

Spherical-maxillary (in the bone of the upper jaw between the lateral incisor and 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 spherical-maxillary cyst may also occur. In this case, the latter causes only an impression of the outer compact jaw plate and is not determined radiographically, but can be detected only after the introduction of a contrast agent into its cavity.

Globular-maxillary and nasoalveolar cystsarise from the epithelium at the junction of the premaxillary bone with the upper jaw. They contain a yellowish liquid without cholesterol (Roginsky V.V., 1987).

In the diagnosis of a spherical-maxillary cyst, X-ray diagnostics helps. On the radiograph, 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.

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

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

A jaw cyst is a common pathology in which a cavity filled with fluid forms in the jaw tissue. Neoplasm occurs due to 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, which involves surgery, are necessary.

Common forms of cysts

There are seven types of disease in total:

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

Causes of a cyst

There are many pathogenic microorganisms present in the oral cavity. Poor hygiene leads to an increase in the number of germs. 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, malnutrition. Other risk factors for the disease include:

Injury to the oral cavity (gums or tooth). These include minor injuries - a cut with solid food or a burn with a hot drink.
infectious infection. Infection can enter the root canal in case of periodontitis or periodontitis. Infection of soft tissue occurs due to untimely or incorrect treatment of diseases of the oral cavity (caries).
Infection can be provoked by multiple ENT diseases (for example, sinusitis).
Improper development and eruption of teeth.

The cyst blocks the exit path for bacteria, which provokes a 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;
the difficulty of curing the disease;
inflammation of soft tissues or bone marrow.

Timely treatment will help to avoid negative consequences.

Symptoms of the disease

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

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

acute pain in the area of localization of the cyst and the affected bone;
elevated body temperature up to 39-40 degrees;
deterioration in general well-being;
chills;
migraine;
nausea or vomiting;
redness of soft tissues;
severe 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 prevails 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 by a shell or pass into the sinus of the jaw.

The cyst of the upper jaw differs depending on the benign and malignant causes of occurrence. The first reason 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, fatigue, migraine. A neoplasm is detected using an x-ray, where the cyst represents a darkened area. Radicular formation is localized in the place of the central teeth.

The cyst can be seen 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 by X-ray examination.

The lower jaw is a paired bone that contains a spongy substance. The cyst of the lower jaw damages the nerve, which is located in the gap between the fourth and fifth teeth. Injury to the nerve leads to increased pain. Symptoms of education can be swelling and redness. Untimely access to the dentist can lead to a pathological fracture, fistula formation or osteomyelitis.

Treatment of neoplasm with cystectomy

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

The main types of surgical intervention include: cystectomy and cystotomy. The first intervention is cutting off the cyst with overlapping of the damaged area. Indications for this surgical intervention:

small volumes of formation, which is located in the area from the first to the third intact tooth;
pathology of the upper jaw, not affecting the sinus of the nose and not having 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 a fracture.

The main goal of surgical treatment - cystectomy - is to save infected teeth and teeth located in the vicinity of a developed cyst. The causative teeth will be filled by specialists, and the material will be brought out over the top of the root.

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

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

With the help of special surgical instruments, the cyst is removed along with the surface of the root. To prevent recurrence, the cyst envelope must be removed. After excision of the cyst, the roots of the nearest teeth are exposed, which provokes the cutting off of their tops. The next step 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. Antihistamines, painkillers and anti-inflammatory drugs are prescribed. Showing mouth rinses or baths with infusions of chamomile or sage. After the operation, a sick leave is issued.

Treatment of neoplasm 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 localization of the cyst, the flap is removed and the wall is trepanated. 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 removed with a dental pump or soaked with cotton swabs. The flap is placed on the wall of the cyst, and the cavity is filled with strips of iodoform gauze. Adjacent teeth are subject to filling. With the healing process, the cavity is filled with a smaller cotton pad. Complete healing of the cavity occurs from 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 appeal to a specialist will help to avoid unpleasant consequences, including surgical intervention.

A cyst on the lower or upper jaw is a benign formation consisting of fibrous tissue that is filled with fluid. Why it is dangerous, we will describe its types and methods of treatment further, so that people facing a similar problem do not delay contacting a doctor.

Do not think that fear of the dentist will protect you from trouble. The cyst is the most common disease of bone tissue and is not treated with home folk remedies. By contacting a doctor at the first symptoms, you can prevent its increase and the appearance of various complications.

Causes

What is a cyst and why is it dangerous? This is a neoplasm on the jaw. It looks like a bag, which is surrounded by fibrous tissue, and purulent exudate accumulates inside. Although it is considered a benign formation, it is still necessary to eliminate the cyst as early as possible, otherwise it will lead to other pathologies and tangible discomfort.

Why does it arise? We list the factors of its occurrence:

Dental diseases of hard tissues - even banal caries, which is not treated in time, leads to the spread of infection in the periodontium through the root canals. Once inside the soft tissues, pathogenic bacteria cause pathological formations. This also includes medical errors, for example, when filling the affected canals.
Inflammatory processes of surrounding organs - sinusitis, gum disease, etc. So, through the general bloodstream, the infection quickly enters the bone tissue from the sinus (maxillary, nasal). And with reduced immunity, the disease can even spread even from distant foci of inflammation.
Traumatic injuries do not appear at first. A pathological cavity is formed from a blow, a bruise, a fracture, an attempt to gnaw nuts or open bottles with your teeth, constant exposure to an unturned edge of a crown or prosthesis, etc.
There are also malformations, congenital anomalies, but among the listed reasons this is the rarest factor.

In short, all such situations come down to two - either the protective properties of the oral cavity, immunity decrease, as a result of a weakening of the general state of health, or the activity of pathogenic bacteria increases sharply. Even elementary neglect of hygiene procedures can contribute to this.

No restrictions and age groups more prone to these formations were found. A cyst can appear at any age - and in a child, even in an infant, adolescents, adults and the elderly.

Symptoms

For a long time, the disease does not manifest itself in any way, and only with a deterioration in the condition, the development of inflammation and an increase in education, the following signs of pathology become noticeable:

pain sensations appear;
reddened gums;
swelling of soft tissues occurs;
purulent accumulations are formed;
body temperature rises;
general symptoms of malaise appear - drowsiness, headache, fatigue, weakness;
jaw bones are deformed;
swelling of the jaw;
sinusitis appears or its symptoms worsen.

Sometimes you can notice a change in the shade of the tooth, and the patient feels discomfort when chewing. In any case, you should immediately see a doctor to clarify the diagnosis and prescribe therapeutic measures. If the disease is already running, then fistulas may appear, the face may swell, healthy teeth may loosen, etc.

Cyst on the jaw and its types

The clinic of the disease looks different depending on the form of education, its distribution, size and causes of infection. Doctors distinguish the following classification:

Primordial, that is, primary - otherwise it is also called keratocyst. This is a kind of growth pathology of the “wisdom tooth”. It can be both multi-chamber and single-chamber formation, which even after removal surgery leads to frequent relapses. Inside is not only liquid, but also crumbled remnants of solid tissue.
Radical, radicular - the most common form of cyst, which is diagnosed in 80% of all cases. It occurs twice as often in the upper jaw than in the lower. It all starts with a prolonged inflammation of the soft tissues around the tooth. Due to the protective actions of the body, a fibrous capsule is formed around the affected area. And although the formation does not spread further, purulent exudate quickly accumulates inside. Over time, reticular processes grow from the cyst, which grow into the surrounding tissues. This leads to malignant tumors of the jawbone. Only this type of basal cyst has such specificity.
Follicular - a formation characteristic of teeth that have not yet erupted. Inside, in addition to the liquid, there may also be the rudiments of future permanent units, or even already formed teeth.
Retromolar - is the result of long-term chronic inflammation that forms in response to complex eruption. Very often located in the area of \u200b\u200bthe "eights", since they are characterized by similar difficulties.
Nasoalveolar (non-odontogenic) - located in the naso-palatine canal, is formed above the anterior upper incisors and looks similar to the basal, but has its own characteristics in connection with the location.
Aneurysmal - a rare variety that affects the lower jaw. Filled with reddish liquid or blood. The only reason for its occurrence is puberty and hormonal disorders. Although this species has been studied quite poorly so far. As the pathology grows and develops, a tumor occurs, and a cosmetic defect leads to deformation of the jaw bones.
Traumatic - turns out to be a consequence of mechanical trauma, impact or unsuccessful treatment with dental instruments. Symptoms may be completely absent, but it will be found during a routine examination or on an x-ray.
Residual - becomes the result of unsuccessful tooth extraction, a complication after the operation.

In most cases, destruction of the epithelial layer occurs inside the cyst. Doctors also divide them into odontogenic and non-odontogenic formations. The former are the result of bone disease, while the latter are not directly related to the teeth or gums. They are the result of a pathological process in the facial bones, more often caused by a genetic factor in newborns.

There are also other types, for example, an epidermoid cyst of the oral cavity, but at the same time, although it is located in the jaw area, it refers more to skin diseases and does not affect bone tissue.

How is a cyst on the jaw treated?

If the formation is small (1-3 mm), then they are called granulomas and doctors monitor their condition for some time. Only with an increase in volumes, methods of treating cysts are used:

Therapeutic manipulations - involve washing the root canals, introducing drugs there and cementing the tissues. Due to the action of medications, the cyst is neutralized and compacted. This method is only suitable for radicular varieties that do not exceed 8 mm in volume.
Other methods of treatment involve surgical intervention, since surgery is indispensable. Cystectomy - removal of the focus of infection and affected roots.
Cystotomy is a more popular method that helps to preserve a full-fledged tooth, since in this case only the front wall of the tumor is removed, carefully scraping all the pathological formations.
Plastic cystectomy is similar to the usual one, but is done without suturing the soft tissues. It is more often used in the treatment of advanced conditions and the appearance of complications of the disease.
Biphasic surgery is considered a more complex procedure that is needed in the most difficult cases. At the same time, they try to preserve healthy teeth or their elements, minimally injure tissues, but remove the entire focus of infection. It combines cystotomy and cystectomy, which are carried out in a certain order.
In extreme cases, it is necessary to remove the affected tooth along with the cyst, which is usually required when it is located in the “eights” zone.
In those situations where the pathology has led to the initial stage of osteomyelitis, more serious intervention is needed. At the same time, not only an opening of the affected area is performed, but also a thorough scraping of pus and destroyed tissues. In parallel with this, antibiotics are required.

Complications and prevention

If you have a question whether treatment is necessary in the absence of symptoms, then you need to familiarize yourself with the possible consequences of a cyst that was not removed on time:

And premature loss of teeth leads to various physiological and psychological problems. Therefore, do not ignore even the minimal symptoms of the disease and contact the dentist on time. What can be done to avoid such problems at all? Doctors repeat their general recommendations constantly:

Daily quality.
Periodic to eliminate plaque and tartar.
Timely access to a doctor and treatment of any pathological changes.
Preventive examinations twice a year to detect early stages of diseases.
Compliance with the rules of nutrition, the use of a variety of foods containing an increased amount of vitamins, minerals, especially calcium and fluorine.

Video: how to remove a cyst on the jaw?

Additional questions

ICD-10 code

All cysts related to the oral cavity and jaw are in the classification of diseases under the code K09, but form their own varieties and subspecies. The only exception is the radicular cyst, which is designated as K04.8, and refers to diseases of the pulp and periapical tissues.

Even a small cyst of the upper jaw is very dangerous. It is a dense capsule ranging in size from 5 mm to 2-3 cm, which is often filled with pus. If left untreated, the capsule will begin to grow over time, which will lead to serious consequences, the worst of which can be oncology. It is not easy to diagnose a neoplasm, since it usually hardly manifests itself in the initial stages. Treatment is conservative and surgical.

First, let's focus on the classification of jaw cysts. Medicine is aware of three main types of inflammation: keratocyst, follicular and radicular type. Keratocyst appears in the area of wisdom teeth and contains cholesteatoma - dead epithelial cells. If, after removal of the neoplasm, the jaw tissues are damaged, inflammation may occur again.

The follicular appearance is formed from the enamel of teeth that failed to emerge from the gums. Inflammation is usually found in the canines on the lower and upper jaws. Inside the cyst is a stratified epithelium. Often it contains the rudiments of teeth.

Causes and symptoms

Jaw cysts are formed under the influence of several factors. Among them:

jaw injuries;
infection during treatment;
dental anomalies;
poor-quality treatment of dental canals;
violation of the technology of installation of dentures.

A cyst in the maxilla or mandible is often discovered incidentally when x-rays are taken to treat other conditions. In the initial stage, inflammation almost does not manifest itself. If a chronic form is observed, then the symptoms of a jaw cyst are reduced to discomfort while eating solid food. In some cases, the teeth begin to shift and darken. When the body is weakened due to infectious diseases, the cyst begins to increase, pus forms in it. At this stage, the signs are more obvious: discomfort in the teeth, severe swelling of the gums, fistulas, headaches. A person feels very weak, his temperature rises and there is an increase in lymph nodes. In this case, you need to urgently contact the dentist.

There are cases when the cyst of the jaw is congenital.

Conservative treatment of neoplasm

First of all, the dentist does a CT scan and X-ray of the jaw. This allows you to determine the location of the cyst of the teeth of the upper jaw or diagnose it on the lower jaw, as well as to identify the connection with the roots of the teeth. During conservative treatment, the channels are treated with medicines, ozone therapy is used. If the treatment has given a positive result, the doctor fills the tooth.

Laser technology is often used. First, the tooth is opened and the root canals are expanded, after which the specialist directs the laser beam into the inflamed cavity. As a result, it is possible to destroy the cyst and all pathogenic bacteria that are present in it.

The method has clear advantages, because after exposure to a laser, tissues heal faster and possible complications are excluded. In some cases, surgical techniques have to be used. Especially if the cyst is in a neglected state and a large amount of pus is observed.

Operation cystectomy

Cystectomy involves the complete removal of the cyst. This surgical intervention is performed only under anesthesia. The doctor makes an incision in the jaw, after which the mucoperiosteal flap is peeled off. It should be of such a size that it can completely cover the jaw defect that arose after the surgical operation.

Then a hole is made in the bone wall, enlarged with a cutter, and the apex of the tooth root is resected. After that, the neoplasm is peeled off with a surgical instrument and removed. It is necessary to remove the entire shell of the cyst, otherwise a recurrence is not ruled out. At the end, the cavity is filled with a blood clot.

After the operation, it is necessary to take painkillers and antihistamines. It is recommended to undergo anti-inflammatory therapy and regularly rinse your mouth with herbal decoctions (chamomile, eucalyptus). Cystectomy is very traumatic, but allows you to completely excise the neoplasm of the jaw.

Carrying out cystotomy

During cystotomy, the anterior wall of the neoplasm is removed along with part of the bone tissue. The operation is also performed under anesthesia. The doctor makes an incision in the gum and peels it off the damaged bone tissue. After that, the cystic and anterior bone walls are removed, the sharp bone edges are smoothed out, and the cyst cavity is irrigated with an antiseptic. At the end of the operation, iodoform turunda is installed.

The resulting cavity does not decrease immediately. This will take about 6-12 months. For 2 months, you will have to regularly bandage, rinse the cavity with antiseptics. Home rinses with a solution of sage or chamomile are recommended. The operation is performed quickly and does not damage the teeth. However, the cyst tissues are not completely removed and jaw deformity is not ruled out. In addition, the open cavity needs postoperative care. For a long time it will be difficult to maintain dental hygiene.

Possible Complications

Ignoring treatment can lead to a fracture of the jaw bone and facial deformity. A person feels severe pain, it is difficult for him to move his mouth and swallow food. When the cyst grows strongly and becomes inflamed, phlegmon develops. In the most advanced cases, the neoplasm can develop into a malignant one and oncology will begin.

It is worth noting that the treatment of jaw cysts also sometimes leads to complications. Problems can affect both the jaw itself and the entire body. They usually arise due to the incompetence of the doctor and errors during dental procedures.

If the vessels are injured during the operation, bleeding is not excluded. When a tooth has to be removed along with a cyst, and the doctor does not use a periodontal splint, a fracture of the upper jaw is possible. Sometimes there are injuries of the maxillary sinuses.

Treatment during pregnancy

If a cyst of the lower jaw forms during pregnancy, a woman needs to 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, since they are performed under anesthesia.

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

Disease prevention

There are no specific measures that would completely eliminate the possibility of a jaw cyst. Prevention consists in 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, regularly rinse with special tooth elixirs. In case of jaw injuries, you should immediately contact the surgeon and subsequently be observed by him so that complications do not arise.