How to perform fenestration surgery on mandibular cyst

Mandibular cyst refers to a cystic tumor containing fluid in the jawbone, which will gradually increase in size and cause great harm to the jawbone. According to the cause of the disease, it is generally divided into two types of cysts: odontogenic and non-odontogenic. For patients, if the condition is serious, surgical treatment should be carried out in time. There are many methods of surgical treatment, and symptomatic treatment should be adopted according to the specific size of the cyst.

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In the treatment of jaw cysts, in addition to age factors, the location of the cyst also determines the choice of surgical method. Whether the cyst is located in the maxilla or mandible, in the front or back, in the midline or on the sides, different methods should be adopted to treat it. Different cyst sizes should also be treated differently.

1. Treatment of small cysts

Small cysts caused by apical infection can be treated by:

If it is caused by a dead tooth, the diseased tooth can be treated with root canal therapy and the cyst can be removed after filling, or the filling can be performed during the operation and the apex resection can be performed at the same time. The wound can be sutured and generally heals by primary intention. If it is caused by residual roots, the residual roots can be extracted, the alveolar socket of the tooth extraction wound can be enlarged, the cyst can be removed or scraped clean, and the tooth extraction wound can be sutured, and primary healing can also be achieved.

Treatment of cleft cysts in the anterior or midline of the palate, such as incisive canal cysts, nasopalatine cysts or median cysts. If a cyst is removed once, it is very easy to penetrate the nasal floor when the capsule is peeled off, causing oronasal leakage. This type of fistula is very difficult to repair, and sometimes it is difficult to repair even after multiple surgeries. In this case, it is best not to remove the cyst but to perform a semi-resection open surgery. That is, the cyst wall, whether protruding or not protruding from the oral cavity, together with the palatal mucosa on the surface, is removed, while the nasal surface is not removed. After the operation, the cyst cavity can be flushed after eating. Generally, it will heal flat 3 to 6 months after the operation, and the color of the cyst membrane will be similar to that of the palatal mucosa, and there is no need to remove it again. This method is minimally invasive and relatively safe, with no complications of nasal perforation, making it very suitable for the elderly.

2. Treatment of medium-sized cysts

The treatment of medium-sized cysts in the jaw of the elderly is more complicated. Because most elderly people are missing teeth or have alveolar bone atrophy. If a medium-sized cyst is located in the front of the maxilla, it may compress the piriform aperture and protrude into the nasal floor; if it is located in the back, it may invade the maxillary sinus. If it is located in the mandible, the mandible of the elderly becomes narrow due to missing teeth, and the cyst in the body or ascending ramus may compress or push the inferior alveolar nerve canal, and push the adjacent teeth to an abnormal position or place the root apex in the cyst cavity. In this case, if the cyst is removed once, the upper jaw may penetrate the nasal cavity or maxillary sinus, and the lower jaw is prone to damage the inferior alveolar nerve canal; if the adjacent teeth are damaged, root canal treatment or extraction is required, causing unnecessary pain. These treatments are not suitable for the elderly. Therefore, for the treatment of medium-sized bone cysts in the elderly, fenestration decompression is the safest method, with less trauma and pain, and can also achieve the purpose of treatment. Of course, the only drawback is that the healing time is a little longer, and the cyst cavity needs to be flushed after meals every day during this period. Because the flushing method is simple, not time-limited, and safe and comfortable.

Usually the decompression time after fenestration surgery is 6 to 18 months. If the cyst disappears after decompression, no stage II surgery is required. If it does not disappear completely, a stage II surgery can be performed to scrape and shrink the cyst. The purpose of fenestration decompression surgery is not to directly eradicate the cyst, but to reduce the size of the cyst cavity, restore the shape of the jaw, and protect the shape and function of the jaw to the greatest extent. Some scholars have also tried not to perform scraping. Some cases have confirmed that the capsule can be transformed into the oral mucosa after open drainage to expose the oral cavity.

3. Treatment of large jaw cysts

Patients with large jaw cysts, especially the elderly. Because the osteotomy range is large, the operation is relatively complicated, facial deformities may occur after the operation, and the elderly are unable to withstand major operations, many people advocate the use of cyst fenestration decompression surgery first to reduce the scope of the lesion, restore the jaw shape, and choose the appropriate treatment plan based on the specific situation after the fenestration surgery.