Decompression as a method of treatment for cystic lesions of the jaws: a review of the literature

Recurrent Cystic Liver Injury. Benign or Malignant?

Evaluation of postoperative changes in the course of mandibular canals impacted by cystic lesions

We wanted to report our two cases of intrathoracic extrapulmonary hydatid cyst in pleural cavity due to its rarity. Our first case is a 24-year-old male patient who was admitted with a cystic mass lesion consistent with hydatid cyst which was incidentally detected in inferior lobe of the right lung neighboring to thoracic wall and diaphragm. Our second case is a 32-year-old male patient who was admitted with chest pain and a cystic lesion in apex of the right hemithorax and intercostal field in basal after he had been medically treated due to hydatid cyst of the dome of the liver for two years. The cysts were removed with thoracotomy. Extrapulmonary intrathoracic hydatid cysts were evaluated with regard to invasion ways and treatment indications and methods.

ABSTRACTBackground:Treatment modalities of odontogenic cystic lesions of the jaws range from conservative to radical. “Dredging” may be considered the “middle path” between conservative and radical treatment options. It comprises three entities—decompression, followed by repeated scraping of the lesion, and finally, peripheral ostectomy providing margin clearance but without significant morbidity.Aim:To evaluate the outcome of “dredging” in the management of large cystic lesions of the jaws, without major resections and maintaining normal functions.Methodology:This prospective study was conducted on 30 patients. Inclusion criteria were odontogenic cystic lesions at least 2 cm in size either in the proximity of vital structures or in children with developing tooth germs or so large that upon enucleation, can result in pathological fracture. All underwent decompression followed by dredging performed at every 2 to 3 months intervals.Results:Drastic decrease in size of the lesion as measured on Cone Beam Computed Tomography (CBCT) and new bone formation was evident in all patients. The total Reduction Rate (RR) of the cystic lesions was 88.79% in 9.2 months. RR was highest in Calcifying epithelial odontogenic cyst (CEOC) followed by Unicystic Ameloblastoma (UA), Odontogenic Keratocysts (OKC), Dentigerous cyst (DC), and Radicular Cyst (RC) in CBCT. The mean speed of shrinkage was fastest in CEOC, followed by OKC, UA, RC, and DC after dredging. Shrinkage was higher in patients below 20 years of age (P 0.012) and patients with large cystic lesions (P 0.00447).Conclusion:The results suggest that dredging with regular, long-term follow-up can be a successful treatment method for large cystic lesions in young adults. This method includes the benefits of both conservative and radical treatment methods but lacks the disadvantages of either.

IntroductionThere is a paucity of studies evaluating the preservation and recovery vitality of teeth associated with cystic lesions in the jaws.The purpose of the present study was to evaluate whether the use of the marsupialization treatment method in the large cystic lesions of the jaws associated within involved teeth would save the pulp vitality.Materials and methodsIt was a cohort study of patients treated at the Department of Oral and Maxillofacial Surgery from April 2019 to April 2023. Patients with primary cystic lesions associated teeth, with a cyst diameter of >3.4 cm, along with dental root resorption of less than half the root length, and treated by marsupialization were included. Patient age, gender, location, associated teeth, size, management, dental pulp vitality before and after marsupialization, and the duration of treatment were evaluated. Pulp vitality of involved teeth was assessed with electrical pulp tester.Predictor VariableIt was the treatment method.Main Outcome Variable(s)The primary outcome variable was the recovery or preservation of pulp vitality.CovariatesThe study variables were demographic, clinical features of the cysts, clinical features of associated teeth, and treatment method.AnalysesCategorical data were presented in mean with standard deviation, and set the level of statistical significance at p < 0.05.ResultsThe sample included 73 patients with large cystic lesions; 47 (64.4%) were male and 26 (35.6%) were female. The age range was 9 to 68 years (mean ± standard deviation, 22.4 ± 4). The 73 patients had 305 teeth associated with large cystic lesions. Of these dentitions, 85.9% of teeth had normal pulp vitality and 14.1% were negative before marsupialization. Following marsupialization, preservation of pulp vitality was noted in 61.3% and 18.0% of teeth lost their vitality. Of those without normal dental pulp vitality, 70.9% of teeth recovered their vitality of which 46.5% had recovered their vitality 9 to 12 months following marsupialization.ConclusionMarsupialization followed by second surgery maybe a treatment option for preserving and recovering the pulp vitality of teeth associated with large cystic jaw lesions.

Liver cysts are common, occurring in up to 5% of the population. For many types of cysts, a variety of different treatment options exist and the preferred management is unclear. A PubMed and Medline literature review was undertaken and articles pertaining to the diagnosis and management of cystic lesions within the liver were retrieved. Therapy for symptomatic cysts may incorporate aspiration with sclerotherapy or de-roofing. Polycystic liver disease presents a unique management problem because of the high morbidity and mortality rates from intervention and high rates of recurrence. Careful patient counselling and assessment of symptom index is essential before embarking on any treatment. New medical treatments may ameliorate symptoms. Acquired cystic lesions in the liver require a thorough work-up to fully characterize the abnormality and direct appropriate treatment. Hydatid cysts are best treated by chemotherapy, followed by some form of surgical intervention (either aspiration and sclerotherapy or surgery). Liver abscesses can be effectively treated by aspiration or drainage. All patients with cystic lesions in the liver require discussion at multidisciplinary meetings to confirm the diagnosis and determine the most appropriate method of treatment.

Liver cysts are common, occurring in up to 5% of the population. For many types of cysts, a variety of different treatment options exist and the preferred management is unclear. A Pubmed and Medline literature review using key words non-parasitic hepatic cysts, polycystic liver disease, echinococcus, hydatid cysts parasitic cysts, Caroli's disease, cystadenoma; liver abscess, surgery, aspiration and treatment was undertaken and papers pertaining to the diagnosis and management of cystic lesions within the liver were retrieved. Asymptomatic simple cysts in the liver require no treatment. Therapy for symptomatic cysts may incorporate aspiration with sclerotherapy or de-roofing. At present, insufficient evidence exists to recommend one over the other. Polycystic liver disease presents a unique management problem because of high morbidity and mortality rates from intervention and high rates of recurrence. Careful patient counselling and assessment of symptom index is essential before embarking on any treatment. New medical treatments may ameliorate symptoms. Acquired cystic lesions in the liver require a thorough work-up to fully characterize the abnormality and direct appropriate treatment. Hydatid cysts are best treated by chemotherapy followed by some form of surgical intervention (either aspiration and sclerotherapy or surgery). Liver abscesses can effectively be treated by aspiration or drainage. With improved antimicrobial efficacy, prolonged treatment with antibiotics may also be considered. All patients with cystic lesions in the liver require discussion at multi-disciplinary meetings to confirm and the diagnosis and determine the most appropriate method of treatment.

Background Posterior mediastinal lesions are classified as solid lesions and cysts. The treatment for both types is surgery. We evaluated the surgical outcomes and recurrence rates after video-assisted thoracic surgery and thoracotomy for posterior mediastinal lesions. Methods Data of 66 resections for posterior mediastinal masses between 2000 and 2014 were reviewed retrospectively. Twenty-two patients were treated by video-assisted thoracic surgery (group V) and 44 underwent thoracotomy (group T); 29 (43.9%) were female and 37 (56.1%) were male, the mean age was 45.9 ± 14.7 years. Results Bronchogenic cyst was the most common cystic lesion (10/12, 83.3%), and benign schwannoma was the most common solid lesion (32/54, 59.2%). The mean diameter of solid lesions was 5.19 ± 2.4 cm (group V 3.98 ± 1.8 vs. group T 5.78 ± 2.5 cm, p = 0.006). The tumor diameter was 4.06 ± 1.9 cm in asymptomatic patients and 6.93 ± 2.2 cm ( p < 0.001) in symptomatic patients. In group V, hospital stay and duration of drainage were significantly shorter than in group T ( p = 0.02, p = 0.01). Local recurrence was detected in 4 (6.1%) patients. Cystic lesions had a higher recurrence rate than solid lesions ( p = 0.01). There was no significant difference in recurrence rates in groups V and T ( p = 0.59). Conclusion Video-assisted thoracic surgery is a safe method for surgical treatment of posterior mediastinal lesions, with a shorter drainage time and postoperative hospitalization and similar recurrence rates. More recurrences are seen in patients with cystic lesions.

Although cavitary lesions of the spinal cord have been recognized for centuries, only recently have effective, noninvasive imaging techniques allowed antemortem diagnosis of this clinical syndrome. Methods of treatment have not been consistently successful in alleviating or reversing the clinical symptoms caused by these cystic lesions. Incomplete understanding of the underlying pathologic basis for the syringes has impeded the development of effective methods of treatment. This review documents historical considerations regarding clinical observations and experimental studies of this entity and the animal models that have been reported for each of the major types of syringomyelia. Recent studies have suggested that development of a relevant animal model of posttraumatic syringomyelia is imminent. Successful development of an experimental model will not only permit definition of the pathogenesis of cyst formation but also provide methods for testing of therapeutic interventions.

Massive intraosseous ganglion of the talus: Reconstruction of the articular surface of the ankle joint

BackgroundBenign Multicystic Peritoneal Mesothelioma (BMPM) is one of the rarest diseases in medicine with only more than 200 cases worldwide. This paper aims to report a case of Benign Multicystic Peritoneal Mesothelioma that strangely arose from the liver and was long treated as Hydatid cyst. The case also had many risk factors including asbestos exposure that had not yet been linked with Benign Multicystic Peritoneal Mesothelioma.Case presentationWe report a case of a 62 years old male with a history of a perforated peptic ulcer and a cystic mass in the liver that was misdiagnosed as hydatid cyst 7 years ago. He presented with generalized abdominal pain and bloating. Image studies showed many cystic formations filled with clear fluid. An en bloc surgery was performed and a pathologic study showed a multiloculated mass lined by flat or cuboidal epithelium leading to the diagnosis of BMPM. A follow up was scheduled after 3 months revealed total recurrence.ConclusionBMPM resembles many other cystic lesions in the abdomen and should be taken into consideration when dealing with nontypical cystic formations. Its diagnostic and treatment methods are still hazy making this disease difficult to approach.

Supratentorial neurenteric cyst: Analysis of 45 cases in the literature

The treatment of space-occupying cystic lesions includes percutaneous cyst aspiration, marsupialization, percutaneous ventriculocystotomy, or Rickham catheter implantation. In some patients, the cysts tend to recur and repeated evacuations are necessary. The authors present a new treatment method with internal drainage of cysts into the ventricular system using a balloon-mounted vascular stent. Six patients with cysts of low-grade gliomas, one with monocystic craniopharyngioma, and one with suprasellar arachnoid cyst were treated between September 2003 and May 2005. All patients were symptomatic after multiple previous treatments. Stent implantations were performed under local anesthesia in adults and under general anesthesia in children. In all patients, the stereotactic frame and computed tomographic and magnetic resonance fusion were used for an optimized approach. The treatment was performed in a compassionate manner and the patients were informed about the off-label use of the device. Stent placement was successful in all eight patients without procedure-related complications. Improvement of clinical symptoms was seen in seven out of eight patients. Seven out of eight cysts decreased in size within a follow-up period of up to 23 months (mean, 17 mo; median, 18 mo; range, 6-23 mo). The first patient showed recurrence of the tumor cyst 3 months after initial treatment with a Herkulink stent (5 x 18 mm), followed by retreatment with an Omnilink stent (6 x 28 mm; Guidant Corp., Santa Clara, CA). Stenting was ineffective in one patient. Treatment of intracranial cystic lesions by internal drainage is possible with the use of stent-assisted ventriculocystostomy.

Retrorectal space tumors are rare, and so are frequently unrecognized, misdiagnosed, and mistreated. A 57-year-old man visited the outpatient clinic with the chief complaints of thin stool and lower pelvic heaviness. A smooth, round huge palpable mass on the right posterolateral rectal wall was detected and pelvic computed tomography showed a 7.8-cm cystic lesion in the right retrorectal space. Laparoscopic procedures were initiated with perirectal dissection for rectal mobilization. After fixation of the peritoneum and tying the rectum for intracorporeal traction, the rectum was mobilized to identify the cyst. The cyst was removed using an endo-bag, with completion of cyst dissection. The final pathologic diagnosis was a tailgut cyst, or retrorectal cystic hamartoma without evidence of malignancy. The patient was discharged without any complications. The patient had no dyschezia or problems with bowel function. Laparoscopic resection is a safe and feasible method for surgical treatment, even for bulky retrorectal tumors, with an early recovery period.

A case of a cystic lesion within the parotid gland of a 71-year-old male is reported. Preoperative image diagnosis with ultrasound sonography. CT scan and MRI indicated a benign unilocular cystic lesion in the superficial lobe of the parotid gland. A superficial parotidectomy revealed that the mass was located in the superficial lobe at the level between upper and lower divisions of the facial nerve trunk.The histopathological picture was consistent with that of the branchial (lymphoepithelial) cyst which suggests anomalies of the first branchial cleft.The clinical features, methods of pre-operative diagnosis and treatment of the parotid branchial cysts are discussed with a review of the literature.