Enucleation Of Cyst Research Articles

The use of grafting material biphasic calcium sulfate for the treatment of osseous defects resulting from radicular cysts. Clinical study and six-month follow up

Aim Surgical treatment of odontogenic cysts of the jaws accounts for a significant percentage of dental surgery procedures. Additionally, a wide range of procedures and augmentation materials are used in the reconstruction of these osseous defects. The authors present a study including histology of surgical treatment of odontogenic cysts using a biphasic calcium sulfate composite bone graft. Materials and methods Two groups, study and control, of 30 patients each with odontogenic cyst were treated for radicular cyst removal with reconstructive surgery using a deproteinized bovine bone graft (xenograft). A modified surgical procedure was performed in the control group, with different types of graft placed in the osseous defects. In the study group wound site closure was performed without periosteum cutting to allow stretching of the flap to attempt primary site closure, whereas in the control group primary wound closure was achieved to protect the xenograft material. Results In the study group complete wound healing and suture maintenance was reported in 29 patients (96.6%); in 1 case (3.4%), a postoperative wound dehiscence (I°) occurred on day 5. In the control group no wounds dehiscences were observed in 24 patients (80%), in 4 cases (12%) a wound dehiscence (I°) occurred on day 3 and 5 and in 2 cases (8%), IIo wound dehiscence over 10 mm with secondary inflammatory features were observed which required graft removal. Conclusions The use of the Bond Apatite® preparation proved to be a simple, inexpensive and effective reconstructive treatment of osseous defects after enucleation of odontogenic cysts.

A clinical study of inferior alveolar nerve damage caused by Carnoy\u2019s solution used as a complementary therapeutic agent in a cystic lesion

BackgroundCyst enucleation, which extracts only the tumor with the application of Carnoy’s solution (CS), has been suggested as a conservative treatment with a low recurrence rate and morbidity. However, there has been a concern that CS’s contact with inferior alveolar nerve (IAN) can cause neurons to degenerate and cause sensory dysfunction. The purpose of this retrospective cohort study aimed to investigate the neurosensory function after surgical treatment with or without the application of CS.MethodsWhile controlling the effects of sex, age, follow-up period, and invasion size of the tumor, we performed the binary logistic regression analysis to examine whether or not the sensory function of the patients who were treated with CS (n = 19) for the cyst enucleation procedure was significantly different from those who were not treated with CS (n = 58) at the end of the follow-up period.ResultsThe logistic regression result showed that the use of CS was not significantly related to the normalness of sensory function at the end of the follow-up period. Rather, the invasion size of the cyst was significantly associated with sensory dysfunction.ConclusionsCS may be used for patients who are diagnosed with OKC and UAM without much fear of its impact on sensory dysfunction. However, a small number of patients who were treated with CS experienced severe sensory damage and did not recover at the end of the follow-up period, suggesting the need for further analysis of these patients.

Effects of kinesiology tape after enucleation of mandibular dentigerous cysts.

ObjectivesKinesiology tape (KT) creates a pulling force on the skin, thus improving blood and lymph flow by alleviating hemorrhage and congestion of lymphatic fluid. The authors hypothesized that the use of KT could be beneficial for the management of complications after head and neck surgery and designed this study to evaluate the effects of KT on swelling, pain, and trismus after enucleation of mandibular dentigerous cysts with third molar extraction.Materials and MethodsForty patients who underwent enucleation of a dentigerous cyst with extraction of the mandibular third molar were selected. The patients were randomized into two groups (n=20 each): a KT group, where KT was applied after surgery in addition to basic postoperative care, and a control group, where patients received basic postoperative care without KT application. Swelling, pain, and trismus were evaluated before surgery (T0) and on postoperative days 1 (T1), 2 (T2), and 3 (T3). Cyst volume, gauze weight for assessing bleeding, and operation time were recorded.ResultsThere was a significant difference between the two groups in the change in swelling up to T1 and the change in swelling between T1 and T2. The maximum swelling in the KT group was significantly less than that in the No-KT group and maximum swelling appeared faster in the KT group than in the No-KT group. Both groups showed a mild pain response but there was no significant difference between the two groups. There was no significant difference on interincisal distance change between the two groups. There were no correlations between cyst volume, bleeding, operation time, and maximum swelling.ConclusionKT can effectively manage facial swelling after oral and maxillofacial surgeries such as cyst enucleation and third molar extraction, thus improving postoperative patient satisfaction levels and quality of life.

Shira's Technique, an Alternative for the Enucleation of Cervicofacial Cysts

Treatment of cystic lesions includes multiple options, ranging from resection, decompression or marsupialization to enucleation. Different techniques for enucleation have been reported for head and neck cysts. This paper describes Shira's technique, using alginate as a filling material inside the cystic cavity, allowing demarcating the limits of the cystic lesions, maintaining their integrity.

Are dental implants the first option in case of severely compromised teeth associated with radicular cyst? A critical case report

Background Nowadays, dental implants are frequently used to replace teeth judged as hopeless, even if other treatments should be primarily considered to save them. The reason lies in the fact that extracting a tooth and placing an implant is erroneously considered by many to be easier, faster, and more predictable. This trend of reduced willingness to save compromised teeth is strengthened by the concomitant presence of periapical tooth pathologies, such as radicular cyst. In such cases, affected teeth are condemned prematurely in favour of implant rehabilitations. This case report aims to illustrate a case where compromised teeth were maintained following the enucleation of a radicular cyst, Case report After enucleation of the radicular cyst, retrograde endodontic treatment of the affected teeth was performed. The residual bone defect was then treated with guided bone regeneration to assist and promote healing and improve the prognosis of adjacent teeth. Conclusion The technique proved to be effective and, most importantly, biologically friendly.

THE EFFECT OF PLATELET RICH-FIBRIN WITH AND WITHOUT AUTOGENOUS BONE GRAFT ON BONE REGENERATION FOLLOWING ENUCLEATION OF MAXILLARY CYSTS

Introduction: Reconstruction of bony defects represents a challenging problem for the surgical community. Autologous bone grafting involves utilizing bone obtained from the same individual receiving the graft. Bone can be harvested from the mandibular symphysis (chin area). Autologous platelet rich-fibrin (PRF) is considered to be a healing biomaterial, which has been widely used for accelerating soft and hard tissue regeneration. The use of bone graft in combination with platelet rich-fibrin helps in rapid bone regeneration when compared to natural healing. Objectives: is to compare the effect of platelet rich-fibrin with and without autogenous bone graft on bone regeneration following enucleation of maxillary cysts. Materials and methods: Twenty-one patients with maxillary cysts had been treated with autogenous bone graft with platelet-rich fibrin versus platelet rich-fibrin without autogenous bone graft following cyst enucleation, and the follow up was done for 6 months using Cone Beam Computerized Tomography (CBCT) to evaluate bone regeneration in the defect site. Results:All groups showed increasing in bone density. Group A showed the best results with a mean 330.71, while Group B showed results with a mean 184. Group C showed results with a mean 117.71. Conclusions: PRF can be considered a healing biomaterial, as it features all the necessary parameters permitting bone regeneration without any adverse reaction. The addition of autogenous bone graft to PRF accelerates the regenerative capacity of bone. They give a predictable clinical and radiographic evidence of bone formation and faster healing than using PRF alone.

CLINICAL AND RADIOGRAPHIC OUTCOMES OF RADICULAR CYST ENUCLEATION USING PIEZOSURGERY VERSUS CONVENTIONAL SURGERY

Abstract AIM: The study was intended to evaluate the effectiveness of piezosurgery in enucleation of radicular odontogenic cysts in comparison to the conventional technique. METHODS: Fourteen patients who had radicular cysts associated with non-vital teeth, were operated at the Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University. The patients were randomly divided into 2 groups;1) the study group in which cyst enucleation was using piezosurgery, 2) control group in which the cysts were removed using the conventional technique. The following were assessed; operation time, hemorrhage control and field visibility, ease of operation, neurosensory evaluation and radiographic percentage of change in bone defect volume. RESULTS: The piezosurgery group showed a statistically significant control over heamorrhage and a clearer, more visible field when compared to the conventional group. The difference between the times required for cyst enucleation in both groups was statistically significant, with longer time recorded with piezosurgery. No complications were observed with the piezosurgery technique. However, with the conventional technique, 2 patients complained of neurosensory involvement which was resolved over time. Also, with piezosurgery, there was a significant reduction of bone defect volume than the conventional surgery, 3 months after the operation in comparison to the preoperative baseline value. CONCLUSIONS: Piezosurgery proved to be more effective for cyst enucleation than the conventional method. The piezosurgery was more efficient for preserving important anatomical structures while providing a clearer field of surgery. Also, better early healing potential of the bone defect resulting from cyst enucleation was detected.

Enucleation of cyst through fracture site

Enucleation of cyst through fracture site

Presentation, Diagnostic Imaging, and Clinical Outcome of Conventional Ameloblastoma in Dogs

A noninductive tumor of odontogenic epithelium occurs within the tooth bearing regions of the jaw in dogs and fits the conventional definition of ameloblastoma, which is distinct from, and less common than, canine acanthomatous ameloblastoma. In order to clarify the clinical and radiological features of this uncommon odontogenic tumor in dogs, we performed a retrospective study of 20 dogs that were diagnosed between 2007 and 2015. Follow-up information was obtained for 17 of 20 dogs. The study group of dogs showed no apparent age, breed, or gender predilection. Conventional ameloblastoma is typically slow growing, well demarcated, and locally destructive. Tumors most commonly occurred as a mass or focal bony swelling within the maxilla (13/20) or mandible (7/20). Based on cases with available diagnostic imaging, as either dental radiographs or computed tomographic images, the tumors were usually intraosseous and caused mixed lytic/proliferative bone changes. Nevertheless, conventional ameloblastomas did not aggressively infiltrate adjacent tissues and recurrence was not observed within the study group, even in patients with narrow surgical margins or treatment by cyst enucleation.

Risk factors for postoperative infection of odontogenic cysts associated with mandibular third molar

BackgroundOdontogenic cysts associated with lower third molar are common. The prognosis for surgical treatment is relatively good. However, postoperative infection discourages the clinicians. Hence, we would like to investigate the factors associated with infection after surgical treatment of cysts associated with the mandibular third molar.MethodsWe retrospectively reviewed the medical and radiographic records of 81 patients who were diagnosed with dentigerous cyst or odontogenic keratocyst and underwent cyst enucleation. The factors affecting postoperative infection were divided into host factor, treatment factor, and cystic lesion factor. To identify the factors associated with postoperative infection, we attempted to find out the variables with significant differences between the groups with and without infection.ResultsA total of 81 patients (64 male and 17 female) were enrolled in this study. There was no statistical relationship about the postoperative infection between all variables (gender, smoking, diabetes mellitus, age, bone grafting, related tooth extraction, previous marsupialization or decompression, type of antibiotics, cortical perforation associated with cystic lesion, preoperative infection, preoperative cyst size).ConclusionsThe results of this study suggest that it is not necessary to avoid bone grafts that are concerned about postoperative infection.

Improving Oral Surgery: A Workflow Proposal to Create Custom 3D Templates for Surgical Procedures

Background: Computer-guided technologies are adopted in various fields of surgery to limit invasiveness and obtain patient benefits in terms of surgery duration and post-operative course. Surgical templates realized through CAD/CAM technologies are widely diffused in implant dentistry. The aim of this work is to propose, beyond implantology, the feasibility of application of 3D printed surgical templates in oral surgery procedures requiring osteotomies (like maxillary cyst enucleation and tooth disimpaction) in order to obtain accurate surgeries, avoid anatomical damage of surrounding structures and decrease patient’s morbidity, using a simple, low-cost protocol of fabrication. Objective: To provide a reliable CAD-CAM workflow for the realization of surgical templates in oral surgery. Methods: Three clinical scenarios are described: A maxillary canine disimpaction, a mandibular cyst removal, and an orthodontic miniscrew placement. Each one was managed using custom surgical templates realized using the proposed workflow. A Stereolithography (STL) file of maxillary structures was obtained by the use of a 3D medical image processing software (Materialise Mimics 20.0) a segmentation toolbox acquiring RX volumes by Cone-Beam Computed Tomography (CBCT). Digital models of the teeth, acquired as STL files directly, are imported in the same 3D medical image processing freeware (Materialise Mimics 20.0) to merge STL files of maxillary structures and teeth. Data are transported into Blue Sky Plan 4.0 (Blue Sky Bio, LLC), a software for 3D implant guides fabrication, together with the DICOM images package of maxillary volumes to carry out the pre-surgical treatment planning. Anatomical structures at risk are identified; a contour of ideal incision shape and bone osteotomy extent is drawn. Finally, the resulting three-dimensional guide is digitally generated and the surgical guide printed. The resulting 3D template shows the following major features: teeth support, flap management and bone osteotomy design. Results: The proposed work-flow aided the surgeon in both pre-operative and intra-operative work phases through accurate virtual planning and the fabrication of precise surgical guides to be used in oral surgery practice. In each clinical scenario, the use of custom 3D templates allowed better control of the osteotomy planes and flap management. No adverse events occurred during both surgical and healing phases. Conclusion: The proposed digital workflow represents a reliable and straightforward way to produce a surgical guide for oral surgery procedures. These templates represent a versatile tool in maxillary cyst enucleations, tooth disimpaction, and other surgical procedures, increasing accuracy, minimizing surgical complications, and decreasing patient’s morbidity.

Kista radikuler besar yang melibatkan dasar cavum nasalis

Objectives: This case will present a radicular cyst and its expansion effect, seen from cone beam CT (CBCT) 3D radiograph.
 Case Report: A 32-year-old patient complained about discoloration of her upper anterior teeth and swollen gums. Periapical radiograph for preliminary examination revealed a large radiolucent area with well-defined cortical border in periapical 21. In coronal view, the lesion extends to 22 also causes the destruction of the nasal cavity floor and palatal cortical bone. Endodontic, cyst enucleation, and bone graft was performed to the patient. After endodontic treatment, CBCT examination was performed to determine the extent of cyst lesions. 
 Conclusion: Large lesion needs an adequate radiographic technique to examine anatomical structure involvement. In large cysts, CBCT examination is matter to consider.

Female reproductive potential after oncological treatment: a rare case report of acute myeloid leukemia in monozygotic twin sisters with literature review

BackgroundAcute myeloid leukemia (AML) in monozygotic twins is a rare event and, until now, only a few cases have been reported. Due to improved oncological treatment and cancer survival rates, quality of life considerations post-treatment have become an important aspect in the treatment regime. The ability to have their own biological children is considered one of the most important indicators of quality of life by cancer survivors. As fertility following oncological treatment is often impaired, fertility preservation methods should be offered to these patients prior to the treatment. Here, we present a very rare case in which we can in vivo observe the impact of oncological treatment on female fertility when applied before and after puberty.Case presentationThis is a very rare case of concordant AML in monozygotic twin sisters. Twin A became sick at the age of 21 months. She was treated with cytostatic medications and then underwent bone marrow transplantation (BMT), the donor being her twin sister B. After 27 years, she is disease free and has regular periods. After trying to conceive for 4 years, she was seen by an infertility specialist. She underwent hysteroscopic uterine septum removal and laparoscopic enucleation of bilateral paraovarian cysts. Following those procedures, she immediately conceived naturally. Twin B became sick at 15 years of age. She was treated with chemotherapy and cranial radiation and relapsed after 10 years. She then received chemotherapy and had a BMT. Until relapse, she had normal menstrual cycles. After the second treatment she became amenorrhoeic and is now part of an oocyte donation program.ConclusionsThis is a case of AML in monozygotic twins who, after treatment, have completely different reproductive potential. They both received oncological treatment, and one of them conceived conceived naturally while the other suffered premature ovarian failure and is not able to have a biological child. Based on the outcome of this case, it appears that the pre-pubertal state truly serves as protection against ovarian failure.

The Composite of Bone Marrow Concentrate and Nano-hydroxyapatite as an Alternative to Autologous Bone

The aim of this study was to examine the evidence behind the use of the composite of bone marrow concentrate and Nano-hydroxyapatite as an alternative to autologous bone graft in the repair of bony defects. The study was conducted on 14 residual surgical non-continuity defects resulting from enucleation of benign odontogenic cysts. The defects were randomly allocated into two groups according to defect filling as follows: Group A (n=7), the defects were grafted using a composite of bone marrow concentrate (BMC) and Nano-hydroxyapatite granules; Group B (n=7), the defects were grafted using autologous bone graft. Radiographic evaluation was done using Cone beam C. T. scan, immediate, six and twelve months post-operatively to assess the volumetric changes of the grafts along the follow-up period. The results of this study revealed that there was no statistically significant difference (p>0.05) between the two groups regarding the percentage of reduction of the graft volume along the follow-up period. In the light of the radiographic results of this study it can be concluded that the use of composite of bone marrow concentrate (BMC) and Nano-hydroxyapatite granules to reconstruct surgical defects is a reliable alternative to autogenous bone graft.

Evaluation of polycaprolactone scaffold for guided bone regeneration in maxillary and mandibular defects: A clinical study.

Objective:This study was carried out to assess bone regeneration following the use of polycaprolactone (PCL) scaffold in maxillary and mandibular osseous defects.Materials and Methods:This prospective study included ten patients with maxillary or mandibular osseous defects present due to enucleation of periapical cysts or alveolar clefts requiring bone grafting and for lateral ridge augmentation that were treated with PCL scaffold. The patients were assessed clinically for pain, swelling, infection, and graft exposure at 1 week, 3rd, and 5th month postoperatively and were also evaluated radiographically for bone fill using intraoral periapical and/or panoramic radiographs at 4th, 6th, and 9th month postoperatively.Results:PCL scaffold was used in a total of six alveolar clefts and three cases of periapical cysts and one case of lateral ridge augmentation. Nine out of ten cases demonstrated wound dehiscence and scaffold exposure in the oral cavity. Radiographically, on comparison to the control regions, all these nine cases failed to demonstrate appreciable bone density gain. Only one case of radicular cyst in the mandible was recorded to have satisfactory healing.Conclusion:Although PCL scaffold has the potential for bone regeneration in osseous defects, the scaffold exhibited marked tendency for dehiscence in intraoral defects that significantly affected bone healing. A long-term study designed with a larger sample size and categorization of the defects is required to assess its efficacy in varied defects. Moreover, comparative evaluation of PCL and autogenous or alloplastic bone grafting material could provide assenting results.

Periradicular Cystic Enucleation and PRF Grafting Following Apicoectomy in Trichotillomania Patient- A Case Report

Diagnosis and treatment planning of untreated traumatised anterior teeth specially in children with psychiatric disorders or special health care needs is a challenge to paediatric dentist, that too in non-pharmacological means is a difficult task. Most of the time when these patients report with such complaint, it is already too late. This could be due to unintentional reasons like lack of parent awareness or patient’s response at the time of insult. All these factors bypass the time of conservative and minimal invasive treatment approaches. Ultimately, delayed treatment of trauma to anterior region exposes pulp and infection progress to periradicular region with cystic changes. Here, in this case report, the non-pharmacological management of periradicular cyst enucleation, followed by apicoectomy and Platelet Rich Fibrin (PRF) grafting was done in a 15-year-old female patient with obsessive compulsive disorder i.e., Trichotillomania (TTM) under local anaesthesia. Symptoms and intraoral swelling was resolved postoperatively in follow-up visits.

Bone-lid technique for cystic enucleation using piezosurgical unit.

Bone-lid technique for cystic enucleation using piezosurgical unit.

Histological changes in odontogenic parakeratinized keratocysts treated with marsupialization followed by enucleation.

Background The purpose of this study was to evaluate whether marsupialization treatment induces changes in the histology of odontogenic keratocyst epithelium and to compare our experience with the literature. Material and Methods A retrospective revision of histological samples was performed. 5 patients with odontogenic keratocyst treated with marsupialization follow by enucleation were selected. Histologic evaluation analyzed the changes in the keratocyst epithelium after marsupialization in terms of type of keratinization, thickness of the epithelium and connective tissue, the presence of acanthosis, the presence and grade of fibrosis, the type and grade of inflammation and the presence and number of mitotic figures and daughter cysts. Results In our case series, a variation of para-keratinized into ortho-keratinized keratocyst was found in one case, and no significant increases were observed in the epithelium and capsule thickness, or even in the level of inflammation. However, we observed an increase in fibrosis and qualitative changes in inflammation type. Conclusions Minor and major histological changes were associated with reduction in cyst volume, which resulted in a simpler and less invasive cystic enucleation after marsupialization. Key words:Keratocyst, marsupialization, enucleation, histology, histological changes.

Kist Enükleasyonu Sonrası Oluşan Kemik Rejenerasyonunun Radyolojik Değerlendirmesinde Konik Işınlı Bilgisayarlı Tomografi ile Panoramik Radyografinin Karşılaştırmalı Olarak İncelenmesi

Objective: The aim of this study is to compare the panoramic radiography and cone-beam computed tomography (CBCT) in the evaluation of bone healing after the enucleation of odontogenic cysts. Methods: Pre-operative and post-operative clinical and radiological data of patients who were successfully treated with enucleation between 01/01/2013 and 01/03/2017 with 1-year follow-up were retrieved from the archives and evaluated retrospectively. The panoramic radiographs and CBCT sections were transferred into a computer program and pre-operative and post-operative measurements were performed on the computer program. The manual segmentation method was used in the volume measurement in CBCT sections. An area index was calculated by multiplying the highest vertical and widest horizontal dimension of the cystic lesion on the panoramic radiography. Results: Twelve patients included in the study. Eight patients were male and 4 of them were female. The mean age was 45. The volume of the defect at post-operative 1-year control decreased by 83.05% on average. The area measurement showed a decrease of 38.79% at postoperative 1-year control. The volume of the cystic cavities in tomographic sections and cystic area on panoramic radiographs were significantly reduced at the end of 1-year follow-up (p<0.05). There was a significant and moderate positive relationship between the post-operative measurement values of CBCT and OPG (p=0.021, r=0.655). Conclusion: Panoramic radiography can be used as effective as CBCT to monitor spontaneous bone regeneration after the enucleation of jaw cysts.

Safety and Effectiveness of Total Thyroidectomy for Benign Multinodular Goitre

Total thyroidectomy is considered the best choice for thyroids carcinoma. However, it is still controversial for benign thyroid diseases because of higher complication rates. But meticulous surgical techniques by expert surgeons can avoid most of the complications and thereby avoid the risk of reoperation for any recurrences. The objective of the study was to evaluate and justify the use of total thyroidectomy in benign thyroid diseases especially in multinodular goiter and Grave’s disease. We have carried out an ongoing prospective study of thyroidectomy cases for different indications over a span of 5 years, from 2012 to 2016; in the Surgery department, Al-Thowra teaching hospital, Al-Beida. The total number of operated cases was 353. Cases were distributed according to age, sex, diagnosis and operative procedures. Various complications encountered were enlisted. Total thyroidectomy was performed in 247 cases for MNG and Thyroid malignancy. Hemi-thyroidectomy or lobectomy was done in 82 cases for solitary nodules. Enucleation of cysts was done in 6 cases. Operations were done for recurrent nodules in 18 cases. Overall complications were few and only minor. We recommend total thyroidectomy for all cases of MNG; which will reduce the risk of recurrence and development of malignancy in residual thyroid tissue. It also can prevent secondary thyrotoxicosis.