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Candidate Of Medical Sciences, Associate Professor Of The Department Of Surgical
Stomatology And Dental Implantology, Tashkent State Dentistry Institute, Tashkent,
Uzbekistan
Sh.K. Isokjonov
Assistant Of The Department Of Maxillofacial Region Diseases And Traumas, Tashkent State
Dentistry Institute, Tashkent, Uzbekistan
ABSTRACT
This article presents a clinical case of the treatment of a mandibular radicular cyst from 3.6 teeth by
creating a decompression "window", which allows the cyst volume to be reduced up to complete
restoration of the bone structure as well as ensuring the integrity of the surrounding anatomical
structures. The subsequent filling of the cavity with newly formed bone is due to secondary
osteogenesis. This operation can be performed on an outpatient basis in a dental surgery room under
local anesthesia
KEYWORDS
Decompression method, radicular cyst, lower jaw.
INTRODUCTION
To date, one of the most pressing problems of
modern maxillofacial surgery is the treatment
of human jaw cysts a traumatically and with
preservation of the integrity of the dentition.
The significance of this topic is determined by
its frequency, prevalence among children,
adolescents and young adults. Patients with
odontogenic cysts of the jaw occupy an
important place in the structure of dental
diseases. [10].
Radicular cysts account for 94-96% of
odontogenic cysts of the jaws detected in
adults. The most frequent localization of
radicular cysts is on the upper jaw, less often
on the lower jaw [3,4,6]. Despite modern
conservative methods of treatment, the need
for surgical treatment of odontogenic cysts
has not decreased. The main surgical method
for the treatment of odontogenic cysts of the
jaw is cystectomy, and less frequently,
cystotomy
Application Of Decompression Treatment For Mandibular
Radicular Cysts
M.A. Askarov
Assistant Of
The Department Of Maxillofacial Region Diseases And Injuries, Tashkent State
Institute Of Dentistry, Tashkent, Uzbekistan
The American Journal of Medical Sciences and Pharmaceutical Research
I
MPACT
F
ACTOR
(ISSN
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2689-1026)
2021:
5.
64
Published:
July 28, 2021 |
Pages:
72-76
Doi:
https://doi.org/10.37547/TAJMSPR/Volume03Issue07-05
OCLC
- 1121105510
The USA Journals Volume
03 Issue 07-2021
73
[1,4,7]. The results of scientific research
indicate that the damage caused to the
supporting dental tissues in youth is
irreparable, and in middle age it leads to a
significant destruction of the dental apparatus.
Preservation of teeth located in the cyst area is
the task of the dentist in the treatment of
periradicular cysts [2,3,4]. It is important to
make a correct diagnosis, excluding oral
oncological pathology because of the similarity
of the clinical manifestations of the pathology
[5,8]. For the treatment of radicular cysts,
classical
elective
surgical
interventions
(cystotomy, cystoectomy) have long been
used, with the help of which a high cure rate is
achieved. The choice of treatment method
depends on the size of the cyst, proximity to
important anatomical structures, and location
in the jaw [1,4,7]. Surgery can be performed
both in outpatient conditions and in the
hospital. However, this can be achieved under
certain conditions (removal of the "causal"
teeth, radicality of the operation). In modern
conditions, when patients have requirements
for a fast rehabilitation process and
preservation of aesthetics throughout the
entire treatment period, some modifications
to the classic stages of surgery are required.
Treatment of cysts begins with diagnosis.
Computed tomography is a mandatory step in
the examination. The second important point
is the morphological examination of the mass.
In some cases with classic slow growth, typical
location of cysts, one-stage removal of the
mass and replacement of the formed defect
with autologous, xenogeneic or allogenic graft
after morphological examination is acceptable
[9].
Purpose of the study: To substantiate the value
of using the decompression method for the
treatment of mandibular radicular cysts.
MATERIALS AND METHODS
Patient M., 14 years old, in October 2020 went
to a private dental clinic "Azimov brothers".
From the medical history it is known that in
2018, the thirty-sixth tooth was treated for
caries, at the time of treatment she had no
active complaints. In 2019, noted "flux" in the
projection of the root of the 36th tooth and
enlarged submandibular lymph nodes. She did
not seek medical attention. In 2020, she went
to the Department of Pediatric Maxillofacial
Surgery, where she was diagnosed with
"Radicular cyst of the lower jaw from teeth 3.6,
3.7" and a CT scan of the maxillofacial region
was performed. The findings revealed a nidus
of bone destruction in the lateral region of the
lower jaw in the region of 3.6, 3.7, 3.8 (Fig. 1, 2).
After examination by a dental surgeon, the
diagnosis was: Radicular cyst of the lower jaw
from tooth 36. The patient was offered
operative treatment.
RESULTS AND DISCUSSION
A clinical and laboratory examination was
performed in preparation for surgery. As a
result, no deformities of the lower jaw were
detected, palpation of the frontal region of the
lower jaw revealed no evidence of neoplasm in
the bone thickness, the cyst wall did not sag
when pressing on it, the mucosa in the cyst
projection was not discolored, pale pink in
color, moderately moistened. There were no
visible external changes of the maxillary
system. An electroexcitation study of the teeth
The American Journal of Medical Sciences and Pharmaceutical Research
I
MPACT
F
ACTOR
(ISSN
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2689-1026)
2021:
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Published:
July 28, 2021 |
Pages:
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Doi:
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OCLC
- 1121105510
The USA Journals Volume
03 Issue 07-2021
74
showed no changes in the pulp of the 37th
tooth (EOD 2 mA). Percussion of teeth 36, 37
was slightly painful, Fries-test of teeth 3.6, 3.7
was negative, Drill-test of tooth 37 was
positive. It was decided to perform a
decompression type cystotomy of the lower
jaw, creating a trepanation hole. This method
was chosen in order to completely remove the
visible lesion, minimize the risk of recurrence
and achieve an optimum aesthetic and
functional result. After a detailed explanation
to the patient and her parents about the
upcoming surgery, they agreed to undergo the
surgery and signed an informed consent form.
The patient was referred to a general dentist
for endodontic treatment of 3.6 teeth.
Under local infiltration anaesthesia Sol.
Articaini 1:100000 - 1.5 ml a 0.5 cm vertical soft
tissue incision was made in the apex projection
of the distal root of the 3.6 tooth.
Skeletonisation of the compact lamina of the
mandibular frontal region was performed. No
visual bone changes (patterns, deformities)
were detected. The bone cavity was opened
using a ball cutter. The diameter of the
trepanation hole was 0.5 cm. About 5 ml of
clear, light yellow fluid was evacuated from the
bone cavity under pressure. The fluid was
taken for cytological examination. A catheter
was placed and the bone cavity was flushed
with warm physiological solution to remove
cleavage products and enzymes. Hemostasis
control is carried out. The wound was sutured
with 6-0 polyamide thread. (Figure 3) On the
following three days, the cavity was irrigated
with warm saline solution. There was no
discharge during the lavage procedure. The
catheter was removed on the fourth day.
Fig.1. Computed tomography scan of the patient before treatment.
The American Journal of Medical Sciences and Pharmaceutical Research
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2021:
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Published:
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Pages:
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The USA Journals Volume
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Fig. 2. After inserting the catheter and suturing.
The American Journal of Medical Sciences and Pharmaceutical Research
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MPACT
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2689-1026)
2021:
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Published:
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Pages:
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Doi:
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OCLC
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The USA Journals Volume
03 Issue 07-2021
76
The early postoperative period was smooth.
Wound healing proceeded by primary tension
without complications. The period of disability
was 1 week. A trepanation hole was formed to
create a decompression effect, allowing
treatment of the cyst cavity with antiseptic
solutions.
CONCLUSIONS
Radicular cysts of the jaw are a common
pathology among young adults, depriving
children and young adults to lead a normal life.
Based on the performed conservative
treatment technique with the creation of the
"window" allows to gradually reduce the
volume of the cyst until the complete
restoration of the bone structure, while
ensuring the integrity of the surrounding
structures (teeth, neurovascular bundle of the
third branch of the trigeminal nerve). Effective
cyst decompression, which is achieved by
creating a "window" in the bone cavity allows
not only to sanitise the cyst cavity with
antiseptic solutions, but also to obtain the
necessary histological material (bone material
and cyst membrane) for further examinations.
The subsequent filling of the bone cavity
defect with newly formed bone tissue is due to
secondary osteogenesis. The operation can be
carried out in a dental surgery under local
anaesthetic. The period of incapacity for work
is usually less than 1 week.
Fig. 3. Computed tomography scan of a patient 6 months after treatment
Follow-up examinations after 3 and 6 months density (Fig. 3). A follow-up examination after using
radiotherapy showed gradual filling of 6 months showed satisfactory results with no the defect with
newly formed bone tissue, recurrence.
which over time began to acquire normal
The American Journal of Medical Sciences and Pharmaceutical Research
I
MPACT
F
ACTOR
(ISSN
–
2689-1026)
2021:
5.
64
Published:
July 28, 2021 |
Pages:
72-76
Doi:
https://doi.org/10.37547/TAJMSPR/Volume03Issue07-05
OCLC
- 1121105510
The USA Journals Volume
03 Issue 07-2021
77
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