Jaw cysts
What is a cyst?
A cyst is a sac (cavity) lined by epithelium and containing fluid. In the jaw, it can be created by the necrosis of a tooth (apical cyst). If left untreated, it erodes the bone, increases in size and extends to adjacent areas. In the upper jaw, it can extend into the sinus or into the nose. If it becomes infected, the result will be an extensive abscess.
A cyst is not only due to the necrosis of a tooth. Another category is odontogenic cysts, which are observed around impacted teeth and are created by the epithelium covering the tooth. They are most often observed in the wisdom teeth of the lower jaw. If left untreated, they increase in size and can cause a pathological fracture (i.e., it is possible to “break the jaw” while chewing).
Treatment:
The treatment is most often surgical, i.e., removal (enucleation) of the cyst and extraction or endodontic treatment of the responsible tooth. More specifically, the cyst caused by a tooth (apical) is treated, if it is very small, with endodontic treatment (aponeurosis) of the responsible tooth. In the past, a tooth that did not respond to endodontic treatment was “doomed” to be extracted. It was not uncommon for many young people to have no teeth and “wear” dentures. Maxillofacial surgery, as in other cases, provided the solution with apical rootectomy. With apicoradiectomy, a relatively small, intraoral procedure, most teeth can be saved.
The treatment of odontogenic cysts is always surgical and consists of enucleation (removal) of the cyst with the co-extraction of the responsible impacted tooth.
What is apicoradiectomy?
It is the removal of the apex (the tip of the root of the tooth). It is performed by the maxillofacial surgeon, usually with local anesthesia and is completely painless. It is preceded by endodontic treatment of the responsible tooth(s) by the dentist and followed by the operation by the maxillofacial surgeon, who in addition to the apicoradiectomy, also removes the cyst or cleans the bone from the abscess. This operation can help most teeth. The tooth cannot be saved, since its entire root is inside the cyst, because then the root of the tooth would have to be removed along with the cyst removal. However, it is worth mentioning a rare case in a young person, where a large cyst was removed and apicoradiectomy was performed on 8 teeth.
The operation, as mentioned, is completely painless and the postoperative complications, lasting one week, include a slight swelling and pain that are treated with medication
Today, with the possibilities offered by maxillofacial surgery, it is a shame to lose teeth, especially the front ones. The aesthetic and functional problem that arises after their extraction constitutes a real disability for the patient. On the contrary, the “inconvenience” of the operation is minimal and is considered insignificant compared to the expected benefit.
