Treatment of large odontogenic cysts in impacted mandibular third molars: a case report. Abstract: Odontogenic cysts of the jaws Varieties of odontogenic cysts

The abstract was completed by an intern of the Department of Dentistry of General Practice and Training of Dental Technicians Kerimova Elnara Rasulovna.

Moscow State Medical and Dental Institute

Introduction.

Odontogenic cysts of the jaws are a very common pathology. Currently, surgical treatment of this pathology is the most effective, which is not unimportant, because. all periradicular odontogenic cysts are foci of chronic infection that has an adverse effect on the body.

This essay will discuss the etiology, pathogenesis, diagnostic methods, indications and methods of surgical treatment.

Etiology and pathogenesis.

Odontogenic cysts are intraosseous cavity retention formations, the appearance of which is caused either by a violation of the development of the dental follicle, or by a chronic inflammatory process in the periodontium.

The epithelium lining the cavity of the cyst originates from the remnants of the tooth-forming epithelial plate (Malyasse Islands) under the influence of chronic inflammation or from the epithelium of the dental follicle. Between the epithelial lining and the bone tissue there is a connective tissue layer.

The components of the cyst are: a shell, consisting of a connective tissue part and an epithelial lining, and a cavity.

The cavity of the odontogenic cyst is filled with liquid or semi-liquid contents - accumulating waste products of the epithelial lining in the form of colloids and crystalloids (in particular, cholesterol crystals)

The accumulation of waste products of the epithelial lining leads to an increase in oncotic pressure, which is accompanied by an increase in hydrostatic pressure in the cyst cavity. As a result, pressure on the surrounding bone increases, osteolysis occurs, which leads to an increase in the volume of the bone cavity (cyst growth) and jaw deformity.

In this schematic drawing, arrow A indicates the connective tissue wall that encloses the cyst. Arrows B indicate different types of epithelium that may line a cyst that develops within the oral cavity.

Classification.

According to morpho- and pathogenesis, as well as localization, the following types of odontogenic cysts are distinguished:

1) Cysts formed from the epithelium of the tooth-forming plate (radicular)

A) apical cyst - periodontal cyst covering the apex of the tooth root

B) lateral periodontal cyst, adjacent or covering the lateral surface of the root of an erupted tooth

C) residual cyst left after tooth extraction

2) Cysts developing from an enamel organ or follicle

A) follicular cyst

B) Primordial cyst,

B) Gingival cyst.

3) Cysts developing from the enamel organ or the islands of Malasse

A) keratocyst.

clinical picture.

It is determined by the type, size of the cyst, the presence or absence of complications in the form of suppuration, the occurrence of a pathological fracture of the jaw.

Complaints with small cysts, as a rule, are absent, and the detection of a cyst is an incidental finding during an X-ray examination for diseases of adjacent teeth.

With an increase in the size of the cyst, deformation of the jaw may occur and patients complain of swelling of the mucous membrane. In the case when the cyst comes from the teeth of the upper jaw, increasing in size, it pushes the maxillary sinus, causing chronic inflammation of the mucous membrane lining it and, as a result, complaints of headache, a feeling of heaviness in the middle zone of the face. The germination of the cyst in the lower nasal passage is accompanied by difficulty in nasal breathing.

With the localization of the cyst in the lower jaw, compression of the lower alveolar nerve is possible. As a consequence, there may be complaints of numbness of the skin and mucous membranes in the corner of the mouth, the mucous membrane of the alveolar process. With a significant increase in the size of the cyst, a pathological fracture may occur.

During the examination, it is possible to detect deformation of the jaw, on palpation, the presence of a symptom of "parchment crunch" (Dupuytren's symptom).

More often the reason for going to the doctor is an exacerbation of the disease - suppuration of the cyst, accompanied by pain - the best motivator for the need for treatment.

Clinical symptoms during exacerbation.

When examining patients with a festering cyst, asymmetry of the face is revealed due to swelling of the perimaxillary soft tissues, hyperemia of the skin. The opening of the mouth can be both in full and limited in cases of suppuration of cysts, the starting point of which was the third molars. During intraoral examination, there is hyperemia of the mucous membrane over the site of localization of the cyst, detachment of the periosteum with pus is possible, which will be accompanied by a symptom of fluctuation. Percussion of the causative tooth is usually painful. Mobility of the causative tooth may also be observed.

Diagnostics.

When collecting an anamnesis, patients with odontogenic periradicular cysts usually point to previous endodontic treatment of the “causal” tooth, after which the pain subsided. Part notes the periodic exacerbation of the disease, which took place after the intraoral incision.

The main place in the diagnosis belongs to the X-ray examination.

With cysts of the upper jaw, the elements of an x-ray examination are:

Allows you to assess the degree of resorption of the bone tissue of the alveolar process (if the height is reduced by 1/3 or less, it is not advisable to perform a tooth-preserving operation). The condition of the root canal of the tooth, the degree and quality of its filling. The presence of fragments of instruments in the canal, the presence of perforations. The relationship of the cyst with the roots of neighboring teeth. The relationship of the roots of adjacent teeth with the cystic cavity may vary. If the roots protrude into the cavity of the cyst, there is no periodontal gap on the radiograph due to resorption of the endplate of the holes of these teeth. If the periodontal gap is determined, then such teeth are only projected onto the area of ​​the cyst, but in fact their roots are located in one of the walls of the jaw.

2) Orthopantomogram.

Allows you to evaluate both jaws at once, it is possible to assess the condition of the maxillary sinuses.

3) Plain radiograph of the skull in the naso-chin projection.

To assess the condition of the maxillary sinuses. Thinning of the bony septum and its dome-shaped displacement are characteristic of a cyst pushing the sinus back. A cyst penetrating into the sinus is characterized by the absence of a bone wall, while a domed soft tissue shadow is determined against the background of the maxillary sinus

However, in the case of large cysts penetrating or pushing back the maxillary sinus, the best of the methods of radiation diagnostics should be recognized as a computed tomogram, which allows the most accurate assessment of the condition of the maxillary sinus, its relationship with the cyst, localization of the cyst (buccal, palatine)

X-ray examination of the lower jaw are used:

1) Intraoral contact radiograph.

2) Orthopantomogram.

3) X-ray of the lower jaw in lateral projection.

4) Computed tomogram.

Of the other diagnostic methods, electroodontodiagnostics should be noted, which is used to establish the vitality of the teeth adjacent to the cyst. With an increase in the threshold of electrical excitability of the teeth adjacent to the cyst, more than 60 mA, their endodontic treatment is recommended.

Cytological and histological examination.

If malignancy is suspected, it is necessary to conduct a cytological examination of the punctate of the cyst and a histological examination of the remote formation.

The most common types of jaw cysts.

radicular cyst.

It is most often localized in the region of the lateral incisors, somewhat less often in the zone of the central incisors, premolars, and first molars.

Before the onset of jaw deformity, the clinical picture of the periradicular cyst is similar to the clinical picture observed in chronic periodontitis - periodically appearing pain in the area of ​​the causative tooth, aggravated by biting.

The tooth has a deep carious cavity, filling or is covered with a crown, its percussion can cause pain. In a number of deer in the region of the alveolar process at the level of the projection of the root of the causative tooth, a fistulous tract or scar is detected. The data of electrodontometry indicate necrosis of the tooth pulp: the threshold of pain sensitivity exceeds 100 mA.

X-ray picture.

In an x-ray examination, in addition to detecting a periradicular cyst in the form of a round or oval enlightenment surrounding the tooth root, it is important to assess the condition of the causative tooth itself, in particular the degree of destruction of the ligamentous apparatus (periodontal), the condition of the root canal, which can be characterized by the following signs:

The root canal is not sealed;

The root canal is not sealed up to the apex;

The root canal is sealed to the top with the removal of the filling material;

There is a fragment of the instrument in the root canal;

Perforation of the wall of the tooth root;

Additional branch from the main channel;

Fracture of the root of the tooth.

residual cysts.

In the case of removal of the causative tooth without removal of the cyst shell, a residual cyst is formed.

X-ray, this cyst looks like a clearly delimited rounded enlightenment of the bone tissue, localized in close proximity to

socket of the extracted tooth.

Most often, the cause of its occurrence is a radicular cyst of a temporary tooth. Increasing in size, the cyst captures the emerging permanent tooth. Leading to retention and dystopia of the latter, and when the rudiment of the permanent tooth is fully included in the cyst, its death occurs.

Also, the option of including an impacted tooth in the cavity of a cyst emanating from a permanent tooth is not excluded.

Primary cyst (keratocyst)

It develops mainly in the lower jaw, is observed relatively rarely, begins imperceptibly and does not manifest itself for a long time. On examination, a slight painless swelling of the jaw area in the region of one of the large molars is found. In some patients, a cyst is detected due to the addition of an inflammatory process, sometimes it is found by chance during an X-ray examination for other diseases.

The keratocyst spreads along the length of the jaw and does not lead to severe bone deformity. Therefore, it is determined when reaching large sizes. The cyst extends to the body, angle and branch of the jaw. The X-ray picture is characterized by the presence of extensive rarefaction of the bone tissue with clear polycyclic contours, while the uneven resorption of the bone gives the impression of a multi-chamber. Often, the coronary and condylar processes are involved in the process. The cortical plate becomes thinner and sometimes absent in some areas. On the radiograph, the periodontal gap of the roots of the teeth, projected onto the area of ​​the cyst, is usually determined (Fig. 3). Primary odontogenic cyst is diagnosed on the basis of characteristic clinical and radiological manifestations. It must be differentiated from ameloblastoma. With the latter, there is a pronounced swelling of the jaw. The final diagnosis is established after a morphological examination of the biopsy material. An open biopsy is performed with the obligatory excision of the bone tissue and the membrane of its cyst by the type of cystotomy. Biopsy is also the first stage of surgical treatment of the cyst. Macroscopically, the primary odontogenic cyst is a single cavity with bay-shaped depressions into the surrounding bone, covered with a membrane and made of an amorphous off-white mass. Microscopically, it is characterized by a thin fibrous capsule lined with keratinized stratified squamous epithelium. Surgical treatment. Since the cyst is capable of recurrence and malignancy, complete removal of its membrane is indicated while maintaining the bone walls. In other cases, a two-stage operation method is used.

Follicular cyst

This cyst develops from the enamel organ of an unerupted tooth, mainly the third large molar in the lower jaw, the canine and the third large molar in the upper jaw. The clinical symptoms of a follicular cyst are similar to those of other jaw cysts, however, when examining the teeth, one of them is characteristically absent in the area of ​​cyst localization, with the exception of the case of its formation from a supernumerary tooth. The possibility of developing ameloblastoma from a follicular cyst was noted. Radiologically, rarefaction of bone tissue with clear, even boundaries is determined by the type of a monocystic focus and the presence of an impacted formed tooth, the crown of which is either facing the cyst cavity or adjacent to its wall. The follicular cyst must be differentiated from ameloblastoma and primary odontogenic cyst. Macroscopically, a single-chamber cavity lined with a membrane and containing a yellowish transparent liquid with cholesterol crystals is determined. Microscopically, the cyst membrane is represented by a thin layer of connective tissue covered with stratified squamous epithelium, 2–3 cells thick. Treatment consists of cystectomy with extraction of the impacted tooth or a two-stage operation.

There are two main types of surgical interventions for odontogenic jaw cysts:

cystotomy - removal (excision) of a part of the cyst wall and the creation of conditions for long-term communication (with the oral cavity, nasal cavity, maxillary sinus), eliminating the main mechanism of cyst growth - an increase in hydrostatic pressure. Some authors (M.M. Solovyov, G.M. Semenov, 2004) call this method cystostomy, and under the operation of cystotomy they understand the dissection of the cyst wall in order to evacuate its contents. This operation is performed according to emergency indications in case of acute purulent inflammatory process;

cystectomy - removal of the entire epithelial-connective tissue lining (cyst shell) of the bone cavity. The operation is completed by bringing the edges of the wound of the mucous membrane of the alveolar process closer together (closed method of maintaining a bone wound) or the bone cavity is filled with a swab (open method).

Cystectomy (PARTSCH-I operation)

This is a complete simultaneous removal of the cyst along with its shell.

Indications for cystectomy:

Cyst, as a result of a malformation of the odontogenic epithelium;

Small cyst located within 1-2 intact teeth;

An extensive cyst, in which there are no teeth in its zone and a sufficient amount of bone tissue is preserved

(for the upper jaw - cysts adjacent or pushing back the maxillary sinus without symptoms of inflammation of the sinus).

It should be emphasized that the task of the operation includes not only the removal, but also the preservation of the teeth that caused the development of the cyst and adjacent to it (AI, Evdokimov). Single-rooted teeth that caused the development of a root cyst are sealed with the removal of cement beyond the top of the root. However, if the cyst is located close to the neck of the tooth, the preservation of the tooth is impractical, since after resection of the apex and part of the root, the stump cannot withstand the load and quickly becomes loose. A multi-rooted tooth, as a rule, cannot be saved (due to obstruction of the canals), and it is removed. Or, if the cyst comes from one of the roots, it is possible to perform a cystectomy with amputation of the root or hemisection of the tooth. Intact teeth projecting in the cyst area and having a periodontal gap on the radiograph must be subjected to EOD. In the absence of a reaction to the electric current, appropriate treatment is carried out. Reduced reaction of the tooth to the electric current after the operation can be normalized. If the periodontal gap is not visible on the radiograph and there is no reaction of the teeth to the current, then the teeth should be depulped and cured before cystectomy.

The operation is performed under conduction and infiltration anesthesia. On the vestibular surface of the alveolar process of the jaw, a muco-periosteal flap is cut out with a mucosal incision to the bone of a semi-oval or trapezoid shape with the base facing the transitional fold. The end of the flap in the presence of teeth should not reach the gingival margin by 0.5–0.7 cm; with a simultaneous removal of a tooth, the incision passes through its hole. If the cyst is located close to the neck of the tooth, the gingival margin with periodontal papillae is included in the flap. The flap should be larger than the cyst: it is cut out in such a way that it freely covers the future bone defect and the suture line does not coincide with it. The mucoperiosteal flap is peeled off from the bone with a raspator, using a gauze swab. It is brought under the raspator and then the bone above the cyst is exposed. In the absence of bone, care is required when exfoliating the periosteum from the cyst membrane. The separated flap is held with hooks or ligatures. Above the cyst in the projection of the apex of the causative tooth, holes are drilled along the perimeter of the future defect with the help of a trephine and connected to each other with a fissure burr. The resulting rounded bone plate is removed, and the front wall of the cyst is exposed. In the presence of a bone usury, the latter is expanded with wire cutters or a cutter. The dimensions of the bone defect should make it possible to view the cyst and resect the root apex. With the help of a raspator, an angular elevator and a surgical spoon, the cyst shell is peeled off, which easily moves away from the underlying bone, but remains connected with the root of the causative tooth. To isolate the shell, the top of the root is sawn off to the level of the surrounding bone, and the cyst is removed along with the root.

After resection of the apical part of the root at the level of the bone, it is possible to scrape out the remains of the membrane in this area, which prevents the recurrence of the cyst.

When examining the root stump, it is necessary to determine the presence of cement in the root canal; if it is absent, retrograde filling with amalgam or special cement (ProRoot MTA) is required. This action prevents inflammation of the bone wound due to infection from the root canal. After removal of the cyst shell, the roots of previously prepared neighboring teeth are exposed, the tops of which are also resected. Then, a revision of the bone cavity is carried out, the remaining pieces of filling material are removed. The cavity is filled with a blood clot, which is a reliable biological factor in wound healing. Washing with antiseptics of such a cavity, as well as the introduction of antibiotics into it, is not indicated. To activate the osteogenesis of a large bone cavity, it is advisable to fill it with a bone graft in the form of gravel, flour, etc. during the operation. In case of flap reduction, its mobilization is required by linear dissection of the periosteum at the base. The flap is placed in place, the edges of the wound are sutured with knotted catgut sutures, sometimes silk. A pressure bandage is applied externally - a “mouse” to limit the movement of the cheeks and lips and create peace in the postoperative area for at least 4–5 days. Painkillers, antihistamines are prescribed, anti-inflammatory therapy is carried out according to indications. The patient is unable to work for 6-7 days. The healing of the bone cavity occurs by organizing a blood clot, as after a tooth extraction. In the presence of a large cavity, radiographic examination for a long time (up to 1–2 years) reveals an area of ​​enlightenment, which tends to decrease and subsequently to complete restoration of the bone. In case of infection of a blood clot, an inflammatory process develops. In this case, it is necessary to create an outflow of exudate between the sutures or puncture the cavity outside the suture line and rinse it with antiseptic solutions. Daily washings for 3-4 days often stop inflammation. With the ongoing purulent process, the edges of the wound are bred, washed, a loose iodoform tampon is introduced into the cavity, screwing the flap inside. As the wound granulates (2-3 weeks), the tampon is forced out, it is gradually cut and removed. Often, a cyst that develops from the upper second incisor extends into the palate and leads to resorption of the palatal plate. Isolation of the cystic membrane in the palate with large defects (more than 2 cm) is difficult, since the cyst wall is soldered directly to the periosteum of the palate. When the cystic membrane is peeled off with a raspator, it often breaks, and therefore the removal is carried out in separate parts. Instrumental examination of the oral cavity does not allow distinguishing the cyst membrane from the tissues of the mucoperiosteal flap. Leaving sections of the cyst wall always leads to relapse.

Cystotomy (PARTSCH-II operation)

This is a method of surgical treatment of a cyst, in which the anterior wall of the cyst is removed and its cavity is connected with the vestibule or with the oral cavity proper.

Indications for cystotomy:

1) A cyst, into the cavity of which 3 or more intact teeth are projected, the periodontal gap is not determined on the radiograph at the roots of the latter;

2) Concomitant diseases;

3) Large cysts of the upper jaw with destruction of the bone bottom of the nasal cavity and palatine plate;

4) Extensive cysts of the lower jaw with a sharp thinning (bone thickness less than 1-0.5 cm) of the jaw base.

Preoperative preparation of teeth for cystotomy, unlike cystectomy, concerns only the causative tooth, the rest, although they are involved in the cyst zone, remain covered by its shell after the operation.

The operation is performed under local anesthesia. As with cystectomy, a semi-oval muco-periosteal flap is cut out no larger than the future bone defect. While maintaining the causative tooth, the base of the flap can be (desirably) turned towards the gingival margin for subsequent closure of the resected root stump.

After the bone wall is exposed, a burr hole is created above the cyst, the dimensions of which should not be less than the diameter of the cyst, since the bone defect narrows during the healing process.

With extensive cysts, especially those occupying the jaw branch, the size of the bone defect should be sufficient to maintain communication with the oral cavity. The cystic cavity is washed, the mucoperiosteal flap is screwed inside and held directly at the entrance to the cavity with iodoform gauze. Some authors fix the screwed-in flap to the cyst membrane with sutures, and also apply suturing of the cystic wall to the edge of the wound of the mucous membrane of the vestibule of the oral cavity. Cystotomy from the palate in cases of its bone defect consists in excision of the mucoperiosteal flap and membrane along the diameter of the cyst; sometimes a tampon is left in the cavity. After 6-8 days after the operation, the iodoform tampon is changed, by this time it becomes mucus and begins to be rejected. Such a change is carried out up to 3, less often 4 times. By the end of the 3rd week, the edges of the wound are usually epithelialized and an additional cavity is formed that communicates with the vestibule or oral cavity. The patient independently rinses it with antiseptic solutions. In some cases, resort to the manufacture of the obturator of self-hardening plastic. Otherwise, the growth of bone tissue and mucous along the edge of the hole will lead to the closure of the message. The obturator, as the bone tissue grows, is ground down with a cutter, without reducing, however, its diameter. The healing time, especially for large postoperative cavities, is up to 1.5–2 years. Patients' ability to work after surgery is disturbed by an average of 5-6 days.

Complications in surgical treatment of jaw cysts.

Complications during the operation.

Bleeding that threatens the life of the patient. Bleeding from soft tissues is stopped by tamponade with a gauze swab. In case of injury to the inferior alveolar artery, tamponade of the mandibular canal is carried out.

Perforation of the floor of the maxillary sinus. In this case, cystosinusotomy is performed, followed by careful suturing of the soft tissue wound.

Jaw fracture. In order to prevent this complication, an individual wire splint should be applied before surgery. In the event of a fracture, it is necessary to splint the jaws and ensure complete drainage of the cyst cavity. The appointment of antibiotic therapy. The final removal of the cyst should be performed after consolidation of the jaw fragments.

Postoperative complications.

1. Inflammatory reaction. After the cystectomy operation, if the patient does not comply with the recommendations (taking antibacterial drugs), suppuration of the postoperative wound is possible. In this case, it is necessary to remove the sutures, rinse the bone cavity and introduce iodoform turunda. Further wound management by the type of cystotomy.

2. Paresthesias are the result of nerve injury. In the postoperative period, the patient notes numbness in the zone of innervation of the corresponding nerve. Treatment: apply physio-and vitamin therapy.

3. Oroantral or oronasal communication. To prevent it, it is necessary to seal the edges of the wound tightly, and the patient to follow the recommendations (do not sneeze, do not smoke).

Conclusion.

Despite the fact that surgical treatment of odontogenic jaw cysts is effective, it should be remembered that the disease is easier to prevent than to treat.

Bibliography

Robustova T.G. Surgical dentistry. Medicine, M, 2008

Ovrutsky G.D., Livshits Yu.N. Non-surgical treatment of periradicular cysts of the jaws. Medicine, M., 1999.

Rabukhina N.A., Arzhantsev A.P. X-ray diagnostics in dentistry. MIA, M, 1999.

Solovyov M.M., Semenov G.M. , Galetsky D.V. Surgical treatment of odontogenic cysts. SpetsLit, St. Petersburg, 2004.

L.V. Kharkov, L.N. Yakovenko, T.V. Kava "Handbook of a surgeon - dentist diagnostics, clinic, surgical and drug treatment", Moscow, "Book Plus" 2004;

Odontogenic cysts are benign neoplasms that occur directly in the jaw bone tissues. They are diagnosed in people of various age categories. But, as practice shows, most often an odontogenic cyst is detected in men aged 30-50 years.

General information

Odontogenic cysts of the jaws are hollow formations with one or more chambers. Inside, they are lined with stratified squamous epithelium, and the outer side of the capsule is covered with a connecting layer.

In most cases, there is a clear yellowish liquid inside the cyst. Less commonly, the contents of the tumor have a grayish tint and a curdled consistency. In 80% of cases, the cause of the formation of such formations is the blockage of the salivary glands, as a result of which the outflow of mucous secretion is disturbed. It begins to accumulate inside the gland, stretching its walls and forming a capsule.

Blockage of the ducts does not affect the amount of secretion produced, but its output is disturbed. Against this background, there is a constant growth of formation, which leads to atrophy of bone tissues and proliferation of the epithelium.

Various factors can provoke blockage of the salivary glands. Most often they are inflammatory and infectious processes that occur in the cavity and cause development:

• caries;
• periodontitis;
• gingivitis;
• periodontal disease;
• stomatitis and more.

Also, a common factor that provokes the formation of an odontogenic cyst is trauma to the tooth, gums and jaw bones. A person can get them not only during a blow or fall, but also during certain dental procedures, for example, tooth extraction, filling, removal of tartar, prosthetics, etc.

Important! In older people, odontogenic cysts of the upper or lower jaws appear mainly due to improper wearing of removable dentures. Many people don't take them off at night, don't clean them, etc. But this cannot be done, since prolonged wearing of prostheses causes irritation of the mucous membranes, as a result of which they become inflamed and the ducts of the glands become clogged.

Odontogenic cysts in children most often appear against the background of abnormal development of the epithelium in the embryonic period. At the same time, these formations can occur in a child both during fetal development and at the time of the formation of teeth, in particular fangs.

In young people, odontogenic cysts mostly appear some time after tooth extraction. This happens due to the pathological growth of tissues as a result of a violation of the process of their regeneration.

Classification

Depending on the cause and location, odontogenic cysts are divided into the following types:

• residual;
• paradental;
• keratocysts;
• periodontal lateral;
• glandular;
• maxillofacial.

According to their structure, odontogenic cysts are divided into single-chamber and multi-chamber.

Symptoms

The process of formation of odontogenic cysts of the upper or lower jaws for a person occurs painlessly and asymptomatically. The clinical picture occurs when the pathological formation grows to medium size (becomes a pea).

At this point, the patient may be disturbed by the constant sensation of a foreign body in the oral cavity, the displacement of nearby teeth or the entire dentition, as well as a change in the color of the teeth that were affected by the tumor. When the cyst grows to a large size, it leads to protrusion of the bony structures of the jaw, which entails a pronounced facial symmetry.

When visually examining the oral cavity, a small tubercle can be noted, which, as a rule, does not differ in color from the mucous membranes of the mouth. However, if the formation of a tumor provoked inflammation of nearby tissues, they become reddish-brown in color and may bleed.

On palpation, the neoplasm is motionless, dense and painless. It has smooth contours and borders. Such cysts are not characterized by a numerous character. They grow "single".

Possible Complications

Despite the fact that the cyst of the odontogenic type is a benign tumor, it is necessary to deal with its treatment immediately after its discovery. After all, absolutely all cystic formations can lead to serious health problems, especially if their rapid growth is noted.

Regardless of the contents of the cyst and its location, it can degenerate into cancer, after which it will be very problematic to cure it. In addition, there are always risks that the tumor will become inflamed or fester, which will lead not only to atrophy of bone tissues, but also to their complete destruction. And if purulent processes occur in the oral cavity, then this is accompanied by yet another risk - the development of an abscess, which can lead to death in a matter of hours.

Large cysts often contribute to the deformation of the teeth, their displacement, loosening and loss. Therefore, it is extremely undesirable to delay the treatment of odontogenic formations in children and young people. In addition, odontogenic tumors in children during the period of changing milk teeth to permanent ones can lead to malocclusion, curvature of the teeth, or to the fact that they will not erupt at all.

It is worth noting that there is always a risk of rupture of the cyst membranes, which is followed by infection of the jaw and the appearance of other, more serious health problems.

Diagnostics

The doctor can detect the presence of an odontogenic cyst in the oral cavity already at the initial examination of the patient. But examination alone is not enough to make an accurate diagnosis. To confirm it, the following diagnostic methods are used:

• X-ray examination of the jaw.
• Computed tomography or magnetic resonance imaging.

It is also mandatory to conduct a biopsy or puncture of the cyst to determine the nature of its contents. If, as a result of examining a patient, doctors suspect a malignant tumor, a histological examination is carried out, which allows you to confirm / refute the presence of cancer cells in the cyst.

These diagnostic methods are used to make a diagnosis. But in order to determine the further tactics of treatment, the doctor needs to know everything about the general state of health of the patient. Therefore, he studies his anamnesis, and also appoints an OAM, OAC, a biochemical blood test, etc.

Odontogenic cysts are not amenable to conservative treatment. The only way to get rid of them and prevent the development of complications is to agree to an operation - cystotomy or cystectomy.

However, if various diseases of the oral cavity were detected during the diagnosis, then in order to avoid tissue infection during surgery, it will be necessary to begin with a complete sanitation of the oral cavity.

Both cystotomy and cystectomy are performed under local anesthesia. It is impossible to use it during an exacerbation of any chronic diseases, as this can lead to a sharp deterioration in well-being. Also, the use of local anesthesia during pregnancy and lactation is not recommended. In the presence of a bleeding disorder, surgical interventions are performed only in extreme cases.

If there are no contraindications to the operation, then the doctors immediately begin to remove the cystic formation.

Cystotomy

Cystotomy is a type of surgical intervention in which the cystic formation itself is not removed. During the operation, its anterior wall is excised and its contents are released. Thus, the cyst is emptied, its walls are connected to the oral cavity, and it is significantly reduced in size.

Before this, doctors cut out a flap from the vestibule of the mouth, which is then screwed into the cavity of the cyst and tamponed with iodoform turunda. Its replacement is carried out every 5-7 days until the wounds begin to heal.

The main indications for cystotomy are:

• Suppuration of the cyst.
• Large size education.
• Penetration of the tumor into the nasal cavity.
• More than 3 teeth in the cyst cavity.

Cystectomy

Cystectomy is a type of surgical intervention in which the complete removal of the cystic formation with its adjacent tissues occurs. After local anesthesia, doctors form a muco-periosteal flap, which is then trepanned into the area where the tumor is located. Stitches and a tight bandage are applied on top, which is removed only after the wound has completely healed.

This method of surgical intervention is the most traumatic and much more difficult to tolerate by patients. However, only with the help of cystectomy can you completely get rid of the tumor and avoid serious health problems.

It should be noted that in some cases, two methods of surgical intervention are used at once to remove an odontogenic cyst - cystotomy and cystectomy. At the same time, at the initial stages of the operation, the cyst is emptied, that is, cystotomy, and after its removal, followed by trepanation of bone tissues (cystectomy).

Does the operation give a 100% guarantee of a complete cure? Unfortunately no. Even after the complete removal of the cyst, it may reappear after a while, since there are many glands on the mucous membranes of the mouth that also function and can become clogged. Therefore, the only way to prevent the recurrence of the disease is a regular examination at the dentist and the implementation of remedial measures in the detection of diseases of the oral cavity, accompanied by infectious or inflammatory processes.

An odontogenic cyst is mistakenly considered a benign disease, although, as a rule, it does not harm the health of patients. Nevertheless, the lack of timely therapy for pathology provokes the development of complications.

What is a tooth cyst?

An odontogenic cyst is a pathological neoplasm that occurs in the upper region of the tooth root. The internal cystic cavity is filled with liquid, and in addition, with purulent mushy contents, it is enveloped by a fairly dense epithelial layer.

The sizes of neoplasms of this kind are from several millimeters, and against the background of rapid development, they reach several centimeters in circumference. Often, pathological processes cover the upper jaw, since the roots of the teeth have a more porous structure.

To understand what an odontogenic tooth cyst is and how to cure it, you need to know why such a phenomenon can occur. Its formation is carried out as a result of inflammation, so the body, as it were, limits healthy tissue from the affected area, clogging it together with bacteria.

Causes of pathology

There are several reasons why a tooth cyst develops. The main reason is the vital activity of pathogenic microscopic organisms in a closed space of teeth. As a rule, the following prerequisites contribute to this:

• The presence of a complex course of pathology along with the lack of timely treatment and incorrectly performed therapy for dental diseases. We are talking about caries, periodontitis and pulpitis.
• Occurrence of infectious complications after filling and implantation procedure. In such situations, doctors remove not only the neoplasm, but also the crown or implants, which makes it possible to avoid relapses.
• The appearance of complications during dentition, especially in the case of eruption of wisdom incisors. In this case, the dental tissue injures the gums, and various bacteria enter directly into the microcracks.
• Pathogenic microorganisms can also enter the wounds formed during mechanical damage to the teeth.
• Against the background of diseases of the nasopharynx. In this case, infections in the nose or throat can go into the oral cavity.

To provide adequate therapy, it is necessary to accurately determine the causes of a tooth cyst, based on this, the dentist will prescribe the appropriate treatment. So, in case of injury, the treatment consists in removing the neoplasm. But if the pathology is a complication of another disease, in addition to removing the bubble, the patient will be prescribed therapy for the underlying disease.

Types of cystic pathological neoplasms

Dental cysts have different classifications, each of them is formed according to certain parameters of the pathology. By the nature of the disease are distinguished:

• Residual cyst, which occurs immediately after tooth resection, is the most common type of pathological formation.
• The retromolar form is formed in the presence of severe eruption of wisdom teeth.
• Radicular. With this form, the formation is located on the tooth root or near it.
• Follicular. At the heart of it there is a germ of a permanent tooth. As a rule, follicular neoplasms appear as a result of poor care of the milk incisors.

Neoplasms are classified according to their origin:

• So, odontogenic cysts are isolated, arising as a result of the transition of inflammatory processes from various dental diseases.
• Nonodontogenic. The causes of their occurrence include, as a rule, problems that are not related to the teeth and oral cavity.

Symptoms of this pathology

The danger of a cyst is that the signs of the disease occur only when the pathological neoplasm reaches a large size. At an early stage, they do not manifest themselves in any way, and at this time infectious processes capture an increasing area of ​​healthy tissue. At the initial stages of development, odontogenic cysts of the jaws are discovered by chance during a routine examination or treatment of other diseases. With the development of pathology, the patient may experience the following symptoms:

• The occurrence of unpleasant and even painful sensations in the tooth, aggravated by chewing solid food.
• The presence of protrusion of the gums of the tooth, while the growth of the gums can become larger with time, and in addition, it is possible that some redness will be observed.
• The appearance of a fistula in the area above the root of the tooth. Serous or purulent accumulations can stand out from it.
• The occurrence of general weakness and malaise.
• Increase in body temperature.

It is worth noting that when such a cyst occurs in a person, the symptoms are not immediately visible, it appears in the later stages of development. Pain during the appearance of a pathological neoplasm may be aching in nature, but it is less pronounced than the pain observed in patients with caries or against the background of pulpitis.

In the event of a clinical picture or suspicion of a pathological process, it is imperative to consult a doctor. It is forbidden to resort to self-therapy, since the cyst of the tooth must be removed. In addition, the use of improperly selected medications can worsen the general well-being of the patient.

Sometimes there are no painful sensations in the oral cavity; instead, the basis of the clinical picture can be expressed in intense headaches. The cause of this phenomenon can be odontogenic cysts of the maxillary sinus and maxillary sinuses.

Maxillary cyst

Such neoplasms in medical terminology are interpreted as one of the varieties of odontogenic formation. Surgical therapy of maxillary odontogenic cysts is especially successful today. This neoplasm occurs most often due to the presence of an inflammatory process in the region of the upper jaw, which, with a prolonged course, can have an intoxicating effect on the human body.

Cyst of maxillary sinus

Odontogenic cysts of the maxillary sinus are benign, spherical formations filled with fluid. The wall of such a neoplasm, as a rule, is two-layered. Their inner layer is represented by an epithelium that produces mucus. Often such a cyst occurs due to a chronic disease like rhinitis or sinusitis, developing in the nose or in the region of the paranasal sinuses.

Treatment of pathology

Treatment of odontogenic jaw cysts is carried out through surgery, conservative therapy or laser exposure. It must be said that conservative treatment produces a positive effect only at the initial stages of the disease, and overgrown neoplasms must be removed.

Performing a surgical operation

To eliminate an odontogenic cyst in the sinus, it is not necessary to remove the entire tooth completely. In this case, only the root of the tooth, on which the neoplasm is located, is subjected to resection. Immediately after the removal of the affected area, the remaining root is sealed by the dentist.

A few days later, the doctor removes the stitches, be sure to control the wound healing process. It is important to make sure that no cyst particles remain in the canal of the tooth, to achieve this goal, a repeated x-ray is performed.

It is worth paying attention to the fact that sometimes it is impossible to perform root removal with a cyst, in such cases the doctor completely removes the tooth. An indication for complete dental resection is a hard-to-reach position along with a severe course of the disease. After surgery and removal of the formation, the patient needs to visit the dentist regularly, following the prescribed medical recommendations.

What else does the treatment of odontogenic cysts involve?

Conservative treatment of this pathology

Treatment of this disease with the help of conservative methods is possible only in the early stages of its development. In order to eliminate education, patients are prescribed rinses and injections.

In the process of treatment, the dentist opens the dental canal, which led to a cystic neoplasm, exudate is pumped out of it. The doctor may not fill the canal for seven days, at which time the patient uses antiseptic solutions with tinctures for rinsing the mouth. Upon completion of the therapeutic course, the dentist processes the root canal with the help of drugs, and then the tooth is sealed.

Laser removal of cysts

Laser treatment is currently a modern way of treating odontogenic cysts of the maxillary sinus. When performing this technique, the doctor opens the dental canal and treats the area with a cystic neoplasm with laser irradiation. The laser destroys not only the epithelium of the cyst, but also hundreds of thousands of bacteria inside the bladder.

The advantages of laser removal are the rapid healing of tissue, along with the absence of risks of introducing secondary infections into the oral cavity and dental canals as well.

Treatment of the disease with antibacterial drugs

In some situations, the treatment of an odontogenic cyst is carried out with the help of antibiotics. Taking antibacterial drugs serves as an auxiliary measure for the destruction of overgrown infections or as the main method of treatment in the event that a tooth cyst develops against the background of primary infectious diseases. Antibacterial drugs can only be prescribed by the attending physician, the following drugs are most commonly used:

• The drug "Amoxicillin". This medicine can have a high antibacterial effect, which greatly facilitates the treatment of cysts by other methods.
• The drug "Cifroploxacin" is a broad-spectrum antibiotic. This tool actively destroys bacteria, removing inflammatory processes.
• The drug "Tetracycline" is a drug that is prescribed more often than others, it can actively stop inflammatory processes along with pain. In addition, this tool facilitates the use of other methods of cyst therapy.

Sometimes doctors can prescribe topical antibacterial agents to patients, but taking such medications is far from always advisable. The fact is that local preparations (antibiotics) are quite problematic to evenly distribute over the affected area.

It is worth paying attention to the fact that antibacterial drugs are potent drugs that affect beneficial bacteria in the human body. It is allowed to take such medicines only as prescribed by the doctor, without increasing the number of doses and dosage.

The maxillary sinuses, like the maxillary bones, paired organs, are present on the left and right sides of the facial skull. They are an integral part of the paranasal sinus system, which also includes the frontal, sphenoid sinuses and the ethmoid labyrinth, and, like other sinuses, communicate with the nasal cavity.

By the term "odontogenic cyst of the maxillary sinus" doctors mean a cyst (a pathological bladder / cavity filled with contents) formed as a result of a tooth disease. In a modern person, the roots of the upper large and small molars are separated from the sinus only by a thin bone septum, so inflammation that develops in the area of ​​​​the tooth root (periodontitis, periodontitis, etc.) spreads to the sinus rather quickly. Often, inflammation of the tooth is accompanied by the formation of a periradicular cyst, which, due to the described anatomical conditions, is introduced into the sinus and continues to grow already inside it.

The cyst contains an infection and inflammation products, therefore, having penetrated into the sinus, it also causes inflammation. This inflammation is chronic with episodes of exacerbation. The disease can proceed almost imperceptibly for a person, manifesting itself as a vague feeling of heaviness in the area of ​​​​the teeth and in the depths of the upper jaw, which accumulates during the night as a thick secret in the nasopharynx. Exacerbations are provoked by colds, viral diseases and other negative factors, and the symptoms are completely identical to other forms of sinusitis, without specific features. Gradually growing, the cyst fills an increasing part of the sinus, up to its complete filling. At the same time, the cyst destroys the mucous membrane of the sinus, and can destroy the adjacent bone, sometimes forming very large defects in the bone walls of the sinus. More details about the manifestations, diagnosis and treatment of odontogenic cysts of the maxillary sinus are described in the relevant sections.

X-ray methods help to identify the "causal" tooth and determine its condition. For these purposes, it is possible to use targeted images of the teeth or panoramic radiography of the jaws, but the quality of diagnosis is significantly higher when using cone beam tomography. If the first types of research give a qualitative, but 2-dimensional picture, then cone-beam tomography is 3-dimensional, while reflecting structures a quarter of a millimeter in size.

The main method for studying the state of the maxillary sinus is also X-ray, while it is time to forget about conventional projection (two-dimensional) images. Their reliability and accuracy is only 25-30%.

Diagnosis of an odontogenic cyst necessarily requires tomography, it can be multispiral or, again, cone beam tomography. The middle and upper third of the face should be included in the scanning area.

In general, preference should be given to cone-beam tomography, since with an equal quality of displaying the state of the maxillary sinus, this method better reflects the state of the dentoalveolar system and, importantly, has a much lower radiation load on the patient compared to multislice tomography.

It should be noted that even the most advanced methods of radiation research do not exclude the need for examination. Examination of the sinus allows you to identify the smallest tissue changes and functional disorders, which is not available to any other methods. In particular, only during examination it is possible to determine exactly what contents the cyst is filled with, the zone of its attachment, etc.

It should be added that diagnostic endoscopy is also used as a control method after sinus surgery, when its anastomosis is already expanded and it is not a problem to look through it into the sinus.

Treatment of an odontogenic cyst of the maxillary sinus is reduced to its mandatory removal, and to the elimination of the odontogenic source of infection that provoked the growth of the cyst.

The cyst can only be removed surgically, which requires endoscopic or conventional radical maxillary sinus surgery. Endoscopic surgery is undoubtedly preferable, because. accompanied by minimal surgical trauma, but in some cases radical surgery is still required.

Such a need arises when the cyst has a bone membrane, which is very difficult to work with with an endoscopic instrument. There is also a need for a radical operation when the cyst grows and destroys the anterior wall of the sinus.

In this case, to isolate and remove the cyst membrane, it is no longer possible to do without access from the mouth. Such operations, unlike endoscopic ones, are more aggressive, more difficult to tolerate by patients, and, most importantly, always leave a defect in the anterior wall of the sinus, so in all other cases, preference should be given to endoscopic intervention. Endoscopic removal of the cyst is performed through the nose, and requires only the expansion of the natural anastomosis between the sinus and the nasal cavity.

Sometimes access through the nose is supplemented by a puncture of the anterior wall of the sinus, to facilitate work in the lowest and deepest parts of the sinus, but this puncture is so small that, as a rule, patients do not notice its trace in the mouth.

To achieve a cure, it is very important to completely remove the cyst membrane. For some time it was believed that it was enough to remove only a large part of its membrane, but experience shows that incomplete removal leads to recurrence of cyst growth.

It is equally important to eliminate the source of cyst formation. If it is a tooth, then, as in other forms of odontogenic inflammation in the sinus, the desire to preserve it prevails. For this, sanitation and filling of the roots can be carried out, including under the control of a microscope, however, even the most thorough treatment does not guarantee the complete elimination of the infection, and therefore requires delayed control after 6-8 months. If the treatment was ineffective, or saving the tooth is meaningless due to its destruction, then the tooth is removed. Tooth extraction is a guaranteed way to eliminate the source of infection.

Without fail, 3-4 months after the treatment, it is necessary to monitor the result. To do this, a tomographic examination is repeated, and, if necessary, a diagnostic endoscopy.

As already noted, cysts tend to recur and grow again if any fragment of its membrane remains in the sinus, or the primary source of infection persists. Its growth may not be noticeable to a person until it again reaches a large size, therefore, even in the absence of symptoms, tomographic control is necessary.

Cyst of the maxillary sinus. Symptoms of a maxillary sinus cyst

Cyst of the maxillary sinus is a fairly common problem. Such a pathology can occur without any symptoms, but under certain conditions it becomes a cause of discomfort. Moreover, sometimes a cyst is really dangerous. And today, many are interested in additional information about this disease. Why does a cyst occur? What methods of treatment does medicine offer? How dangerous can surgery be? The answers to these questions will be useful to many.

What is a cyst?

Of course, first of all, it is worth understanding what this education is. It's no secret that in the human skull there are special air cavities, which are called the paranasal sinuses. And the maxillary sinuses (or maxillary sinuses) are the largest of them.

The cyst of the maxillary sinus is a benign formation. It is a small bag with a two-layer wall and a liquid inner content. The inner layer of the cystic wall contains special cells that produce a mucous secret. Essentially, a cyst forms due to a blockage in a mucus-producing gland.

According to statistics, every tenth person on the planet has a similar neoplasm. But in most cases, the cyst does not cause any concern to the patient. Moreover, most often it is discovered quite by accident, at a time when the doctor examines the nasal cavity and sinuses for the presence of any other diseases.

The main causes of neoplasm

It is extremely important to find out why the cyst of the maxillary sinus formed. Treatment in most cases depends on this. As already mentioned, the nasal cavity and paranasal sinuses are lined with a mucous membrane, the special cells of which produce a mucous secretion. Under the influence of certain reasons, the excretory ducts of the mucous gland can become clogged, as a result of which the secret begins to accumulate in its cavity - this is how a cyst most often occurs. But the causes of blockage can be very different:

• Most often, the cause is frequent inflammatory diseases of the nasal passages and paranasal sinuses - these can be rhinitis, sinusitis, as well as sinusitis and other diseases.
• Some people have some anatomical features (for example, facial asymmetry) that make them more prone to this type of disease.
• In addition, the reasons include an increased allergic background of the body.
• There is also a hypothesis that some changes or features of the immune processes in the body can become the cause of the formation of cysts, although this opinion has not yet been confirmed during research.
• Separately, it is worth mentioning the odontogenic cyst, the formation of which is associated with a disease of the maxillary teeth.

Classification: main types of cysts

Today, people want to know what a maxillary sinus cyst is. Symptoms, treatment of the disease - all this is also of interest to many. In addition, it is worth considering that such structures may be different. To date, there are several systems for classifying such neoplasms.

For example, depending on the causes of occurrence and some structural features, it is customary to distinguish the following types of cysts:

• A true (retention) cyst is formed as a result of blockage of the excretory ducts of the mucous gland. At the same time, from the inside, the neoplasm is lined with typical cells of the mucous membrane, which continue to produce a secret.
• A false, or pseudocyst, usually forms with prolonged exposure to an allergen. The reasons for its formation include inflammatory processes in the roots of the maxillary teeth. This formation does not have mucous cells.

In addition, the cyst may have a different filling - for example, a neoplasm may contain purulent masses, mucous secretion or serous fluid inside. A cyst can form both on the left and on the right side, which also needs to be taken into account in the diagnostic process.

What are the symptoms of the disease?

It is worth noting that in most cases this disease occurs without any symptoms. The cyst does not interfere with breathing, does not cause pain and does not affect the quality of life of a sick person in any way - often an otolaryngologist discovers it quite by accident during the diagnosis of sinusitis or some other diseases.

On the other hand, inflammation or rapid growth of the neoplasm can lead to the appearance of characteristic signs. So what are the symptoms of a maxillary sinus cyst? Often, one of the first signs of pathology is pain that appears above the site of the cyst, but can also radiate to the orbit or temples.

In addition, many patients complain of persistent nasal congestion and difficulty breathing. If the patient has a cyst of the left maxillary sinus, then, accordingly, congestion will be felt more precisely on the left side. In some cases, scanty discharge of purulent origin can be observed.

Severe headaches can also be attributed to the symptoms of a cyst. Soreness, as a rule, is characterized by a clear frontal localization.

Why is this pathology dangerous?

It is immediately worth noting that with timely therapy, the likelihood of complications is minimized. Nevertheless, a cyst of the maxillary sinus can lead to extremely unpleasant consequences. In particular, one of the most common complications is its inflammation and suppuration, which is accompanied by pain, fever, purulent discharge, etc.

There are also well-known cases when the long-term growth of such a neoplasm led to increased pressure on the bones and some organs of the head. Bone under constant impact can be deformed. Moreover, in some cases, the cyst compresses those other parts of the visual analyzer, which leads to diplodia and some other disorders. In an extremely neglected state, such an ailment can lead to rejection or necrosis of bone tissue. That is why in no case should you leave this pathology unattended.

Modern diagnostic methods

To date, there are several fairly important methods for diagnosing such a disease. Only a doctor can make a diagnosis of "maxillary sinus cyst", so if you have any disturbing symptoms, you should immediately contact a specialist.

First of all, the patient will be referred for x-ray, as this is the fastest and most affordable diagnostic method. Pictures in two projections help to determine the presence of neoplasms, to establish their exact location, as well as their size.

More accurate results can be obtained using magnetic resonance and computed tomography. In addition, the doctor can perform an endoscopic examination of the maxillary sinuses, during which the cavities can be carefully examined from the inside using special equipment equipped with fiber optics. This is how the cyst of the maxillary sinus is determined. Endoscopic surgery, by the way, also includes a biopsy - the removed structures are sent to the laboratory, where they are used for cytological, biochemical and microbiological studies.

Maxillary sinus cyst: treatment with conservative means

It is immediately worth noting that the choice of therapy is the task of the attending physician. Only a specialist can decide what to do next after examining the maxillary sinuses. Treatment with medication is not carried out. Tablets, nasal drops, rinsing solutions - most often all medicines are simply useless.

If the presence of a cyst does not affect the patient's condition in any way, and no inflammatory processes were detected during the examination, then specific treatment may not be required at all - patients are recommended only dynamic observation, which will give the doctor the opportunity to see the pathological changes in this neoplasm in time.

Often, therapy depends on the cause. For example, to eliminate the inflammatory process and pain that arose against the background of an odontogenic cyst, it is enough to carry out the correct treatment of a diseased tooth - the symptoms will then disappear on their own. In some cases, the doctor performs a puncture of the sinuses or neoplasms, which can also have an effect, since the tissues can be freed from pus. Nevertheless, the cyst shell remains, and therefore the likelihood of a recurrence in the future is high.

In some cases, removal of the cyst of the maxillary sinus is the only effective method of therapy. The decision to perform the operation is made by the attending physician.

Removal of a cyst of the maxillary sinus: when is it necessary?

Today, there are several main techniques of surgical procedures. Only the doctor decides how the cyst in the maxillary sinus will be removed. The operation, or rather, the method of its implementation, depends both on the individual characteristics of the patient's body and the type of cyst, and on the availability of the necessary equipment in the clinic.

Quite often, the so-called Caldwell-Luc operation is performed. This procedure is most often performed under general anesthesia, although local anesthesia is also possible. First, the doctor makes an incision under the upper lip, after which he opens the front wall of the sinus. With the help of special surgical instruments, the specialist removes the cyst through the hole made.

Unfortunately, this technique has several disadvantages. The fact is that the hole after the operation is overgrown not with bone, but with scar tissue, which leads to some consequences. In particular, patients after such a procedure often suffer from persistent rhinitis and sinusitis.

Endoscopic removal of the maxillary sinus cyst is considered more effective and less dangerous. With this procedure, no incisions are required - the doctor inserts all the instruments directly through the nasal passages. In addition, the endoscope is equipped with an optical fiber, which allows the doctor to clearly monitor the process and perform the necessary actions.

Endoscopic removal has a number of important advantages. To begin with, it is worth noting that after surgery there are no cuts or scars left. The procedure does not require long-term hospitalization - the patient is usually discharged after 1-2 days. The risk of complications is minimized. In addition, this technique has practically no contraindications.

Other treatment requires an odontogenic cyst. In such cases, the cyst is removed through an incision under the upper lip. The procedure is performed under local anesthesia.

If the inflammation is caused by the activity of bacterial microorganisms, then before and after the operation the patient is treated with antibiotics (the choice of the drug depends on the nature and characteristics of the pathogen). Antibacterial therapy is in any case necessary after surgery to eliminate the risk of complications.

Is it possible to treat with the help of traditional medicine?

Of course, traditional medicine offers a lot of non-traditional methods of treating this disease. But it is immediately worth noting that in no case should such self-treatment be started without first consulting a doctor, as this can only aggravate the situation. So which means are considered the most effective?

For example, drops that can be prepared at home are considered quite effective. You need to mix a tablespoon of water, a teaspoon of glycerin and two grams of mummy. It is necessary to instill three drops into each nasal passage. The procedure is repeated twice a day.

Another effective medicine is the juice of the golden mustache, which also needs to be instilled three drops twice a day. You can also try the juice obtained from the tuber of the forest cyclamen (it must first be diluted with water in a ratio of 1 to 4). It is desirable to bury the nose in the morning (no more than two drops). The course of treatment lasts about a week.

Such home remedies help relieve inflammation, and are also considered an excellent prevention of sinusitis. But you need to understand that the drops will not help get rid of the cyst - surgical intervention is necessary here.

It is worth remembering another important point. Inhalations with essential oils, washing the nose, heating the sinuses can only aggravate the situation. And the use of plant extracts in the presence of hypersensitivity can trigger an intense allergic reaction. Therefore, do not self-medicate without the permission of a doctor.

Are there effective methods of prevention?

Unfortunately, today there are no means that can permanently protect a person from the occurrence of this disease. Therefore, doctors recommend avoiding exposure to the most common risk factors whenever possible. In particular, all sinusitis, rhinitis, sinusitis and other diseases of the nose should respond to full therapy in time. Some experts associate the formation of cysts with allergic reactions, so their occurrence should also be avoided (take antihistamine medications on time, do not come into contact with the allergen).

In any case, such a disease, with timely detection and treatment, does not pose a particular threat - you just need to seek help and carefully follow the doctor's instructions.

Cyst of the maxillary sinus and its treatment

Among the pathologies of the paranasal sinuses, benign neoplasms are often found, in most cases they do not cause much concern to the patient. Their endoscopic removal or surgery is performed on an outpatient basis using local anesthesia. In this material, we will consider the symptoms and treatment of one of the varieties of such a pathology.

The cyst of the maxillary sinus is a volumetric benign formation with an internal cavity, which occurs in 10% of cases of examination with a disease of the maxillary sinuses. Education may be variable, of different origin and causes, may consist of different tissue (mucous cells, fibrous fibers), have an empty or filled with pus or liquid cavity.

To begin with, it is worth talking about the common types of pathological changes and the likely causes of their occurrence.

Retention cyst of the maxillary sinus or false structures

Allocate true and false cysts of the maxillary sinuses. True cysts are formed when the excretory duct of the gland of the mucous membrane of the nasal passages and sinuses is blocked. The secret of the gland (mucus) constantly accumulates without an exit and a capsule of epithelial tissue is formed around it. This is the so-called retention cyst of the maxillary sinus, which gradually increases and fills the space of the maxillary sinuses. Usually blockage of cysts occurs with long-term and poorly treated chronic sinusitis.

False cysts of the maxillary sinus are formations from other tissues. Most often they are of dental origin and develop from fibrous or bone tissue, and can also be presented as cholesteatomas, or keratocysts, containing cholesterol crystals, horny structures and epithelium. Predisposing factors in this case are chronic periodontal inflammation, caries, severe chronic diseases.

Odontogenic cyst of the maxillary sinus

The odontogenic cyst of the upper jaw, that is, the cavity that forms from the tissues of the tooth, is a false form. It is usually located in the lower parts of the maxillary sinus and is formed during dental disease from the tissue of the follicle.

• Incisal foramen (nasopalatine);
• Radicular;
• Follicular;
• Retromolar;
• Nasoalveolar;
• Globulomaxillary.

The most common form of all types of cysts of the upper and lower jaw is radicular. It is formed from the structures of the tooth root after an inflammatory process with the formation of granulomas. Usually its size does not reach more than 1 cm, but sometimes there are also large ones - up to 3 cm. It is thin, consists of fibrous tissue, in which plasma cells and lymphocytes are found, lined inside with a stratified epithelium. The inflammatory process leads to hyperplastic processes with the development of processes directed inside the capsule. With complete melting of the epithelium, the formation cavity can be completely filled with granulomatous tissue. Such neoplasms tend to suppurate, can cause destruction of the adjacent bone tissue, the bone plate. Inside the cavity, xanthoma cells, cholesterol crystals can be found. The location of radicular cysts can lead to displacement or germination into the maxillary sinuses.

Retromolar is a cyst that forms with the growth of wisdom teeth.

Nasoalveolar arises at the junction of the upper jaw and the bones of the nose at the border of three processes (nasal, frontal, maxillary). Such a tumor is formed in soft tissues and can be lined with any type of epithelium: flat, cylindrical, transitional, cubic.

The cyst of the incisive canal, with gradual growth, destroys the palatine bone, can be lined with a flat or cylindrical epithelium.

Follicular arises from the enamel of underdeveloped incisors, molars and premolars and may include one or more tooth buds or formed teeth. Its thin capsule consists of squamous stratified epithelium cells.

Globulomaxylar - formed between the canine and lateral incisor, grows slowly and can grow into the nasal cavity or upper jaw. The fluid contains cholesterol crystals, and the cavity is lined with squamous, columnar, or cuboidal epithelium.

The probable causes of the pathology have been sufficiently studied

The mechanisms of pathology formation are sufficiently studied by science and doctors have a detailed idea of ​​all tissue transformations under the influence of probable causes. A true cyst of the maxillary sinus can form as a result of the curvature of the nasal septum and the inflammatory process (sinusitis). In both the first and second cases, an obstacle arises for the outflow of the mucous secretion of the glands, which causes the formation of a tumor.

False neoplasms occur with the growth of granulomatous tissue due to dental diseases.

Probable causes are supplemented by predisposing factors, in the role of which allergic processes and inflammations, infections and metabolic disorders, hypovitaminosis, and immunodeficiency serve.

Signs and symptoms to look out for

In the initial stage of development, a cyst in the maxillary sinus does not give symptoms, but there are signs that you should pay attention to for a timely examination. At first, this may be a slight elevation above the surface of the upper jaw, adjacent to the tooth, if this is an odontogenic pathology. And if a true cyst develops, then the symptoms will resemble the clinical picture of sinusitis: headache and pain in the jaw on the side of the lesion, nasal congestion, as with a runny nose, chronic rhinitis. With odontogenic development of education, patients are concerned about pain during chewing and biting. If the tumor has reached a visible size, round, painless formations of varying density can be felt on the upper jaw or in the nose area. With suppuration in the area of ​​\u200b\u200bthe formation, there will be swelling and inflammation, pain when touched.

If the tumor is located close to the exit of the second branch of the trigeminal nerve, that is, in the upper part of the air sinuses, even a small tumor will cause severe pain. In this case, a large cyst in its lower sections can be painless. In addition, in people who are fond of scuba diving, the disease causes discomfort and headaches when diving to a depth.

If an autopsy occurs, then fluid flows out of the nasal cavity from the side of the rupture, filling the cyst.

To confirm the diagnosis of a false or true cyst of the maxillary sinus, it is necessary to take an x-ray or computed tomography of the sinuses. From the picture, you can determine the localization, size, shape and nature of the surrounding bone structures.

Treatment options for maxillary sinus cysts: surgery or endoscopic removal

If the diagnosis reveals cysts of the maxillary sinuses, the treatment of such formations can only be surgical. And the sooner such treatment is started, the faster the recovery will come. It is better not to bring the disease to a complicated course and traumatic surgical methods. The most common methods of therapy are surgery or endoscopic removal of the neoplasm without skin incisions.

The intervention does not require incisions and special accesses and is carried out through the natural airways. A thin probe is introduced into the nasal passage and further into the anatomical communication with the maxillary sinus, with the help of which the operation is performed under video surveillance. In this case, the patient does not need registration in the hospital - he goes home three hours after surgery.

In any case, if there is a neoplasm, the operation is performed according to individual indications, taking into account all age, physiological characteristics of the body. The smaller the size of the formation, the less postoperative trauma and the likelihood of complications.

Classic surgery to remove a neoplasm

The classic operation to remove a cyst of the maxillary sinus, which is performed in most clinical cases, is to make an incision in the upper jaw in the area of ​​transition to the upper lip. Next, the anterior wall of the maxillary sinus is excised and the internal formation is removed, the sinus cavity is sanitized. A small postoperative defect in the area of ​​the bone wall does not require filling and overgrows with time.

There are two types of operative interference:

Cystostomy is indicated for existing long-term chronic diseases, lesions of bone structures or several teeth with a cyst. In this case, a puncture and drainage of the contents is carried out. The capsule remains intact. In cases of suppuration of the formation, a constant outflow and drainage of the cystic cavity is necessary. To do this, after the operation, the wound is not sutured, but a message is left with the oral cavity.

Cystectomy is a complete removal along with the capsule and epithelium to prevent recurrence of growth of the formation. Cystectomy is indicated in the absence or loss of teeth in the area of ​​operation, the capture of two teeth in the pathological process, the size of the cyst is 7 mm or more. To strengthen the bone structures and prevent re-growth, the cavity remaining after the operation is filled with a special material. If the cyst captures no more than a third of the root of the tooth, then its resection or incision is possible. In other cases, the affected tooth is removed.

After removal of the cyst of the maxillary sinus, in some cases, the tumor grows again. It depends on the quality of the operation performed, and on the individual characteristics of the organism. Therefore, after the operation, it is advisable to cure chronic infections of the upper respiratory tract, caries, periodontitis, sinusitis, chronic runny nose, correct the deviated nasal septum, which contribute to the recurrence of the disease.

To do this, it is also necessary to constantly be observed at the dentist and ENT and undergo the prescribed examination and treatment on time, lead a healthy lifestyle and eat well.

Cyst in the maxillary sinus: treatment, doctor's answers, surgery

Often we consider a runny nose and other diseases of the nasal cavity to be insignificant problems that can go away on their own, but sometimes they become a manifestation of a number of dangerous complications, one of which can be a maxillary sinus cyst. What is it and how can it turn out for a person?

What it is?

The maxillary or maxillary paranasal sinuses are one of the 4 sinuses of the nose. They are located on both sides of it, slightly below the eye sockets and slightly above the wings.

In shape, they resemble peculiar 4-sided pyramids that have direct communication with the nasal cavity through the anastomosis. Their inner surfaces are lined with a mucous membrane rich in vessels, glands and nerve endings.

In all people, the volume of these sinuses is different, which is determined by the thickness of their walls and the anatomical features of the structure of the facial structures. Moreover, they change their shape and size as a person grows up.

The cyst of the maxillary sinus is a benign neoplasm filled with fluid and surrounded by a dense capsule.

The basis for its formation is the gland, which produces natural mucus. As a result of blockage of its duct by clots of secretions, secretion accumulates, which leads to its gradual increase and, in fact, the formation of a cyst.

Pathology received the ICD code 10 J34.1. Moreover, the manifestations and tactics of treatment if it is present in a child and an adult are the same.

There are two types:

True or retention. The presence of neoplasms of this kind is said when they form from the tissues of the mucous membrane of the nasal structures in any part of the paranasal sinus and are surrounded by a two-layer capsule. False. Such neoplasms appear in the maxillary sinuses due to their germination from other tissues, such as gums (odontogenic cyst), or due to the characteristics of an allergic reaction. Thus, they are also localized in the sinus, but have a different nature, and they, as a rule, are single-layered and grow from its lower wall.

At the same time, neoplasms can affect only one of the sinuses, and can form immediately in both. Depending on this, there are:

• cyst of the left maxillary sinus;
• cyst of the right maxillary sinus;
• bilateral.

Causes of the appearance and occurrence of pathology

Blockage of the excretory ducts of the glands most often occurs against the background of chronic inflammatory processes:

• sinusitis, especially sinusitis;
• polysinusitis;
• rhinitis, including allergic and vasomotor.

Increases the risk of cystic cavity formation:

• deviated septum of the nose;
• the presence of carious teeth, which become a constant source of infection;
• pulpitis;
• polyps;
• malocclusion and omission of the hard palate;
• allergy.

The main symptoms of the presence of a tumor in the sinus

Signs of a cyst begin to appear only after it reaches a certain size or acute inflammation does not occur, for example, an exacerbation of chronic sinusitis occurs. How long the cyst of the maxillary sinus is filled depends on many factors, but, above all, on the frequency and intensity of the development of inflammation and the individual characteristics of the patient.

Sometimes they grow very slowly and do not manifest themselves in any way, and therefore are found only during routine examinations or by chance during an examination for another reason.

As the pathological cavity enlarges, patients may experience one or more of the following symptoms:

• Pain radiating to forehead, temple and eye socket. Often it is one-sided and appears on the side of the lesion.
• Discomfort in the nose
• Possible rise in temperature
• The presence of a feeling of the presence of a foreign body in the maxillary sinus.
• Regular or constant feeling of congestion in half (with a unilateral process) or the entire nose (with a bilateral lesion).
• An increase in the frequency of exacerbations of chronic ENT diseases, and they proceed much harder and longer than before the formation of a cystic cavity.

Thus, the manifestations of pathology in many ways resembles the signs of sinusitis. And since these diseases often accompany each other, the patient may not be aware for a long time that he has a cyst in his nose.

In addition, some patients complain of congestion and discomfort in the ears. This may be due to swelling in the nose. That is, there is a certain relationship between the cyst and the ear.

What does it threaten and what can it lead to?

Since the contents of the cystic cavity can become infected at any time, it is a potential source of chronic infection.

In this case, pus actively accumulates in it, and its capsule may burst. If this happens, the patient will notice the release of a yellowish secret with an unpleasant odor.

At first glance, the fact that a benign tumor burst is good. But after this, a serious exacerbation of chronic diseases can follow, since the pouring pus contains a lot of bacteria. In addition, they can penetrate the ear and cause otitis media.

Even if education remains intact, it can cause a significant decrease in the quality of life. It can grow to an impressive size and occupy the entire maxillary sinus. What can such a thing lead to?

Firstly, difficulty in nasal breathing will constantly be observed, which provokes:

• severe headaches;
• spasm of blood vessels, including the brain;
• oxygen starvation, which is especially unsafe for pregnant women, or rather a developing fetus, etc.

Secondly, the growth of the neoplasm can cause:

• development of diseases of the cardiovascular system;
• the occurrence of episodes of apnea, that is, stopping breathing during sleep;
• the development of dilopia, that is, a pathology of vision, manifested by a split image;
• general deterioration.

Methods and methods of diagnosis

It is impossible to find out for yourself about the presence of pathology. After all, it does not have specific signs, so it is easy to confuse it with other diseases.

An accurate diagnosis can be made on the basis of x-rays taken in the direction of an ENT or dentist, for example, if a sinus lift is required. Also used in diagnostics:

• rhinoscopy;
• CT (the most informative method that provides information about the size, structure and thickness of the walls of the formation).

It is worth noting that cysts of the maxillary sinuses are found in about one in ten, but treatment is not always required. When do you need to take action?

How to treat a cyst in the maxillary sinus?

Quite often, the presence of neoplasms in the sinuses does not require emergency treatment. What to do in each case should be decided by the doctor, based on the patient's complaints, the degree of neglect of the pathology and the existing concomitant diseases.

In the presence of cystic cavities of insignificant size, most otolaryngologists advise to observe the rate of their growth and the nature of the changes, as well as to make attempts to eliminate the causes of their occurrence.

So, if there is a tooth cyst in the maxillary sinus, there is a chance that it will resolve after a full dental treatment.

But most modern experts are confident in its inefficiency and even harmful effects, since some drugs can cause new sources of cyst formation or create fertile ground for the reproduction of pathogenic microflora.

You should not try to cope with the pathology on your own, guided by the advice of friends, relatives, etc. Especially those that recommend warming up the nose.

Such procedures will provoke a rapid increase in the neoplasm and the spread of the inflammatory process to healthy areas.

Thus, whether a cyst needs to be removed should be decided on an individual basis with the ENT. But even if it is of sufficient size for surgery, with an exacerbation of the inflammatory process, surgical intervention cannot be performed. Therefore, the patient should undergo a course of conservative therapy to suppress inflammation, including:

• saline solution (Aquamaris, Physiomer, Humer, saline solution, Marimer, etc.);
• medicines that normalize the outflow of contents from the sinuses (Sinuforte);
• topical corticosteroids (Nasonex, Baconase);
• local antibiotics (Isofra, Polydex, Bioparox);
• systemic antibiotics (azithromycin, amoxicillin, lincomycin, etc.)
• vasoconstrictor sprays (Sanorin, Tizin, Nazol, Xilen, Nazivin, Rinazolin, Otrivin), etc.

If the patient is not ready to radically resolve the issue, a puncture is performed. That is, the doctor, using a special device similar to a syringe, pumps out the contents of the neoplasm, after piercing the shell with a needle, and installs drainage. But a cyst puncture gives only a short-term improvement and does not help in how to cure the pathology completely.

If, nevertheless, a decision is made to perform a surgical intervention and there are no contraindications to the operation, the patient has the right to decide independently where to remove the neoplasm (in which medical institution in your city) and which otorhinolaryngologist to contact.

Feedback from real people who have already gone through this procedure will help you make the right choice.

However, removal of the neoplasm is not a 100% guarantee of recovery. If a full-fledged treatment of the disease that provoked the formation of a cystic cavity is not carried out, with a high degree of probability it will form again.

Endoscopic maxillary sinusectomy: operation

The operation to remove the formation can be performed in the traditional way, that is, through an incision in the tissues of the face, or using endoscopic equipment. In recent years, the second method is usually preferred, since it does not involve soft tissue incisions.

Removal of a cyst from the sinus with an endoscope is performed under local anesthesia. The surgeon inserts the device into the affected sinus through the nasal passage and, skillfully manipulating the microinstruments on its head, removes all existing neoplasms, and, if necessary, the affected areas of the mucous membranes, that is, performs a maxillary sinusectomy.

Control over the course of manipulation is carried out through a miniature video camera on the endoscope, which transmits the image to the monitor.

Endoscopic removal of the cyst of the maxillary sinus, the price of which is approximately 15-25 thousand rubles in Moscow, is a low-traumatic procedure with minimal health risks. Therefore, after its implementation, a long rehabilitation is not required, which justifies the higher cost compared to classical maxillary sinusotomy.

laser

You can also radically solve the problem with a laser. The essence of the procedure is the evaporation of the cyst due to the thermal effects of the laser beam. To gain access to the maxillary sinus, a small hole is made in its wall, but there are no scars or other visible cosmetic defects.

The process of how neoplasms are removed by this method takes no more than 15 minutes. By the way, for the removal of a cyst from the maxillary sinus with a laser, the price is somewhat lower than for endoscopic surgery and averages 10-18 thousand rubles.

Possible complications after surgery

After removal of the cystic cavity by one method or another, complications may arise. The risk of their development is much less when choosing an endoscopic technique, but this is not a guarantee of the absence of adverse events.

Patients may experience:

• bleeding;
• dizziness;
• nausea;
• inflammation;
• change in voice timbre;
• outflow of cerebral liquor.

Nevertheless, proper rehabilitation and contacting a doctor at the slightest deterioration in the condition makes it possible to establish in a timely manner what the threat to the patient's health is and eliminate it.

Sometimes there may be a seal after removal. If it does not disappear on its own within two weeks, an otolaryngologist consultation is required.

Treatment without surgery by folk methods

Traditional medicine also offers a lot of ways to eliminate neoplasms in the nose. But before deciding how to remove cysts and whether it is worth using folk remedies at all, you need to talk with an otolaryngologist.

We draw your attention to the fact that none of them can lead to resorption of the pathological cavity.

The maximum effect that you should count on when using folk remedies is to eliminate discomfort and slow down the growth of the neoplasm.

1. Daily instill 3 drops of diluted aloe juice into the nostril from the side of the lesion.
2. Rub the cyclamen tubers on a fine grater and squeeze the juice with gauze, which is diluted with the same amount of water. The resulting product is instilled 3 drops into the nasal passage.
3. Inhalations with essential oils.

Questions to the doctor

How dangerous are sinus cysts?

In general, such neoplasms are harmless, but only until an infection penetrates into them. It is the consequences of this that are dangerous, since a chronic focus of inflammation is formed in the body, which can spread to nearby organs, including the brain.

Is it possible to get pregnant with a cyst (maxillary sinus)?

The presence of a cyst is not a contraindication for pregnancy. But it is better to remove it in advance to reduce the risk of exacerbation of sinusitis during gestation and the development of hypoxia, that is, what is dangerous for its growth.

Can a cyst give an allergy?

No, more often it is the result of an allergy.

Can it dissolve on its own?

In rare cases, cysts can resolve on their own, but you should not especially hope for this. If it is small, it is better to try to slow down its growth by taking the drugs prescribed by the doctor. For large sizes, surgical intervention is indicated.

Can it be heated?

No. Any thermal procedures contribute to the growth of the neoplasm and the spread of inflammation to healthy tissues.

Can it burst?

Undoubtedly. This most often occurs with suppuration of education. And it is not necessary to say how dangerous such a situation is. After all, pus contains not only dead, but also living bacteria, which quickly affect the healthy mucous membranes of the maxillary sinus, which results in severe widespread sinusitis.

The abstract was completed by an intern of the Department of Dentistry of General Practice and Training of Dental Technicians Kerimova Elnara Rasulovna.

Moscow State Medical and Dental Institute

Introduction.

Odontogenic cysts of the jaws are a very common pathology. Currently, surgical treatment of this pathology is the most effective, which is not unimportant, because. all periradicular odontogenic cysts are foci of chronic infection that has an adverse effect on the body.

This essay will discuss the etiology, pathogenesis, diagnostic methods, indications and methods of surgical treatment.

Etiology and pathogenesis.

Odontogenic cysts are intraosseous cavity retention formations, the appearance of which is caused either by a violation of the development of the dental follicle, or by a chronic inflammatory process in the periodontium.

The epithelium lining the cavity of the cyst originates from the remnants of the tooth-forming epithelial plate (Malyasse Islands) under the influence of chronic inflammation or from the epithelium of the dental follicle. Between the epithelial lining and the bone tissue there is a connective tissue layer.

The components of the cyst are: a shell, consisting of a connective tissue part and an epithelial lining, and a cavity.

The cavity of the odontogenic cyst is filled with liquid or semi-liquid contents - accumulating waste products of the epithelial lining in the form of colloids and crystalloids (in particular, cholesterol crystals)

The accumulation of waste products of the epithelial lining leads to an increase in oncotic pressure, which is accompanied by an increase in hydrostatic pressure in the cyst cavity. As a result, pressure on the surrounding bone increases, osteolysis occurs, which leads to an increase in the volume of the bone cavity (cyst growth) and jaw deformity.

In this schematic drawing, arrow A indicates the connective tissue wall that encloses the cyst. Arrows B indicate different types of epithelium that may line a cyst that develops within the oral cavity.

Classification.

According to morpho- and pathogenesis, as well as localization, the following types of odontogenic cysts are distinguished:

1) Cysts formed from the epithelium of the tooth-forming plate (radicular)

A) apical cyst - periodontal cyst covering the apex of the tooth root

B) lateral periodontal cyst, adjacent or covering the lateral surface of the root of an erupted tooth

C) residual cyst left after tooth extraction

2) Cysts developing from an enamel organ or follicle

A) follicular cyst

B) Primordial cyst,

B) Gingival cyst.

3) Cysts developing from the enamel organ or the islands of Malasse

A) keratocyst.

clinical picture.

It is determined by the type, size of the cyst, the presence or absence of complications in the form of suppuration, the occurrence of a pathological fracture of the jaw.

Complaints with small cysts, as a rule, are absent, and the detection of a cyst is an incidental finding during an X-ray examination for diseases of adjacent teeth.

With an increase in the size of the cyst, deformation of the jaw may occur and patients complain of swelling of the mucous membrane. In the case when the cyst comes from the teeth of the upper jaw, increasing in size, it pushes the maxillary sinus, causing chronic inflammation of the mucous membrane lining it and, as a result, complaints of headache, a feeling of heaviness in the middle zone of the face. The germination of the cyst in the lower nasal passage is accompanied by difficulty in nasal breathing.

With the localization of the cyst in the lower jaw, compression of the lower alveolar nerve is possible. As a consequence, there may be complaints of numbness of the skin and mucous membranes in the corner of the mouth, the mucous membrane of the alveolar process. With a significant increase in the size of the cyst, a pathological fracture may occur.

During the examination, it is possible to detect deformation of the jaw, on palpation, the presence of a symptom of "parchment crunch" (Dupuytren's symptom).

More often the reason for going to the doctor is an exacerbation of the disease - suppuration of the cyst, accompanied by pain - the best motivator for the need for treatment.

Clinical symptoms during exacerbation.

When examining patients with a festering cyst, asymmetry of the face is revealed due to swelling of the perimaxillary soft tissues, hyperemia of the skin. The opening of the mouth can be both in full and limited in cases of suppuration of cysts, the starting point of which was the third molars. During intraoral examination, there is hyperemia of the mucous membrane over the site of localization of the cyst, detachment of the periosteum with pus is possible, which will be accompanied by a symptom of fluctuation. Percussion of the causative tooth is usually painful. Mobility of the causative tooth may also be observed.

Diagnostics.

When collecting an anamnesis, patients with odontogenic periradicular cysts usually point to previous endodontic treatment of the “causal” tooth, after which the pain subsided. Part notes the periodic exacerbation of the disease, which took place after the intraoral incision.

The main place in the diagnosis belongs to the X-ray examination.

With cysts of the upper jaw, the elements of an x-ray examination are:

Allows you to assess the degree of resorption of the bone tissue of the alveolar process (if the height is reduced by 1/3 or less, it is not advisable to perform a tooth-preserving operation). The condition of the root canal of the tooth, the degree and quality of its filling. The presence of fragments of instruments in the canal, the presence of perforations. The relationship of the cyst with the roots of neighboring teeth. The relationship of the roots of adjacent teeth with the cystic cavity may vary. If the roots protrude into the cavity of the cyst, there is no periodontal gap on the radiograph due to resorption of the endplate of the holes of these teeth. If the periodontal gap is determined, then such teeth are only projected onto the area of ​​the cyst, but in fact their roots are located in one of the walls of the jaw.

2) Orthopantomogram.

Allows you to evaluate both jaws at once, it is possible to assess the condition of the maxillary sinuses.

3) Plain radiograph of the skull in the naso-chin projection.

To assess the condition of the maxillary sinuses. Thinning of the bony septum and its dome-shaped displacement are characteristic of a cyst pushing the sinus back. A cyst penetrating into the sinus is characterized by the absence of a bone wall, while a domed soft tissue shadow is determined against the background of the maxillary sinus

However, in the case of large cysts penetrating or pushing back the maxillary sinus, the best of the methods of radiation diagnostics should be recognized as a computed tomogram, which allows the most accurate assessment of the condition of the maxillary sinus, its relationship with the cyst, localization of the cyst (buccal, palatine)

X-ray examination of the lower jaw are used:

1) Intraoral contact radiograph.

2) Orthopantomogram.

3) X-ray of the lower jaw in lateral projection.

4) Computed tomogram.

Of the other diagnostic methods, electroodontodiagnostics should be noted, which is used to establish the vitality of the teeth adjacent to the cyst. With an increase in the threshold of electrical excitability of the teeth adjacent to the cyst, more than 60 mA, their endodontic treatment is recommended.

Cytological and histological examination.

If malignancy is suspected, it is necessary to conduct a cytological examination of the punctate of the cyst and a histological examination of the remote formation.

The most common types of jaw cysts.

radicular cyst.

It is most often localized in the region of the lateral incisors, somewhat less often in the zone of the central incisors, premolars, and first molars.

Before the onset of jaw deformity, the clinical picture of the periradicular cyst is similar to the clinical picture observed in chronic periodontitis - periodically appearing pain in the area of ​​the causative tooth, aggravated by biting.

The tooth has a deep carious cavity, filling or is covered with a crown, its percussion can cause pain. In a number of deer in the region of the alveolar process at the level of the projection of the root of the causative tooth, a fistulous tract or scar is detected. The data of electrodontometry indicate necrosis of the tooth pulp: the threshold of pain sensitivity exceeds 100 mA.

X-ray picture.

In an x-ray examination, in addition to detecting a periradicular cyst in the form of a round or oval enlightenment surrounding the tooth root, it is important to assess the condition of the causative tooth itself, in particular the degree of destruction of the ligamentous apparatus (periodontal), the condition of the root canal, which can be characterized by the following signs:

The root canal is not sealed;

The root canal is not sealed up to the apex;

The root canal is sealed to the top with the removal of the filling material;

There is a fragment of the instrument in the root canal;

Perforation of the wall of the tooth root;

Additional branch from the main channel;

Fracture of the root of the tooth.

residual cysts.

In the case of removal of the causative tooth without removal of the cyst shell, a residual cyst is formed.

X-ray, this cyst looks like a clearly delimited rounded enlightenment of the bone tissue, localized in close proximity to

socket of the extracted tooth.