This document discusses the surgical management of odontogenic cysts. It describes different flap techniques used such as trapezoidal, triangular, envelope, and semilunar flaps. It also discusses the surgical procedures for enucleation and marsupialization of cysts. Enucleation involves complete removal of the cyst sac while marsupialization creates a window to drain the cyst contents and suture the cyst wall to heal. The steps for each procedure are outlined including reflection of flaps, removal of bone, draining of cyst, and suturing.

1. SURGICAL MANAGEMENT OF
ODONTOGENIC CYSTS
SUBMITTED BY
YASMIN MOIDIN
2008 Batch
Al Azhar Dental College

2. 1. local anesthesia.
2. Types of Flaps.
3. Surgical removal the of the cyst .

4. 1. Trapezoidal flap.
 Advantage : Provides excellent
access, allows surgery to be
performed on more than two teeth,
produces no tension in the tissues
allows easy reapproximation of the
flap to its original position.
 Disadvantages: Produces a defect
in the attachedgingiva

5. 2. Triangular Flap.
 Advantage : Ensures an adequate
blood supply, satisfactory visualization,
very good stability .
 Disadvantages: Limited access to
long roots, tension is created when the
flap is held with a retractor, and it
causes a defect in the attached gingiva.

6. 3. Envelope Flap.
 Advantage : Avoidance of vertical
incision and easy reapproximation to
original position
 Disadvantages: Difficult reflection
(mainly palatally), great tension with
a risk of the ends tearing, limited
visualization in apicoectomies,
limited access, possibility of injury of
palatal vessels and nerves, defect of
attached gingiva

7. 4. Semilunar Flap.
 Advantage : Small incision and easy
reflection, no recession of gingivae
around the prosthetic restoration.
 Disadvantages: The incision being
performed right over the bone lesion
due to miscalculation, scarring in the
anterior area, difficulty of
reapproximation , limited access and
visualization, tendency to tear.

8.  Enucleation: This technique involves complete
removal of the cystic sac and healing of the wound by
primary intention. This is the most satisfactory method
of treatment of a cyst and is indicated in all cases
where cysts are involved, whose wall may be removed
without damaging adjacent teeth and other anatomic
structures.

9.  The surgical procedure for treatment of a cyst
with enucleation includes the following steps:
1. Reflection of a mucoperiosteal flap.
2. Removal of bone and exposure of part of the cyst.
3. Enucleation of the cystic sac.
4. Care of the wound and suturing.

10. Panoramic radiograph showing an
extensive radicularlesion at the
region of teeth 22, 23, 24
Clinical photograph of case

11. Removal of maxillary cyst, with labial access. Incision for creating a
trapezoidal flap.
Reflection of flap and exposure of surgical
field.

12. Removal of bone at the labial aspect respective to the
lesion.
Osseous window created to expose part of the
lesion.

13. Removal of cyst from bony cavity, using hemostat and
curette.
Surgical field after removal of lesion.

14. Operation site after placement of sutures.
Panoramic radiograph and clinical photograph taken 2 months after the surgical
procedure.

15.  Marsupialization This method is usually employed
for the removal of large cysts and entails opening a
surgical window at an appropriate site above the
lesion. In order to create the surgical window, initially
a circular incision is made, which includes the
mucoperiosteum, the underlying perforated (usually)
bone, and the respective wall of the cystic sac

16.  Marsupialization: After this procedure, the contents of the
cyst are evacuated, and interrupted sutures are placed around the
periphery of the cyst, suturing the mucoperiosteum and the cystic
wall together . Afterwards, the cystic cavity is irrigated with saline
solution and packed with iodoform gauze ,which is removed a
week later together with the sutures. During that period, the
wound margins will have healed, establishing permanent
communication. Irrigation of the cystic cavity is performed several
times daily, keeping it clean of food debris and avertinga potential
infection.

17. Marsupialization method. Circular incision includes mucosa and
periosteum.
Enlargement
of osseous
window with
rongeur
Exposure of buccal cortical plate and removal of portion of bone with
round bur

18. Exposure of cyst
after removal of
bone
Suturing of
wound margins
with cystic wall

19. Packing of
cystic cavity
with iodoform
gauz
Cystic cavity
after insertion
of gauze