22. TREATMENT OF CYSTS

what does the treatment of cysts depend on?

etiology

localisation

when is the Partsch 1 method indicated?

for large mandibular cysts

what is the Partsch 1 method?

1. make opening on the outer wall of the cyst

- cyst drains in mouth

2. the cyst will shrink in size because pressure has been released

3. insert iodoform gauze into the cavity to prevent infection- leave this for 1-2 days

4. after 1-2 days, take an impression and create an obturator

5. fill the obturator every 8 days until it gets smaller and smaller

6. eventually it falls out

what are the advantages of Partsch 1 method?

• Good for very large cysts

• Avoids creating a massive bone defect

• Less risk of jaw fracture

what are the disadvantages of the Partsch 1 method?

slow healing

cyst lining remains inside - potential recurrence

lots of aftercare required

when is the Partsch 2 method indicated?

for small (under 2.5cm) jaw cysts

what is the Partsch 2 method?

this is called 'enucleation'

1. complete removal of the cyst cavity including lining

2. blood clot in the cavity will stimulate new bone formation

if the cavity left is larger, how can we stimulate new bone formation after enucleation?

we use a graft

- autogenous (from patient)

- allogenous (from another human)

- xenogenous graft (from another species)

what is the disadvantage for enucleation?

bone regeneration needs several months

what is the dual method by Hermann?

this is a modified approach to Partsch 1

what happens in phase 1 of Hermann?

this is the standard Partsch 1 method (marsupialisation)

what happens in phase 2 of Hermann?

this happens 12-16 months after the first surgery

we left the cyst capsule in the cavity, so this is removed

the wound is closed by primary healing

what are the disadvantages of Hermann's technique?

it requires 2 surgeries

the treatment time is very long

what additional tx can be done for OKC?

• cryotherapy

• carnoy's solution

• decompression + cystectomy

what is carnoys solution?

a chemical applied to destroy residual epithelial remnants

What is cryotherapy?

liquid nitrogen/ nitric oxide applied into cavity after enucleation (freezes cells at -70dg)

what is decompression + cystectomy?

- basically enucleation via small drainage tube being inserted

- cystectomy after 9-12months of healing