Biphase Treatment of Large Mandibular Cysts - Case presentationReportar como inadecuado

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Acta stomatologica Croatica, Vol.38 No.4 December 2004. -

A young female patient, aged 28 years, was admitted to the Out patient Department of the Clinical Department of Oral Surgery in May of this year. She was referred to us by an oral surgeon because of a large cyst in the mandible. The patient brought with her an orthopantograph which showed a large multilocular translucency in the mandible on the right side, which extended from the area of the second premolar up to the incisura semilunaris on the ramus of mandible. We performed another orthopantograph on which the translucency did not differ essentially from that on the orthopantograph which the patient had brought. Because of the swelling of the lower edge of the jaw and multilocular translucency we were unsure as to the nature of the pathological lesion. To help us decide on which operative procedure to use we sent the patient for a CT of the mandible. However the finding failed to dispel our uncertainty, in spite of the fact that we felt almost convinced that it was a cyst and not a cystic tumour. However, before finally deciding on which operation to perform we took a piece of tissue, under local anaesthesia, from the osseous cavity for biopsy which confirmed our suspicion that it was a keratocyst. As it was an exceptionally large cyst and because of the danger of mandibular fracture in the case of complete removal of the buccal corticalis, we decided to use the biphase technique. The plan was to carry out decompression of the cyst in the first phase by opening the calotte on the most prominent part of the cyst from the buccal side and construct an obturator. This method enables regeneration of the thinned bone. The obturator is worn continuously and is not reduced. The patient has a check-up by the dentist at least twice a week, who rinses the cavity in the bone with 3% hydrogen peroxide and physiological solution. As soon as the clinical and radiographic findings show that the cyst has decreased and that the bony defect has healed we plan to carry out the second phase of treatment, in which the cyst will be completely removed and the remaining bone defect primarily closed. The X-rays performed 6 weeks and 3 months after the operation show good recovery of the bone and significantly decreased cystic cavity. Continuation of treatment is planned in approximately one month. The results obtained show the justification of such an approach in the treatment of large cysts.

Autor: Jakša Grgurević -



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