Jaw cysts. Follicular cyst of the jaw

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Perihilar (radicular) cystsare the last stage of development chronic periodontitis. Usually patients do not complain of pain. Only with the development of perihilar cysts is relatively large sizes patients may complain of deformation of the alveolar process of the jaw, displacement of teeth.

Note that among patients admitted to dental hospitals, patients with perihilar cysts account for about 8%. About half of them (46%) are patients with suppurating jaw cysts. Moreover, radicular cysts are found more often in the upper (63%) and much less frequently in the lower (34%) jaw; they are equally often localized on the right and left sides of the jaw (K.I. Tatarintsev, 1972).

An objective examination reveals a change in the color of the tooth crown and its destruction by the carious process, painless probing of the root canals, during which a yellowish liquid may be released. Percussion of the “causal” tooth can cause discomfort, but usually painless. In this case, deformation of the alveolar process and displacement of the teeth adjacent to the “causal” one are possible. When palpating the area of ​​deformation of the alveolar process, the symptom of “parchment crunch” (Runge-Dupuytren’s symptom), or the symptom of a rubber or plastic toy (Vernadsky Yu. I., 1966), i.e. springiness of the wall, is revealed. Electroodontometry of the “causal” tooth is at least 100 μA. If the pulp of neighboring teeth has undergone necrosis, then their electromyography (EOM) is also within 100 μA. In the absence of pulp necrosis, their electrical excitability decreases due to compression of the vascular nerve bundle(Tatarintsev K.I., 1972).

Speaking about the frequency of symptoms, we note that, according to the same author, the most common (21.8%) symptom clinical manifestation perihilar cysts are considered a symptom of elastic tension, i.e. sagging of the thinned bone wall at the site of protrusion of the cyst without signs of fluctuation and parchment crunch. The “parchment crunch” symptom is observed in 5.8% of patients, i.e., much less frequently than the fluctuation symptom (18.3%). The symptom of facial deformation with perihilar cysts is observed in 36.4% of patients.

Reaction of regional lymph nodes more often clinically manifested when localized in the lower jaw and then mainly when they suppurate. It is with festering cysts that fistulas are usually observed, connecting the cyst cavity with the oral cavity - in 29.2% of cases.

It is noted that the intensity of constant intoxication of the body with non-festering and suppurating perihilar cysts is almost the same, despite the significant clinically identified differences in the intoxication syndrome in such patients and their different well-being according to subjective sensations.

On an x-ray, a perihilar cyst is projected as a rounded or oval-shaped area of ​​clearing with clear contours, with a diameter exceeding 5-10 mm. The focus of clearing always has a rim in the form of a thin strip of darkening, bordering the contours of the cyst, the anatomical basis of which is compacted bone tissue. When a cyst suppurates, the clarity of its contours is disrupted and they become “blurred.”

Perioral cyst upper jaw . Computer tomogram:
1 - cyst cavity; 2 - maxillary sinus; 3 - external nose; 4 - oral cavity

Morphologically, the cyst is an encysted cavity, the inner surface of which is lined with multilayered squamous epithelium of the epidermal type, located in 4-12 rows. The epithelium often forms vegetations with the formation of a wide looped network. The underlying tissue consists of fibrous connective tissue with a concentric arrangement of fibers. The cyst cavity contains a clear yellowish liquid with cholesterol crystals. When suppuration occurs, this fluid becomes cloudy and appears as pus. The cyst capsule contains a significant amount of nerve fibers.

As cysts grow, they can push upward the lower wall of the pyriform opening, causing the formation of a characteristic ridge at the bottom of the nasal cavity, the “Gerber ridge.” When the cyst grows towards the maxillary sinus, the bone wall of the sinus is usually resorbed and the cyst grows into the maxillary sinus (MS). Sometimes, when the phenomena of bone opposition prevail over resorption, it is possible for the wall of the maxillary sinus to move away from the pressure of the shell of the cyst increasing in size. In this case, the sinus can decrease to the size of the gap (Verlotsky A. E., 1960). Therefore, depending on the relationship between the cyst and the maxillary sinus, the following types of cysts are distinguished: adjacent, pushing away and penetrating cysts.

Perihilar cyst of the upper jaw to the right of the 15th tooth, deforming the wall of the maxillary sinus. Chronic right-sided sinusitis:
1 - upper jaw; 2 - left upper quadrant (normal); 3 - right upper jaw; 4 - cavity of the perihilar cyst; 5 - external nose

In the presence of adjacent cysts between the unchanged cortical plate of the sinus and the cyst, the bone structure of the alveolar process is determined.

With pushing cysts, there is an upward displacement of the cortical plate from the alveolar bay of the sinus, but its integrity is not compromised.

Penetrating cysts are revealed on an x-ray in the form of a hemispherical shadow with a clear upper contour against the background of the air of the maxillary sinus; the cortical plate is interrupted in places or completely absent. In the case of penetrating cysts of the jaws, sometimes difficulties arise in their differential diagnosis with retention cysts of the mucous membrane of the maxillary sinus (Vorobiev D.I., 1989).

With the growth of cysts of the lower jaw, the latter changes the configuration of the alveolar process or body only in advanced cases, when the cysts exist for many years. In the first stages of its development, the cyst grows polarly in the thickness of the bone along the cortical plates, capturing only areas of the spongy substance. In this case, the walls of the mandibular canal are usually resorbed, and the cyst shell fuses with the neurovascular bundle. However, in such cases, changes in sensitivity in the zone of innervation of the mandibular nerve have never been observed. During surgery, as a rule, it is possible to separate the cyst membrane from the neurovascular bundle without damaging it. Note that even with atraumatic removal of such cysts in the postoperative period for 2-4 weeks. patients may notice impaired sensitivity of the lower lip on the corresponding side.

As the cyst grows along the alveolar arch, the cyst shell compresses the neurovascular bundles of adjacent teeth, which causes atrophic changes pulp and is diagnosed during electroodontodiagnostics by increasing its values ​​to 20 μA or more. Sometimes there are aseptic necrosis pulps, which must be identified at the stage of preparing the patient for surgical treatment and endodontic treatment of such teeth.

About 30% of radicular cysts are residual and remain after tooth extraction or loss. The origin of the cyst in these cases is evidenced by its localization in close proximity to the socket of the missing tooth (Ryabukhina N. A., 1991).

Residual cyst of the mandible(photoprint from a fragment of an orthopantomogram of the lower jaw of patient M., 60 years old)

Peri-coronal (follicular) cystsare the result of a malformation of the dental epithelium, i.e., racemose degeneration of follicle tissue. Therefore, as a rule, in close relationship with the follicular cyst there is always either an intact, rudimentary or supernumerary tooth that has completed or has not yet completed its formation. Typically, such a tooth is located deep in the bone and is unerupted.

Some authors (Albanskaya T.I., 1936; Agapov N.I., 1953; Vernadsky Yu.I., 1983) also believe that follicular cysts can arise due to inflammatory processes at the apexes of the roots of baby teeth, when the source of inflammation reaches the follicle permanent tooth, causing its irritation with the subsequent development of a cyst.

E. Yu. Simanovskaya (1964) believes that follicular cysts develop over a fairly long period of time, and some phasing can be observed in the clinical course of this pathology.

Stage I - latent development of a follicular cyst with the absence of clinical symptoms. Upon examination, a missing permanent tooth or a retained milk tooth is discovered (radiography helps).

Stage II - the appearance of deformation of the alveolar process or the body of the jaw due to dense painless or slightly painful swelling. When the wall becomes thinner (large-sized cyst), a parchment crunch and fluctuation appear. The duration of this stage ranges from several months to several years. It is at this stage that infection of the cysts can occur.

Follicular cysts are diagnosed more often in adolescence (12-15 years) and mature age, especially in the third decade of life.

A follicular cyst is a single-chamber cavity located in the jaw and delimited from bone tissue membrane (a connective tissue capsule with stratified squamous epithelium lining the inner surface of the cyst), which is easily separated from the bone tissue of the jaw when the cyst is removed).

Follicular cysts are most often localized in the upper jaw, molars and canines, respectively. Sometimes follicular cysts can be located in the lower edge of the eye socket, in the nose or in maxillary sinus, completely filling it (Migunov B.I., 1963).

According to the localization of the cyst, thickening of the jaw occurs, often with facial deformation.

Follicular cysts are characterized by an x-ray picture: a sharply defined oval or round bone defect, immersion of the coronal part of an unerupted tooth into this defect, or even the complete location of the tooth in the area of ​​the identified defect. The largest observed size of such a cyst is the size of a chicken egg.

Follicular cyst of the mandible

Upon puncture, a clear yellow liquid is detected, opalescent in the light, with an admixture of cholesterol crystals.

In infected cysts, their lumen contains a turbid fluid with a large number of leukocytes.

Due to the period in which the violation occurs normal development dental follicle, can be diagnosed: 1) follicular cyst without teeth; 2) follicular cyst containing a formed tooth or teeth (Braytsev V.R., 1928).

Treatment of follicular cysts is surgical. The extent of surgical intervention should be planned individually and depends on the nature of the cyst, its location, the presence of suppuration, the prospects for the eruption of an impacted tooth, as well as the size of the cyst, the degree of damage to the jaw bone and the possibility of reparative osteogenesis.

For tooth-containing cysts, it is advisable to perform cystectomy as a method that involves complete removal of the cyst shell (Dmitrieva V.S., Pogosov V.S., Savitsky V.A., 1968). Included teeth are removed.

Note that when performing a cystectomy, complete removal of the membrane with its epithelial lining is necessary to prevent relapses. In some cases, especially with festering cysts, it is possible to use the cystotomy method.

In children, plastic cystotomy is often indicated (Vernadsky Yu. I., 1983), as it allows for the final development, movement and correct eruption of the impacted tooth around which the cyst has arisen.

For follicular cysts of inflammatory origin, both cystectomy and cystotomy can be used with equal success.

The technique of two-stage cystectomy may be the method of choice in the treatment of patients with large follicular cysts on the lower jaw. In this case, it is sometimes advisable to preventively (in order to avoid a pathological fracture of the lower jaw) apply V. S. Vasilyev’s splints to the dentition in the preoperative period or make and fit dentogingival splints (mouth guards) from plastic such as Weber or Frihof.

Retromolar cystscan be classified as a type of eruption cyst. They arise in connection with a chronic inflammatory process in periodontal tissues, caused by difficult teething, often wisdom teeth. Sometimes due to cystic transformation cover epithelium under the “hood” above the retromolar cyst, it can be fused to the crown of the erupting tooth and is localized in the area of ​​the angle of the lower jaw, immediately behind the coronal part of the lower third molar.

Retromolar fossa cyst

The diagnosis of a retromolar cyst is confirmed by X-ray examination. However, such a diagnosis is rarely made by dentists. For example, during a clinical and x-ray examination of a large number of people with difficult eruption of wisdom teeth, A. V. Kanopkiene (1966) never noted the presence of retromolar cysts in them. Treatment is surgical (cystectomy, cystotomy).

Primary cyst (keratocyst).Keratocysts arise from odontogenic epithelium, usually in those places where there are teeth, but have no connection with the latter.

Philipsen first described the clinical and histological picture of keratocyst in 1956. He also coined the term “odontogenic keratocyst” and noted the possibility of this neoplasm for frequent recurrence and malignant degeneration. In our country, E. Ya. Gubaidulina, L. N. Tsegelnik, R. A. Bashinova, Z. D. Komkova (1986), D. Yu. Toplyaninova and Yu. V. Davydova (1994) and etc. According to W. Lund (1985), keratocysts make up 11% of odontogenic cysts. Keratocysts are found mainly in the lower jaw at the level of the molars and, like follicular cysts, they may not appear clinically for a long time and increase in size unnoticed by the patient. Clinical symptoms Keratocysts are similar to the main symptoms of other jaw cysts. They are diagnosed accidentally during an X-ray examination for other dental diseases or in case of infection and suppuration. If a keratocyst is detected, it is necessary to exclude the presence of a basal cell nevus (Gorlin-Goltz syndrome), for which all family members should be examined.

Keratocysts, like radicular cysts, increase in size along the body of the jaw and lead to its deformation years after their appearance.

An X-ray examination, puncture or biopsy usually helps to direct the doctor to the idea that a patient has a keratocyst.

On a radiograph, a keratocyst looks like a focus of rarefied bone tissue or a polycystic lesion with clear polycyclic contours. Due to uneven bone resorption, a multi-chamber appearance is created, which requires differential diagnosis with adamantinoma. The contours of the periodontal fissure in teeth located in the cyst cavity are initially preserved and then cannot be traced. Resorption of the apices of their roots is possible (Vorobiev Yu. I., 1989). Sometimes keratocysts are located next to impacted teeth or tooth buds. During puncture, it is sometimes possible to obtain a thick mass of dirty gray color with an unpleasant odor.

With a biopsy, which can simultaneously be the first stage of surgical treatment, it is possible to macroscopically identify a cavity covered with a membrane, which protrudes into the bone tissue in bay-shaped protrusions and contains keratin masses. Histological examination of the surgical material reveals a thin connective tissue capsule lined with stratified squamous epithelium with pronounced keratinization phenomena. In the epithelial lining of keratocysts, higher mitotic rates are noted than in epithelial layer radicular cysts (Main M. Q., 1970; Toller R. A., 1971).

E. Ya. Gubaidulina, L. N. Tsegelnik, R. A. Bashilova and Z. D. Komkova (1986) identified some features of the clinical and radiological picture, collectively most characteristic of an odontogenic primary cyst:

1. anamnestic and clinical data do not reveal a connection between the occurrence of a cyst and dental pathology;
2. the cyst is localized mainly on the lower jaw in the area of ​​the body, respectively, the molars, angle and branch of the jaw;
3. despite extensive intraosseous damage, no pronounced deformation of the jaw is noted, which is apparently explained by the spread of the process along the length of the bone in the form of a single cavity;
4. Radiologically, as a rule, a loss of bone tissue is determined with clear boundaries, often with a polycyclic contour. A sharp swelling of the cortical plate is not detected, although the lesion covers a large area of ​​the jaw. The periodontal gap of the tooth roots in the projection of the cyst is most often preserved.

For surgical treatment, the method of choice is cystectomy. However, taking into account that keratocysts are capable of recurrence and malignancy, some authors recommend, if cystectomy is impossible, to use a two-stage operation technique (Gubaidulina E. Ya., Tsegelnik L. N., 1990). This method of treating keratocysts gives good results when used in outpatient setting(Toplyaninova D. Yu., Davydova Yu. V., 1994). At the same time, N.A. Ryabukhina (1991) notes that the frequency of relapses when removing a keratocyst varies from 13 to 45%.

Cyst of the nasopalatine canal (incisive foramen)is epithelial non-odontogenic, arises from the remnants of the epithelium of the nasopalatine duct, split off in the embryonic period in the nasopalatine canal and is the most common among “slit” cysts. According to W. Petrietall (1985), it occurs in 1% of people. It is usually located in the area of ​​formation of the alveolar arch above the incisors of the upper jaw, which is why it can be mistaken for a perihilar cyst. Increasing in size, it leads to resorption of the palatine process of the upper jaw.

When examining the oral cavity in the anterior part of the palate, a painless round-shaped formation with clear boundaries is determined in its middle. On palpation, a “ripple” is noted. The central incisors of the jaw are, as a rule, intact, the electrical excitability of the pulp is within normal limits. In the diagnosis of nasopalatine canal cysts, an X-ray examination is of decisive importance, which reveals a rounded loss of bone tissue in the area of ​​the incisive foramen. The contours of the periodontal gap of the central incisors are preserved.

When diagnosing cysts of the nasopalatine canal, a cystectomy operation is performed using access from the palatal surface of the alveolar arch of the upper jaw. If a cyst is significantly detected in the vestibule of the oral cavity, it is removed from the vestibular side of the alveolar arch of the upper jaw.

Cholesteatoma of the jaw- a tumor-like cyst-like formation, the shell of which is lined with epidermis, and the contents have the appearance of a pasty mass, including horny masses and cholesterol crystals. In punctate, up to 160-180 mg% of cholesterol can be determined (Vernadsky Yu. I., 1983). It is due to the presence of cholesterol that this tumor-like neoplasm often has a greasy or stearic tint, which was the reason for its name (Muller, 1938).

Cholesteatomas in the jaw area occur in two types: 1) in the form of an epidermoid cyst that does not contain a tooth; 2) in the form of a periodontal (follicular) cyst with special contents surrounding the crown of an unerupted tooth (Kyandsky A. A., 1938). The upper jaw is most often affected.

It is important to note that inside the cholesteatoma cavity there is always a mushy mass that has a pearl (pearl) tint, which quickly disappears after opening the cholesteatoma and the latter takes on a greasy appearance. The pearly luster is caused by the presence in the cholesteatoma masses of concentrically layered particles of decay of cellular accumulations from the keratinized epithelium, which gave Cruvielhier (1829) the reason to call cholesteatoma a “pearl tumor”.

The clinical picture of cholesteatoma of the jaws is most often generally similar to clinical picture cysts of the jaws, less often - a cystic form of adamantinoma, which has a two- or three-chamber structure. Usually accurate diagnosis cholesteatoma is established by histological examination or, more often, during surgery and is already confirmed by histological examination of the surgical material.

When cholesteatoma is diagnosed, it is removed by cystectomy, or less commonly by cystotomy.

Traumatic cysts of the jawsare rare. They are classified as non-epithelial cysts. Such cysts are found in the lower jaw, in the initial stages they are asymptomatic and are diagnosed accidentally on an x-ray in the form of a clearly demarcated cavity with sclerotic bone edges in the lateral part of the body of the jaw, not connected with the teeth. The pathogenesis of such cysts is unknown. Histologically, the cyst does not have an epithelial lining. Its bone walls are covered with thin fibrous tissue, which contains multinucleated giant cells and hemosiderin grains (Gubaidulina E. Ya., Tsegelnik L. N., 1990). Traumatic cysts may have no liquid content or be filled with hemorrhagic fluid.

Some experts consider the cyst to be the result intensive growth bone disease, in which the spongy substance of the bone does not have time to rebuild, and bone cavities are formed. Similar cysts are found in the epiphyses tubular bones. However, there is an opinion that traumatic cysts are the result of hemorrhage in the central parts of the jaw. Hemorrhages into the thickness of the spongy substance can lead to the formation of intraosseous cavities lined with a capsule of connective tissue, in the formation of which endosteum takes part. When suppuration occurs, a fistula can form, which is a path for the vegetation of the epithelium of the mucous membrane of the gums deep into the jaw with subsequent lining of the cyst shell completely or, more often, partially. The pulp of teeth bordering traumatic cysts of the jaws, as a rule, remains viable (Kyandsky A. A., 1938). Removal of traumatic jaw cysts is performed by enucleation or cystotomy, which depends on the size of the pathological formation.

Aneurysmal bone cystsclassified as non-epithelial cysts. Etiopathogenesis is practically not studied. Long years this type of cyst was considered as a cystic form of osteoblastoclastoma (Kasparova N.N., 1991). It usually occurs in the area of ​​intact teeth on the lower jaw in prepubertal and pubertal age (Roginsky V.V., 1987). The lesion is a cavity, sometimes a multi-cavitated lesion, filled with blood, hemorrhagic fluid, or may have no fluid contents at all. The bone cavity of the cyst is usually lined with a membrane of fibrous tissue devoid of epithelium and contains osteoblasts and osteoclasts.

The name “aneurysmal” cyst denotes only one of the late symptoms of this pathology - deformation (“swelling”) of the lower jaw.

In the early stages of development of an aneurysmal bone cyst, patients do not complain. Radiologically, a focus of bone clearing with clear boundaries in the form of one or several cysts is diagnosed; thinning of the cortical plate is often noted, late stages- deformation of the jaw in the form of swelling.

When diagnosing this type of cyst, surgical treatment is performed, which consists of curettage of the cyst membrane.

Spheroidal-maxillary (in the bone of the upper jaw between the lateral incisor and the canine) and nasolabial or nasoalveolar cyst (on the anterior surface of the upper jaw in the projection of the apex of the root of the lateral incisor and canine), a spherical-maxillary cyst can also occur. In this case, the latter only causes depression of the outer compact plate of the jaw and is not determined radiologically, but can be detected only after the introduction of a contrast agent into its cavity.

Globular-maxillary and nasoalveolar cystsarise from the epithelium at the junction of the premaxilla with the upper jaw. They contain a yellowish liquid without cholesterol (Roginsky V.V., 1987).

X-ray diagnostics helps in diagnosing a globular maxillary cyst. An x-ray usually reveals a bone loss in shape, resembling an inverted pear with clear boundaries. The roots of the lateral incisor and canine are usually moved apart, while the contours of the periodontal fissure are preserved.

Ball-maxillary and nasoalveolar cysts are removed by cystectomy using access from the vestibule of the oral cavity.


"Diseases, injuries and tumors maxillofacial area"
edited by A.K. Iordanishvili

The history of the disease comes from the Greek word “cyst” and is translated as “blister”. This is quite justified, since a bubble is formed filled with liquid and pus. A radicular cyst of the upper or lower jaw (ICD code - 10) may appear due to cystic degeneration of the tooth. All the causes of the disease will be described in more detail below. The outer layer of the cyst itself consists of connective tissue, and the inner layer is filled with epithelium. Most often, a cyst is diagnosed in the upper jaw rather than in the lower jaw.

In the early stages, the medical history confirms that it does not cause discomfort or anxiety. The resulting granuloma in the sinus can only be detected after an x-ray examination. After a short period of time, external symptoms appear.

All symptoms of the disease are described in more detail below.

Causes of the disease

Each of us is taught to take care of the oral cavity and the condition of our teeth from early childhood. The history of the development of the disease proves that the disease can occur even in children in the left, lower and maxillary sinuses. But this does not mean that everyone completely follows these recommendations. Therefore, among the causes of maxillary or mandibular cysts (ICD - 10), doctors identify:

• jaw injuries;
• gum disease;
• peredontitis;
• caries;
• the body's tendency to develop tumors, heredity.

IN Lately often a radicular cyst of the upper or lower jaw (ICD code - 10) appears as a result of a previous disease. Periodontal disease or peredontitis can cause the appearance of neoplasms, that is, cysts near the root of the tooth. And if treatment is not carried out, a radicular cyst can appear quite quickly.

Important! If you notice the characteristic symptoms of the disease that will be discussed here, you should seek help from a dentist. Self-medication and warm rinses can only worsen the condition.

Symptoms and diagnosis of the disease

A radicular cyst of the lower or upper jaw (ICD code - 10) can develop in a person over many years without causing concern. This is proven by the medical history. It is necessary to regularly monitor the condition of the oral cavity and carry out preventive sanitation. In the early stages, treatment is simple and favorable. If the disease is advanced, surgical intervention will be required.

Sooner or later, the cyst will announce its presence with characteristic symptoms:

• redness of soft gum tissue;
• pain in the tooth area;
• tooth pain;
• swelling of the gums;
• pus or liquid with an unpleasant odor that may appear when pressure is applied to the gum;
• elevated body temperature.

You can notice a cyst with the naked eye at the moment when it increases in size. It is difficult to do this on your own in the maxillary sinus. A cyst of the lower or upper jaw does not affect the nerve endings of the teeth. But if it increases, a blood clot may form, which will impair blood circulation. As a rule, treatment begins with an x-ray examination. It can be prescribed by a doctor even in the absence of obvious signs.

In the early stages, the disease is easier to cure and the history of the development of the disease has much evidence of this. Therefore, such medical measures should not cause confusion in the patient. The doctor knows better, he knows the history of the disease, how it develops, what complications it causes. In most cases, suspicions are justified.

Treatment

Modern dentistry involves several methods of treating the disease. This:

Any of the methods involves the removal of molars, next to which there is a cyst (ICD code - 10). Treatment of the disease using cystotomy involves opening a cyst formed in the area of ​​the lower, left, right or maxillary sinus. This is done to reduce blood pressure.

The second method is more often used to treat a maxillary cyst or a cyst in the maxillary sinus. This means an operation to remove the cyst along with the membrane. After the operation is completed, the surgeon assesses the condition of the cyst itself. The operation takes place under local anesthesia. A neat incision is made on the upper or lower jaw (left or right side) in the area of ​​the tumor. After this, the cyst itself is removed with a scalpel, and the upper part of the affected tooth is removed with a bur.

Before surgery, all carious teeth located next to the cyst can be removed. Only after this is surgery performed to remove the cyst in the sinus. Variants occur in this disease when it affects adjacent tooth. Therefore, the story ahead is not the most favorable when the second tooth is to be removed. This occurs in cases where the medical history goes on for a long time and has been brought, often through the fault of the patient, to a chronic state.

This has already been mentioned here. If there is a suspicion of the appearance of this disease, then no warm rinsing or heating is acceptable. This will only make the condition worse. This requires qualified medical assistance. In general, any rinsing and warming should be done only on the recommendation of a doctor.

The listed methods and the operation itself are carried out with the goal that the cyst on the jaw is subject to complete removal or reduction in size. The cyst in the maxillary region, and in the lower jaw, can recur. Therefore, after the operation has been performed, the resulting cavity is filled with a special composition. The patient will be observed in the clinic for six months to exclude progression of the disease, and only after that the cavity is cleaned and closed.

Endoscopy is a more gentle operation than the methods listed above. Used to remove cysts on the upper jaw. An endoscope is inserted into the sinus anastomosis through the nostrils and the cyst is removed. The operation is performed on an outpatient basis, and the patient can be discharged after three hours.

Can there be complications after surgery?

Without a doubt, complications after a cyst (ICD code - 10) are possible. There is a large amount in the sinus blood vessels, damage to which may cause bleeding. When molars are removed before surgery, a jaw fracture is possible. Therefore, during its implementation, the surgeon uses periodontal splints.

In the history of this disease, there are cases where molars were injured in the maxillary sinus. To avoid such a story, it is necessary to treat all chronic diseases and carry out sanitation of the oral cavity in a timely manner.

Why is a cyst dangerous?

Many people believe that a cyst in the maxillary sinus, classified according to ICD - 10, is not particularly dangerous. This is nothing more than a bag of pus, which only needs to be opened for the problem to be resolved. In this statement lies the great danger to which people with such an approach expose themselves. The medical history provides multiple facts with fatal. This is a new growth. As in any other case with tumors, benign neoplasms, if left untreated, quickly turn into malignant tumors.

Moreover, a cyst that is not removed in a timely manner causes a disruption in the functioning of all internal organs. An abscess may subsequently develop in the area of ​​the neoplasm. And the speed of development of all these pathologies is rapid. The body will not be able to launch protective functions, and there is a danger of complications. Moreover, this process proceeds rapidly. The blood spreads pathogenic microbes throughout the body with lightning speed, and it is unknown where they will gain a foothold.

Rehabilitation measures and prevention

Removal of a radicular cyst in the jaws (ICD - 10) or in the maxillary sinus does not always mean a complete recovery. Regular examination is required to prevent recurrence of the disease. In addition, the doctor recommends all kinds of physiotherapeutic procedures and the use of traditional medicine.

Visiting a physiotherapy room is only possible with a doctor's prescription. Self-medication using traditional medicine should be excluded. Only the advice given by the doctor is followed. Even if good friends recommended this or that remedy, it can only be used after consultation with specialists.

For example, a cyst in the maxillary sinus is not removed during an exacerbation of sinusitis. First the patient must go complex treatment worsening illness. Once the condition has stabilized, surgery may be scheduled.

The use of aloe juice is recommended not only by ancient recipes. Three drops of this life-giving liquid can be injected into the left or right nostril. But you can only use juice from plants that are at least three years old. The juice is squeezed out of the leaves; after cutting, they must remain in the refrigerator for at least three days.

An aqueous solution of mumiyo is used no less effectively. To treat a radicular cyst (ICD - 10) or a neoplasm in the maxillary sinus, a golden mustache is used. Cyclamen is also effective in solving this problem.

Traditional medicine cannot be a panacea for the treatment of a jaw cyst (ICD - 10) or in the maxillary sinus. All this gives an effect only in combination with the main treatment or as a preventive measure during sinusitis, rhinitis and other inflammatory diseases, which can result in the appearance of various neoplasms.

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Classification of jaw cyst

IN medical practice There are three types of jaw cysts - follicular, radicular, and keratocyst.

The most common is the radicular cyst, occurring in 80% of jaw cysts. It mainly forms near the roots of the tooth. Most often it develops with long-term periodontitis. Its walls are formed by fibrous tissue, and the surface is lined with epithelium of a multilayer structure. Cell tissue is formed by lymphocytes and plasma cells. Inflammatory processes hyperplasia plasma cells, which turn inside the wall, causing painful sensations. Severe growth of the cyst leads to its penetration into the maxillary sinuses, which causes chronic sinusitis.

The formation of a follicular cyst occurs from the enamel of unerupted teeth. More often it is localized in the area of ​​the lower and upper canines - the third and second premolars. The internal cavity of the cyst is lined with epithelium. Often, a follicular cyst contains unformed or developed teeth.

A keratocyst develops at the site of wisdom tooth formation. It occurs both single-chamber and multi-chamber. A cyst often forms in the cavity benign tumor- cholesteatoma.

Jaw cyst: symptoms

Most often, the symptoms of a jaw cyst are not detected for a long time. But if the cyst progresses in volume, then its symptoms are expressed in thinning of the facial wall of the jaw, resulting in a round protrusion of the cyst. The jaw cyst becomes painful.

With the development of purulent processes, the symptoms of a jaw cyst are similar to those of osteomyelitis - infectious inflammation bone tissue.

Jaw cyst: treatment

The main methods of treating jaw cysts are cystectomy and cystotomy.

The cystectomy procedure involves removing the cyst and then suturing the wound. This operation is performed for a cyst formed as a result of the pathological development of the epithelium, for small cysts localized in the tooth-containing area of ​​the jaw within the boundaries of one or two healthy teeth.

In addition, cystectomy is prescribed for a large cyst of the lower or upper jaw in the absence of teeth in this area.

The indication for the cystectomy procedure is the immersion of no more than a third of the length of the tooth root into the cystic cavity, because When completely immersed in the cystic cavity, the teeth quickly fall out.

A disadvantage of cystectomy is the frequent re-infection of cut microtubules.

Following removal of the jaw cyst, the bone cavity is filled with biocomposite materials, which enhance regeneration and allow you to quickly restore the shape and function of the jaw.

The cystotomy operation consists of the process of removing the anterior wall of the cyst and combining it with the oral cavity. Cystotomy reduces and flattens the cystic cavity. The procedure is well tolerated by patients, but the postoperative defect persists for quite a long time.

Oronasal cystectomy and oronasal cystotomy are used to remove a jaw cyst that extends into the maxillary sinus and pushes it back when chronic sinusitis. During the operation, the maxillary sinus is combined with the cavity of the cystic formation and a communication is formed between the cavity and the lower nasal passage.

Oronasal cystectomy is used if there are no teeth in the cystic area or if there are 1-2 teeth in it.

In case of existing concomitant diseases or a significant number of healthy teeth in the area of ​​the cystic cavity, oronasal cystotomy is used.

If cystotomy or cystectomy is performed in a timely manner, then it is possible to avoid opening the cyst. However, in practice, it is more often necessary to perform an autopsy to remove suppuration and clean the cyst cavity.

The procedures of cystotomy and cystectomy allow you to save the teeth located in the area of ​​the cyst and restore lost functions.

In plastic cystectomy, the cystic membrane is completely removed. After this, the wound is tamponed with a bactericidal solution. For large cysts, both types of treatment are sometimes used - cystotomy and cystectomy. In this case, the first stage is a decompression operation - a cystotomy is performed: communication with the oral cavity is performed, and then, after about two years, a cystectomy is performed.

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Common forms of cysts

There are seven types of the disease:

1. Peri-root, or radicular cyst, is the most common pathology. The tumor occurs as a result of improper dental treatment or inflammation of the periodontal tissue. Develops from dense and inflamed nodules on the root of the tooth. These cysts form on the maxillary sinus and reach a diameter of up to 2 cm. The inside of the neoplasm is lined with non-keratinized epithelial tissue, and the walls of the cyst are covered with plasmatic and immune cells. The crisis of the disease leads to an inflammatory process: an increase in cell volume and the formation of filament-shaped processes directed into the wall. These signs appear only in this form of the disease.
2. Keratocyst(retromolar) forms on the lower jaw or in the corner of the gum. The appearance of the disease can be caused by the growth of wisdom teeth. The neoplasm consists of fibrous and thin walls, and inside there are epithelial tissue and tumor-like formations. After surgery, relapses of the disease often occur.
3. Follicular The cyst is formed from the base of unerupted teeth. Localization occurs at the site of dislocation of the incisor, canines or third molar. The neoplasm consists of a flexible wall and an internal tissue surface. Tissue cells are in an altered state and can produce mucous secretions. The formation contains the rudiments or formed teeth.
4. Aneurysmal cysts occur in the area of ​​an intact tooth and consist of blood or liquid mixed with blood. Untimely treatment of this form of cyst leads to deformation of the jaw bones.
5. Nasoalveolar neoplasms They are made of tissue and form in the space between the upper jaw and the jaw bone.
6. Traumatic cysts They are hollow or fluid-filled structures. This form of cyst is characterized by asymptomatic progression. The disease is detected during a preventive examination of the oral cavity.
7. Residual cyst is a rare complication after improper tooth extraction.

After removal of the cyst, relapses are possible due to tissue disorders. Treatment of the disease will depend entirely on the type of pathology.

Causes of cysts

There are many pathogenic microorganisms present in the oral cavity. Poor hygiene leads to an increase in the number of germs. The development of the disease may be associated with a decrease protective functions body. Human immunity is reduced by factors such as insomnia, severe stress, overwork, and poor nutrition. Other factors causing the disease include:

• Injury oral cavity(gums or tooth). These include minor injuries - a cut from hard food or a burn from a hot drink.
• Infectious infection. Infection can enter the tooth canal in cases of periodontitis or periodontitis. Infection of soft tissue occurs due to untimely or improper treatment of oral diseases (caries).
• The infection can be triggered by multiple ENT diseases (for example, sinusitis).
• Improper development and eruption of teeth.

The cyst blocks the exit path for bacteria, which provokes rupture or suppuration. Inflammatory processes can provoke unpleasant consequences:

• inflammation and enlargement of lymph nodes;
• swelling of the face or jaw area;
• inflammation of the gums;
• difficulty in curing the disease;
• inflammation of soft tissue or bone marrow.

Timely treatment will help avoid negative consequences.

Symptoms of the disease

At an early stage of the disease, no symptoms are detected. A person may notice a small pouch on the gum, visible to the eye and uncomfortable while talking or chewing food. The cyst can be detected on x-ray, during preventive examination at the dentist.

The further stage of the cyst is accompanied by suppuration and severe symptoms:

• acute pain in the area where the cyst is located and the affected bone;
• increased body temperature up to 39-40 degrees;
• deterioration in general health;
• chills;
• migraine;
• nausea or vomiting;
• redness of soft tissues;
• severe swelling of the localization site.

Untimely treatment can lead to damage to nearby tissues and organs.

Maxillary cyst

This type of disease occurs in most cases. The upper jaw is a paired bone of the cranial region. It contains a soft substance that predominates in quantity over other components. Due to the soft structure of the bone, the cyst spreads quickly. Each person has an individual structure of the maxillary sinus: the cavities are different, and the roots of the molars or premolars are covered with a membrane or extend into the sinus of the jaw.

Maxillary cyst varies depending on benign and malignant causes occurrence. The first reason may be the spread pathogenic microbes through the roots of the teeth or periodontal pockets. Symptoms of this type of cyst may include swelling, pouch-like formation, fever, pain when chewing, increased fatigue, and migraine. The neoplasm is detected using an x-ray, where the cyst represents a darkened area. Radicular formation is localized in the area of ​​the central teeth.

Mandibular cyst

Pathology with a hollow formation - a cyst of the lower jaw. Untimely treatment leads to fluid accumulation in the cavity. A sick person does not feel any changes in his health, and there is no jaw defect. The disease progresses, but it can only be detected by X-ray examination.

The lower jaw is a paired bone that contains spongy substance. A mandibular cyst damages the nerve that is located between the fourth and fifth teeth. Nerve injury leads to increased pain. Symptoms of formation may include swelling and redness. Failure to see a dentist in a timely manner can lead to a pathological fracture, fistula formation, or osteomyelitis.

Treatment of neoplasm with cystectomy

Cyst removal is performed exclusively surgically using modern equipment. When the cyst suppurates, the contents are immediately drained using drainage. There are also uncomplicated diseases that do not lead to surgical intervention.

The main types of surgical intervention include: cystectomy and cystotomy. The first intervention involves cutting off the cyst and covering the damaged area. Indications for this surgical intervention:

• small volumes of formation, which is located in the area from the first to the third intact tooth;
• pathology of the upper jaw that does not affect the sinus and does not have teeth at the localization site;
• pathology of the lower jaw in the place of absence of teeth and the presence of the required amount of bone tissue to prevent a fracture.

The main purpose of surgical treatment - cystectomy - is to save infected teeth and teeth located near a developed cyst. The causal teeth will be filled by specialists, and the material will be removed over the top of the root.

An operation to save teeth is resection of the root apex. The teeth located in the cyst cavity fall out after surgery, so there is no point in saving them. Teeth with a complex root system structure often need to be removed due to the difficult passage of root canals. During the operation, impacted teeth are removed if they are the root cause of the development of the cyst. There is electroodontometry for this purpose. If the tooth does not respond to electric current, and an X-ray examination does not reveal any expansion of the periodontal space, the dentist will fill the tooth before performing the operation.

The cystectomy operation is performed under anesthesia: conduction or infiltration. The incision is made according to the size of the cyst. A trapezoid-shaped periosteal and mucosal flap is formed and removed.

Using special surgical instruments, the cyst is removed along with the root surface. To prevent relapses, the cyst membrane must be removed. After excision of the cyst, the roots of the nearby teeth are exposed, which provokes the cutting off of their tops. The next step is a revision of the tooth cavity, which becomes covered with a blood clot. Antibiotics or antiseptics are not used. Osteogenic medications are injected into the open wound. Then a flap is applied, which is fixed with catgut sutures. Antihistamines, painkillers and anti-inflammatory drugs are prescribed. Mouth rinses or baths with infusions of chamomile or sage are indicated. After the operation, a sick leave certificate is issued.

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Why does a cyst form at the roots of a tooth?

A pathological formation at the apex of the tooth root is a jaw cyst. It is covered with a dense layer of epithelium, its internal component is a kind of liquid, and in some cases, a porridge-like mass. Typically, the cavity of a dental follicular cyst is filled with pus (dead cells and microorganisms). The cyst of the upper jaw grows more actively, this is due to the slightly more porous structure of the tooth roots.

Jaw cysts can be small formations, just a few millimeters, but during the process of inflammation they increase and can reach enormous sizes. The body tries to protect healthy tissue from pathological areas, which is how jaw cysts arise.

Infection is the main source of radicular cysts of the upper jaw; it affects the internal tissue. Pathogenic microorganisms penetrate into the site of inflammation due to mechanical action or due to poor oral hygiene.

Most often, a jaw cyst is formed due to:

Types of odontogenic cysts

Jaw cysts vary in size, location and the reasons that provoke them. Cystic formation can occur near the tooth root, under a filling, and even between crowns. The cyst can be localized on the upper or lower jaw and in the maxillary sinuses.

The size of the purulent sac may not exceed a few millimeters, but x-rays residual cysts are clearly visible. While the affected area is small, the patient does not experience any discomfort; as the cyst grows, convex, rounded formations may be noted, and the facial wall of the jaw becomes thinner.

In dentistry, odontogenic cysts of the jaw are divided into:

Kerokysts occur against the background of improper tooth formation. A follicular cyst most often appears during teething, while the residual type occurs after tooth extraction. If the process of eruption of “eights” is associated with inflammation, then we are talking about paradental cysts. The latter type is quite common; as a rule, it is formed from a granuloma.

Radicular cysts

Often the patient is not aware that he has a radicular cyst. During an examination, the dentist may see that the color of the tooth has changed. While probing the root canals, the doctor may notice the release of fluid with a yellowish tint. During the procedure, the patient experiences quite unpleasant painful sensations.

If sick for a long time doesn't apply for medical care, a radicular cyst, growing, moves nearby standing teeth, deformation of the alveolar process occurs. Palpation reveals a characteristic crunch and pliability of the walls. In some cases, a radicular cyst leads to facial asymmetry. Cystic formation destroys bone tissue; if no measures are taken, a bone fracture is possible.

The patient begins to experience aching toothaches in the affected area, and symptoms of intoxication appear. Upon examination, the doctor reveals swelling and hyperemia of the tissues surrounding the radicular cyst. If treatment is not started during this period, a fistula may form, phlegmon or osteomyelitis may develop. The inflammatory process can spread to the maxillary sinuses and inner ear, leading to serious complications.

Follicular cysts

Follicular cysts of the lower jaw are formed from the enamel of an unerupted tooth; they can be localized in the area of ​​the third and second premolar or canine. The cyst also affects the upper jaw. A pathogenic cavity can affect one immature tooth or several at once. Often, the cyst of the upper jaw contains already formed teeth.

Follicular cysts of the jaw consist of an outer and inner membrane. The first includes connective tissue, covered with multilayered epithelium. Inside the follicular cystic structure is fluid that contains cholesterol crystals.

Residual cysts

Often, after an incorrect tooth extraction, patients have to go to the dentist again, and they develop a residual cyst. An X-ray examination allows you to see a transparent cavity, which is located in the area where the tooth was previously removed. According to its clinical and histological characteristics, a residual cyst is similar to a radicular one.

Keratocysts

Keratocysts are localized in the lower jaw near the third molars. The formation occurs due to anomalies in the formation of the “eight”. This type stands out from the rest due to keratinization of a thin layer of epithelium of the internal cavity of the mandibular cyst. In dental practice, there are both single-chamber and multi-chamber cystic formations, which in turn consist of one volumetric cavity and many small formations.

The symptoms of keratocysts are mild, usually detected on x-rays or with significant growth, when the area of ​​the jaw next to the affected area begins to protrude. Often a cyst of the lower jaw degenerates into a cholestoma, less often a malignant tumor, which is extremely dangerous. If cystic structures are not removed in time surgically, serious consequences are possible.

The difference between a cyst and a flux

Periostitis is popularly called gumboil. This disease is caused by inflammation of the periosteum. Microorganisms penetrating into dental cavity or gum pocket, begin to actively reproduce. The accumulated pus makes its way, stopping at the periosteum, and a flux appears in this place.

An inflammatory process begins in the soft tissues near the causative tooth. A patient with flux experiences throbbing pain. If periostitis is not treated in time, the inflammation will affect the periosteum, the patient’s body temperature will rise, and the discomfort will intensify.

Many people may confuse the symptoms of gumboil and jaw cyst, but experienced doctors They can always find the differences. Cystic formations are usually the precursors of flux; they look like a sac with liquid contents, grow gradually, affecting healthy tissue and are almost always painless.

Treatment of cysts

According to statistics, about 3% of patients encounter this problem, so before carrying out this or that procedure, the doctor needs to conduct a competent diagnosis. Often the existing follicular formation is a granuloma; at the initial stage, it is successfully treated with medication. To determine the presence of a follicular or any other dental cyst, the doctor sends the tissue for histology.

Therapeutic treatment

The altered tooth root must be treated with an antiseptic, the tooth thoroughly cleaned and sealed. Sometimes, as an alternative, electric shocks are applied to the affected tooth, after introducing a therapeutic suspension containing copper and calcium. Drug treatment is used in the following cases:

• absence of fillings on root canals;
• The root filling installed in the root filling is of poor quality and does not cover the entire length of the canal;
• small radicular cysts up to 8 mm.

When treating small jaw cystic structures, special medicines, which provide negative impact on their shell and internal contents. Then the doctor removes the pus, filling the cavity of the cystic formation with a special paste that helps restore bone structures. Finally, a filling is placed on the tooth, but even the competent actions of the dentist do not provide a 100% guarantee that the cyst will not reappear.

Removal

In most cases, cystic formations of the maxillofacial area must be removed. These include:

• large cyst sizes, more than 8 mm;
• the appearance of swelling accompanied by pain;
• there is a pin in the root canal;
• A prosthesis is installed in place of the causative tooth.

Not so long ago, the cyst was removed along with the tooth, but today dentists using alternative treatment methods are able to save the tooth. If the roots are affected by cystic structures, only then surgery cannot be avoided.

There are three main methods of tooth extraction:

During cystotomy, large reticular cystic structures are removed. The surgeon creates an opening for fluid drainage. An obturator is installed to allow all fluid to leave the cavity. The doctor also removes necrotic tissue. This treatment method is quite complex, it requires constant monitoring by a dentist, and treatment can take several months.

Most effective method removal of radicular cysts is considered a cystectomy. Removal of cystic structures is carried out only if they are small in size and the process of their suppuration has begun. During the operation, according to indications, the surgeon may remove the top of the tooth. During hemisection, the entire tooth or part of it along with the follicular cyst must be removed.

Throughout postoperative period you need to rinse your mouth antiseptics, in some cases, the doctor may prescribe antibiotics. Pain and swelling after the intervention should go away the next day if painful sensations intensify, then you need to visit the dentist as soon as possible.

Consequences

If you do not pay attention to the symptoms that appear for a long time, the proliferation of cystic structures can lead to:

• suppuration of the cyst;
• damage to bone structures, up to a jaw fracture;
• inflammation of the maxillary sinuses, with maxillary localization;
• hearing impairment;
• osteomyelitis or periostitis;
• abscess development;
• sepsis.

If a cystic formation on the upper or lower jaw becomes large, as seen in the photo above, this leads to malocclusion, destruction of the dental pulp, and loosening of neighboring teeth. Prevention is regular visits dentist and maintaining personal hygiene rules.

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Classification of jaw cysts

Jaw cysts are divided into the following types:

1. Radicular (perihilar) is the most common of all jaw cysts (about 80% of all). It is formed as a result of chronic periodontitis or poor-quality dental treatment (injury, instrument breakage). Develops from complex granulomas in the area of ​​the teeth. Such cysts most often occur on the upper jaw. Their sizes are up to 2 centimeters in circumference. Epithelial multi-level tissue lines the surface of the formation from the inside, it is not prone to keratinization, its walls are fibrous, dotted with lymphocytes and plasma cells. During an exacerbation, an inflammatory process occurs in the formation, the cells increase, this leads to the appearance of thread-like processes directed into the wall. Such symptoms characterize only this type of cyst.
2. Retromolar or keratocyst. It is localized in the corner of the lower jaw, and can sometimes appear on the gum in the part where the so-called “wisdom tooth” should grow. This formation has thin fibrous walls; inside it is covered with a layer epithelial tissue. After removal of such a cyst, frequent relapses occur. It can be single-chamber or multi-chamber. There is a tumor-like formation inside it.
3. Follicular. It is also called an unerupted tooth cyst. It is formed from the base of unerupted teeth. Its localization is the alveolar edge of the jaws (second incisor, third molar, canines above and below). Such formations are characterized by thin walls consisting of multi-layered tissue (which lines their inner surface). The cells of this tissue are changed, sometimes producing mucus. The cyst contains both formed teeth and their rudiments. It is an unfavorable form of cysts of the upper jaw.
4. Aneurysmal. They are rare and unexplored. They appear in the precinct healthy tooth. They contain blood or hemorrhagic fluid inside. In advanced stages of such cysts, deformation of the bones of the lower jaw occurs.
5. Nasoalveolar. They are formed from tissues and are localized in the area between the upper jaw and between the jaw bone.
6. Traumatic. Rarely occur. They develop asymptomatically and are discovered accidentally. They can be hollow or filled with a characteristic liquid.
7. Residual. Appears due to complications after tooth extraction.

Often, inflammatory processes occur in such formations, which are accompanied by the destruction of the internal epithelium and the formation of a replacement substance inside them.

Causes of jaw cysts

In the oral cavity of each person there are approximately five thousand different microorganisms. Among them there are both pathogenic and conditionally pathogenic. If oral hygiene decreases, the number of pathogenic organisms increases significantly, and due to a decrease in the level of the body's protective functions, the development of a pathogenic neoplasm is possible. The immune system suppressed by factors such as stressful situations, sleep disturbance (insomnia), hypothermia, overwork, unbalanced nutrition.

Other reasons for the appearance of cysts are the labor-intensive process of teething, trauma, and infectious processes. If the cyst is small, it can exist for a long time and go unnoticed.

The causes of cysts are odontogenic and non-odontogenic factors. One of the reasons for the appearance is infection entering the thickness of the tooth through the root canals. Such a formation is diagnosed using an x-ray image, in which it will look like a darkened area.

A cyst in the lower jaw is a pathological hollow change in the thickness of the jaw. After some time, it fills with a characteristic liquid. A person who develops this pathology does not notice any changes in his condition and in the structure of the jaw. The formation is detected using fluoroscopy.

Symptoms of a cyst

Various varieties of such pathologies do not manifest themselves in any way. If their diameter is large, a round painful protrusion may appear on the face (due to thinning of the facial wall). Cystic formations can be painless for a long time, but their growth continues even in the absence of pain. If the disease is accompanied by an inflammatory process, the following symptoms appear:

• pain syndrome;
• redness;
• swelling of the gums;
• suppuration;
• increased body temperature;
• swelling of the jaw;
• deformation of the jaw bones;
• drowsiness;
• migraine;
• headaches (often occur as a result of compression of nerves);
• signs of sinusitis (rhinitis, nasal congestion, unpleasant odor);
• chills.

If a secondary infection occurs, the cyst rots, swelling of the face appears due to swelling of the surrounding tissues, mouth movements are limited (since it affects chewing muscles), mobility appears painful tooth, pain when chewing, tissue may peel off. Carpal formation of the upper jaw occurs more often than the lower jaw.

Treatment of jaw cysts

The most important method of treating such pathologies is surgery. Sometimes perihilar cysts can be treated without surgery, but if suppuration and complications occur, this requires immediate surgical intervention (which includes opening and draining the cavity). The most important task of the doctor is to preserve the teeth that are located around and directly in the area of ​​the cyst and restore their impaired functioning.

Types of treatment:

1. Cystectomy. This method is complete removal jaw pathology and wound suturing. This method allows the doctor to simultaneously remove the affected tooth root.
2. Cystotomy is a popular method of treating cysts. During this procedure, only the front wall of the tumor is removed, and the back wall is included (sewn) into the oral cavity.
3. Plastic cystectomy. With this method, the cyst is completely removed without suturing the wound. This method is sometimes used for complicated or advanced cysts.
4. Two-phase operation. Consists of two different types surgical intervention (cystotomy and cystectomy). This procedure allows you to save teeth and is minimally traumatic for the tissues of the oral cavity. This method gives complete cure from education.

In the oral cavity, due to various unfavorable factors, pathological formations - jaw cysts - can occur. They differ in their variety, stages and symptoms.

The main treatment method for such pathologies is surgery.

Forecasts after surgical procedures are favorable if large cysts are not complicated by jaw fractures.

Among all the existing lesions of the jaw bones, the jaw cyst is the most common type of disease. The pathology itself is benign neoplasm, presented in the form of a cavity. Its walls consist of fibrous tissue, and inside it is lined epithelial cells. On this moment There are many types of cystic neoplasms of the jaw. That is why there is a certain classification of this disease, thanks to which it is possible to distinguish various symptoms, causes, diagnosis and treatment.

As mentioned above, a jaw cyst is a cavity formation filled with fluid inside. It may not bother a person for a long time, and as a result becomes the cause of many complications. According to statistics, cysts in the upper jaw are 3 times more common than in the lower jaw.

Upper jaw

Cystic formation of the maxilla can result from odontogenic or non-odontogenic etiology. The main reason is the spread of infection into the thickness of the tooth through the root canals. The disease is easy to recognize if there is suppuration. In this situation, the patient will experience the following symptoms:

• the appearance of drowsiness;
• feeling pain syndrome at the moment of biting;
• increased body temperature;
• swelling;
• headache.

X-rays are used as diagnostics, where darkened areas will be visible in the image.

Lower jaw

A mandibular cyst is characterized by a hollow neoplasm that can fill with fluid over time. As a result of the active growth of the cyst due to compression or damage to the mandibular nerve, the patient may experience severe pain. There may also be swelling and redness on the affected side. The main complications of a cyst formed on the lower jaw are periostitis, osteomyelitis or fistula formation.

The occurrence of pathology can be accompanied by inflammatory processes with the destruction of the internal epithelium and the formation of replacement material inside. Jaw cysts have a classification, which will be presented below.

Retromolar

It is otherwise called a keratocyst. It is formed mainly on the lower jaw, especially in the area of ​​the gum where the “wisdom tooth” erupts. The tumor-like neoplasm has fibrous thin walls, and the inner side of the cyst is lined with epithelial cells.

The disease is diagnosed only as a result of an X-ray examination, and the tumor is eliminated surgically. It is noteworthy that even after removal, frequent relapses of the pathology are possible.

Radicular

This type of cystic neoplasm is the most common among all those diagnosed. Usually the disease appears as a result of unsuccessful dental treatment or chronic periodontitis. It is localized on the upper jaw, and its formation can reach up to 2 cm in diameter.

It consists of multilayer epithelial tissue that is not prone to keratinization. The wall of the cystic formation is dotted with plasma cells and lymphocytes and is fibrous. When the pathology recurs, the cells begin to increase, resulting in an inflammatory process with characteristic symptoms. Also at this moment, thread-like processes form inside the cyst wall.

Aneurysmal

A rather rare phenomenon in dental practice, therefore its pathogenesis and causes have not yet been fully studied. Most often, an aneurysmal cyst can be found in the area of ​​a healthy tooth or an intact one (med. term.), located on the lower jaw. There is hemorrhagic fluid or blood inside the cystic formation.

In the early stages of the disease, it does not have clinical severity, so the pathology becomes increasingly worse, and as a result of the neglect of the process, the patient may notice deformation of the lower jaw.

Follicular

A follicular cyst is formed from the buds of unerupted teeth, so it is also called an unerupted tooth cyst. The location is usually the canines or premolar area on the upper or lower jaw. The internal contents of a cystic neoplasm may contain unformed tooth buds or full-fledged teeth. The walls of the cyst are thin, consisting of multi-level tissue with altered cells, sometimes producing mucus. This type of pathology is considered extremely unfavorable.

Nasoalveolar

The cyst is formed from epithelial tissue and is localized in the area of ​​​​the junction of the premaxillary bone and the upper jaw. The cavity fluid is yellowish and does not contain cholesterol.

Residual

Appears as a result of incorrectly performed extirpation (removal of a tooth from the root). In terms of clinical or histological characteristics, it is completely consistent with a root cyst. The X-ray image will show transparency in the area of ​​the extracted tooth.

Traumatic

A cyst resulting from trauma is quite rare. Its pathogenesis is unknown, and the cyst itself is not epithelial. Also, its internal contents may be hollow or contain hemorrhagic fluid. It can be discovered by chance x-ray examination, because initial stage pathological process is asymptomatic.

What are the causes of the disease

It is not for nothing that they say that the human oral cavity is the most “unclean” area in the entire body. It contains about five thousand different pathogenic microorganisms, which, under the influence of unfavorable factors, begin to actively multiply. Most often this occurs as a result of lack or insufficient oral hygiene or the presence of a weakened immune system.

The etiology of cystic neoplasms also includes the following reasons:

• teething;
• getting injured;
• the course of infectious processes;
• hereditary predisposition, etc.

Immune suppression is most often associated with frequent stress, overwork, sleep disturbances, hypothermia or an unbalanced diet. Therefore, the best prevention is to exclude these factors from your life.

What are the signs of the disease?

The disease is easy to recognize by its clinical symptoms. However, some types of cystic neoplasms may not be expressed by symptoms, thereby complicating the course of the disease. As the cyst grows and reaches a large size, as a result of thinning of the facial wall, a painful protrusion may occur on the patient’s face. Such a pathology may not bother the patient for a long time, but the severity of the disease will worsen every day. If a benign tumor is accompanied by an inflammatory process, the disease can be noticed by the following signs:

1. the appearance of pain;
2. increase in body temperature to subfebrile or febrile levels;
3. discharge of purulent contents;
4. the appearance of deformation of the jaw bones;
5. hyperemia and swelling of the gums;
6. the occurrence of symptoms of sinusitis (nasal congestion, unpleasant odor, rhinitis);
7. frequent headaches and dizziness;
8. chills;
9. swelling of the upper or lower jaw.

If you have a jaw cyst, these symptoms require an immediate visit medical institution and doctor consultations.

Diagnostics

The disease can be diagnosed only by the results of an x-ray or ultrasound examination. Also in some cases it is possible to perform a puncture.

Treatment of pathology

The cyst is treated primarily surgically. In this case, the main task of the doctor is to preserve the tooth, which is located in the area of ​​the cystic formation. Removal of a cyst and restoration of impaired tooth functions is carried out using the following methods:

Cystectomy.	In this case, the surgeon completely removes the cyst and sutures the wound. Such surgical intervention is advisable if the tooth root is immersed in the cyst cavity by no more than 1/3. With deep immersion, the possibility of saving the tooth is very reduced and, as a rule, it quickly falls out.
Cystomy.	This method is the most common, in which the cyst is removed only along the front wall, while the back side communicates with the oral cavity. Fusion occurs over the course of one week, where the cavity is gradually filled with smaller tampons. Full recovery is observed within six months or a year. And for the first two months, the patient must come daily for dressings, where, after removing the tampon, the cavity is washed and treated with antiseptics.
The operation is two-stage.	The surgical intervention combines cystectomy and cystomy. It is the safest and least traumatic. Even despite the size of the lesion of the tumor-like neoplasm, this method allows you to preserve the contours of the jaw.
Plastic cystectomy.	This method is used quite rarely; most often it allows you to treat a keratocyst or a suppurating part of a tooth-containing cystic neoplasm. In this case, the surgeon completely removes the tumor without suturing the wound.

Sometimes root cysts can be cured without surgery. However, in the presence of complications or the formation of purulent exudate, immediate opening of the pathological focus and drainage of the cavity is required.

Jaw cysts are pathological neoplasms. They arise as a result of many unfavorable factors, and the pathogenesis of development may vary depending on the type of cystic neoplasm. It is difficult to predict this process, but it can be cured in time. Therefore, if any alarming symptoms appear, you should immediately contact your dentist and undergo oral hygiene. If there is a suspicion of a cystic formation, the doctor will prescribe a diagnostic test, on the basis of which a correct diagnosis can be made.

Follicular cyst

Follicular cyst is a rare odontogenic neoplasm of the jaws. At the Leningrad Dental Institute for 1934-1938. observed 411 patients with jaw cysts, of which 14 were follicular. In the clinic maxillofacial surgery Perm Medical Institute over 25 years, out of 990 patients with jaw cysts, 41 patients had follicular cysts.

Follicular cysts in the jaws occur more often at the age of 12-15 years and in the third decade of life.

In our biopsy material, 26 patients had follicular cysts: 14 in males and 12 in females. The patients were distributed by age as follows: 7-10 years - 8 patients, 11-20 years - 8, 21-30 years - 3, 31-40 years - 3, over 40 years - 4 patients.

The follicular cyst is most often localized in the upper jaw, respectively, in the molars and canines, less often in the premolars, and very rarely in the incisors. Sometimes a follicular cyst is located in the lower edge of the orbit, in the nose or in the maxillary sinus, filling it entirely.

Radiologically, a follicular cyst is defined as a round or oval defect in the bone tissue of the jaw with a sharply defined edge and the presence of a tooth (teeth) in the wall or cavity of the cyst.

Currently, the size of the cyst at most reaches the size of a chicken egg.

A follicular cyst is, as a rule, a single-chamber cavity located in the jaw, delimited from the bone tissue by a capsule. According to the localization of the cyst, thickening occurs in the jaw area, often with facial deformation. In other cases, the bone tissue of the jaw can be sharply thinned - until it is completely resorbed.

A very characteristic feature of a follicular cyst is the presence of one or several rudimentary or formed teeth, most often located in the wall of the cyst; the crowns of the teeth usually protrude into the lumen of the cyst. Sometimes there are only tooth crowns, without the formation of roots. In some cases, the tooth lies freely in the cyst cavity; Often it contains an impacted tooth that is missing from the dentition. The cavity of the cyst is filled with a light, yellowish liquid, in which cholesterol crystals, desquamated epithelial cells, and sometimes an admixture of blood are found.

A microscopic examination of the walls of a follicular cyst reveals the following picture: stratified squamous epithelium lines the inner surface of the cyst and is located on a connective tissue capsule, which is easily separated from the bone tissue of the jaws when the cyst is removed. Sometimes stratified squamous epithelium forms separate outgrowths inside the cystic cavity.

In infected follicular cysts, the epithelium is often desquamated; the inner surface of the cyst is fresh granulation tissue, only in places with an epithelial lining (Fig. 46).

Along the periphery there is a connective tissue capsule, also with perivascular inflammatory cellular infiltrates of round and plasma cells with an admixture of leukocytes. In these cases, the lumen of the cyst contains a turbid or purulent fluid containing a large number of leukocytes.

A follicular cyst develops from a normally embedded or supernumerary dental germ of a permanent, less commonly, milk tooth.

A follicular cyst occurs from the outer epithelial layer of the dental sac (follicle) in the period before the formation of enamel and occurs as a result of degeneration and proliferation of cells of the enamel organ and the subsequent appearance of a cyst. The latter can form both around permanent and baby teeth.

As for the causes of a follicular cyst, there are different opinions, which mainly come down to trauma to the developing tooth, such as pressure on the tooth germ of a baby tooth, or to a lack of space for a growing wisdom tooth, or infection of the tooth germ.

Due to the period in which the normal development of the dental follicle is disrupted, the following may occur: 1) a cyst without teeth, 2) a cyst containing parts of them, 3) a cyst containing formed teeth. Thus, a follicular cyst is essentially a dental malformation.

A follicular cyst develops slowly over a long period of time. Sometimes, in case of incomplete removal of the epithelial lining, relapses occur after surgery.

Morphologically, a follicular cyst should be differentiated from a radicular cyst and a cystic form of adamantinoma.

Macroscopically, a follicular cyst is characterized by the presence of rudimentary and formed teeth, which does not happen in a radicular cyst.

Microscopically, based on a piece of the cyst wall sent for examination, it is not possible to differentiate it from a radicular cyst without additional clinical and radiological (presence of teeth) data.