Maharana Pratap Dental College and Hospital

Department of Oral Surgery

MARSUPIALIZATION & ENUCLEATION IN TREATMENT OF CYSTS OF ORAL CAVITY
UNDER GUIDANCE OF-

DR. AKSHAY GURRAHA DR.HEMANT BAJPAI DR. NISHANT SINGH DR. UMANG AGARWAL

Submitted by-

AMOL CHATURVEDI
BDS FINAL YEAR

CONTENTS
Definition Principle Indications Contraindications Advantages Disadvantages Conclusion

MARSUPIALIZATION (Cystotomy)
Marsupilium = Pouch First introduced by Partsch in 1892 Definition An operation for the cure of a hydatid or other cyst , the sac of tumour is opened & emptied of its contents and then its edges are stiched to the edges of external incision ,which is kept open while inferior of cyst suppurates & closes by granulation -Stedmans medical dictionary

PRINCIPLE
Marsupialization refers to creating a surgical window in the wall of cyst & evacuation of cystic contents. This process decreases intracystic pressure & promotes shrinkage of cyst & bone fill.

INDICATIONS
Amount of tissue injury Proximity of cyst to vital structures could create an oronasal or oroantral fistula, injure neurovascular structures or vital teeth during enucleation. Surgical access If access to all portions of cyst is difficult ,portion of cystic wall may be left behind. Assistance in erupton of teeth In a young patient with a dentigerous or pseudofollicular keratocyst, it permits eruption of unerupted teeth. Extent of surgery Marsupialization is preferred in a unhealthy or debilited patient , because it is simple & less stressful for patient. Size of cyst in very large cyst,there is a risk of fracture of jaw during enucleation.

CONTRAINDICATIONS
ODONTOGENIC KERATOCYST RECURRING CYSTS SMALLER CYSTS( < 2X2 cm)

ADVANTAGES
Simple procedure to perform. Spares vital structures eg. blood vessels,nerves Even quite large cyst can be dealt under Local anaesthesia as anaesthesia of deeper recesses is not essential. Simplest way to treat a fracture complicating a large cyst of mandible, as ribbon gauze & Whiteheads varnish pack will splint the fragments. Allows eruption of teeth. Prevents oronasal,oroantral fistulae. Prevents pathological fractures. Reduces operating time. Reduces blood loss,helps in shrinkage of cystic lining. Allows for endosteal bone formation to take place. Alveolar ridge is preserved.

DISADVANTAGES
Pathologic tissue is left in situ. Histologic examination of entire cystic lining is not done. The need for regular postoperative care, occurs a substantial period of time. The change in voice may occur when cavity is not obturated Unpleasant taste and smell may occur due to accumulation of stagnant saliva & food debris in cavity. Regular adjustment of plug. Periodic changing of pack. Secondary surgery may be needed. Formation of slit like pockets that may harbour foodstuffs. Risk of invagination & new cyst formation. Longer healing time.

ENUCLEATION (Cystectomy)
DEFINITION The removal of a tumour or other body entire without rupture,as one shell out the kernel of a nut Introduced by Partsch in 1910.

PRINCIPLE
Enucleation allows for cystic cavity to be covered by a mucoperisteal flap & the space fills with blood clot,which will eventually organize & form normal bone.

INDICATIONS
Treatment of odontogenic keratocysts. Recurrence of cystic lesions of any cyst type. Should be employed with any cyst of jaw that can be safely removed unduly sacrificing adjacent structures.

CONTRAINDICATIONS
Dentigerous cyst. Young patients with erupting teeth. Medically compromised or debilited patients. Proximity to vital structures. Very large cysts,may cause fracture of jaw.

ADVANTAGES
Entire pathological tissue is removed. Tissue available for histopathological examination. Chances of recurrence are less. Healing time is reduced. Enucleation with primary closure eliminates need for repeated appointments for packing,irrigation,adjustment of plug etc.

DISADVANTAGES
After primary closure,it is not possible to observe healing of cavity. In young patients,the unerupted teeth in a dentigerous cyst will be removed with the lesion. Removal of large cyst may make mandible more prone for fracture. Damage to adjacent vital structures. May lead to pulpal necrosis. Adjacent tooth may be devitalized.

CONCLUSION
Enucleation is definately a better alternate than marsupialization because of complete removal of pathological cystic lining. Marsupializaton could be preferred in cases with increased morbidity & mortality and impaired host defense mechanism. Marsupialization can also be employed in cases of large cysts, promixity to vital structures & young patients with a dentigerous cyst as it allows eruption of unerupted tooth & prevents tooth bud injury. While enucleation should be used for cyst having high recurrence potential as odontogenic keratocyst & other recurring cyst.

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