What is a Cystectomy?

Watch Dental Video about Cystectomy

A cystectomy is one possible therapy of a cyst. Cystectomy means the removal of a cyst, i.e. the scraping out of the cyst cavity.

A cyst is a tissue cavity that is enclosed by a membrane (epithelium) and may consist of several chambers, usually containing a liquid/mushy content.

In general, the cystectomy is the therapy of choice for cysts in the area of the head/neck. With the exception of very large cysts or if, for example, important anatomical structures are located in close proximity of the cyst, which could be damaged during the removal of a cyst, a so-called, "Cystostomy" is first performed – more on that in the video entitled "Cystectomy".

You will now see a cystectomy (i.e., the removal) of a radicular cyst. The cause of the cyst was a badly performed root canal treatment (on the anterior #1 tooth) – more on that in the videos entitled "Dental Cyst" and "Radicular Cysts".

The root canal treatment was renewed prior to the operation in order to prevent any further cyst formation after the cystectomy. The mucous membrane has been opened up and the thin bone lamella located above the cyst is removed. Now, the cyst is scraped with a sharp spoon. After the scraping of the cyst cavity, the wound is primarily closed.

Folicular Cyst

Folicular Cyst

Normally, the resulting bone defect fills with blood. Within the course of the healing of the wound, vessels grow back into the developing blood clot, followed by the subsequent development of new bone.
In general, the removal of larger cysts carries a certain risk of wound healing disorders, because the removal of the cyst creates a large bone defect that normally fills with blood immediately after the surgery.
As the blood dries, the clot shrinks. A large blood clot contracts more than a small one; it may contract to such a degree that it no longer touches the walls of the wound.

In such a case, it is not possible for blood vessels to grow from the walls into the blood clot. This prevents the clot from being supplied with oxygen, nutrients, and finally, with bone cells – which are an important prerequisite for the regeneration of the bone.

Consequently, the blood clot disintegrates – pus develops and a wound infection results.
In order to avoid these complications in large cysts, one could attempt to stabilize the blood clot and to reduce its contraction, for example, by filling the bone defect with a granulate made of bone substitute materials – as can be seen in this example. This prevents a contraction of the blood clot, allowing vessels to grow in from the walls – the basis for a subsequent bone regeneration.

Cystectomy

Cystectomy

An alternative to the planned surgery would be the initial performance of a cystostomy followed by a cystectomy. If left untreated, cysts in the area of the mouth, jaw, and face usually grow in size over the years, sooner or later leading to the corresponding local complications.

The risks of the surgery are negligible when performed by an experienced surgeon; nevertheless, complications may occur in individual cases, possibly requiring additional measures. Every additional measure may in turn lead to further complications which, in the course of the surgery, could become life-threatening. At this point, we will only discuss the specific complications encountered in the cystectomy. These are, for example:

  • Injury to surrounding structures such as nerves, cheeks, blood vessels, dental roots, and teeth with the respective consequences
  • An accidental cystectomy of malignant tumors that should be removed while employing a safety margin
  • wound infections
  • a fracture of the jaw
  • leaving parts of a cyst behind, which may result in a recurrence of the cyst

Luckily, such complications have become very rare due to the positive developments in medicine in the last decades.

Click here to see the video: Cystectomy

 

This post is also available in: German

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