A radicular cyst is a benign cavity formation, the cause of which is an inflammatory process in the periodontium around the tooth.. Occurs at the apex of the tooth root.
The radicular cyst is a consequence of the inflammatory process in the tooth Development mechanism Development begins with the formation of a slight granuloma in the tooth area. Then, with the progression of inflammation, collagen and fibroblasts accumulate around the cavity, which are involved in the formation of the capsule.. Further, inside the newly formed capsule, the development of epithelial cells occurs.. They form the internal component of the cavity (line it from the inside), which produces a secret and ensures its growth.. As the cystic formation grows, it causes local ischemia and atrophy of the bone area..
The process of neoplasm development in the jaw area includes several conditional stages:.
Stage.
Peculiarities.
Granuloma.
Dense fibrous formation of small size, occurs in the periodontium. It is the primary reaction to the inflammatory process in the tissues (restrictive barrier). The only visualization method is radiography.
Cystogranuloma.
Occurs as the disease progresses. Symptoms are poor, often asymptomatic.
Cystic neoplasm.
The final stage of formation. Has a relationship with the tooth and a characteristic clinical picture. A consultation with a dentist is indicated in order to determine the tactics of treatment.
The process can be stopped at any stage.
Features1. The cavity is filled more often with serous fluid (when a secondary infection is attached, the nature of the exudate changes to purulent).
Rarely becomes chronic. As a rule, this phenomenon is associated with unqualified help (frequent relapses).
May not have symptoms for a long time (slow growth).
Rarely grows into surrounding tissues and organs (in particular, the radicular cyst of the upper jaw can grow into the maxillary sinuses).
Radicular cyst of the mandible is more common (3:1).
Occurs with equal frequency in men and women.
Is not a tumor.
Causes There are several main causes of this type of neoplasm:.
Inflammatory diseases of the teeth (pulpitis, periodontitis), in which the infection through the dental canal reaches the root of the tooth, and then goes beyond it.
Poor quality dental care. With improper canal filling (incomplete rehabilitation of the focus of infection), poor-quality restoration (tooth chipping, gum damage), the infectious agent can penetrate into the root of the tooth and later into the surrounding tissues.
traumatic injury. It is necessary to separate post-traumatic formations caused by a violation of the integrity of the bone structure, and trauma, followed by infection (classic cyst). In the first case, the cystic cavity is filled with aseptic hemorrhagic fluid and has no signs of suppuration (another nosological form).
Inflammatory diseases of adjacent organs (stomatitis, gingivitis). In this case, there are some difficulties with differential diagnosis with respect to other cystic formations (follicular, gingival cyst), since it is difficult to establish the main etiological factor.
Disruption of the immune system. In this case, cystic cavities will form due to a low immune response to an infection (including an opportunistic one).
Several factors may be involved in the development of pathology at the same time..
Symptoms When cysts are less than 2 cm, the clinical picture is poor and often the neoplasm can only be detected using x-rays.
For radicular cysts of a tooth larger than 2 cm, the following manifestations are characteristic:.
Bulging in the area of \u200b\u200bthe outer wall of the cyst. The direction of the bulge will depend on which tooth is involved (upper premolars and molars - growth towards the maxillary sinus; lateral incisor - growth towards the palatal plate).
Compression of the neurovascular bundle leads to the development of paresthesia (burning, tingling).
Deformation of the dentition in case of growth of the formation towards the pear-shaped opening. This causes compression of the lower nasal passage and difficulty breathing, manifested by a feeling of heaviness and nasal congestion.. In other cases, visible deformity of the facial part of the skull is less common..
Thinning of bone tissue and the appearance of crepitus, a symptom of parchment crunch. As the bone progresses, it almost completely atrophies, the cystic formation appears through the tissues of the periosteum and mucous membrane, a fluctuation symptom occurs.. In advanced cases, pathological bone fractures are possible..
The pain syndrome has a weak severity, occurs only with a large size of the neoplasm and a pronounced compression of the nerve fibers by it..
There is a carious tooth above the cystic cavity (typical signs for this particular type of cyst). During its treatment, as you move along the root canal to the top, a clear yellowish liquid will be released..
When a secondary infection is attached, the cyst turns into a purulent process, which is accompanied by:.
severe intoxication (fever, headache, weakness);
sharp pain in the affected area, both on palpation and at rest;
hyperemia and swelling of the gum area at the site of the lesion;
slight deformation of the dentition (a characteristic symptom for a long process, and not for an acute one).
Radicular cysts of the maxillary premolars, molars, and sometimes canines due to eruption into the maxillary sinus often cause the development of sinusitis.
TreatmentSurgical treatment:.
Cystectomy - acceptable for any type of radicular cystic formations. The method is radical and has a low risk of recurrence, but, taking into account the complete excision of all the walls of the cystic formation, it is the most traumatic.
Cystotomy - used for complicated cystic formations (germination in the sinuses, destruction of the palatine plate) or in the elderly in order to reduce the load on the body. In this case, the neoplasm is not completely excised, but only the anterior wall is removed, thus ensuring normal drainage of the cavity and smoothing out clinical manifestations.. The wound is not sutured, but plugged and waiting for the natural replacement of the bone defect with connective tissue (dressings are required 2 times a week).
Plastic cystectomy is a combination of these two methods. At the first stage, cystotomy is performed, and a year later - cystectomy.
In suppurative processes, there are the following features:.
first, a puncture is performed to reduce pressure;
puncture more often along the alveolar ridge;
do not perform a puncture at the site of a future surgical intervention (risk of fistulas);
classical surgery is indicated only after the inflammation has subsided;
drainage often required for 2-3 days for adequate outflow of contents.
A brief description of the methods of surgical intervention is presented in the table:.
Operation.
Technique.
Cystectomy.
Before removing the cyst, filling and treatment of the causative tooth (or its removal) is indicated. During the operation, a mucous flap is cut out over the cystic cavity (usually in the form of a trapezoid). All tissues are separated to the jaw bones and trepanation is performed. The cyst is removed with all the membranes and the capsule, if indicated, the top of the tooth is resected. The cavity that formed after the removal of the formation is thoroughly washed with an antiseptic solution, hemostasis is provided. The wound is tightly sutured.
Cystotomy.
Before removing the cyst, filling and treatment of the causative tooth (or its removal) is indicated. The initial stage (up to and including trepanation) is similar to the previous technique. Further, the cyst is not completely husked, but only its front wall is removed.. A mucoperiosteal flap is placed in the wound, which was cut out at the first stage, and a swab soaked in an antiseptic solution. The duration of such treatment varies widely (permanent dressings are required to prevent the addition of a secondary infection).
Plastic cystectomy.
Combined treatment method (all stages of the two above methods). Used for severe suppurative processes, when classical treatment causes recurrence of the disease.
Oronasal cystectomy, oronasal cystotomy.
Two types of surgeries that are used for sinus involvement.
The execution technique is based on creating an outflow of contents along natural paths (sinus fistula, cysts and lower nasal passage). The goal is to drain the cavity to start the regeneration process (replacement of the pathological area with connective tissue and self-closing of the anastomosis).
At the moment, minimally invasive methods for the treatment of radicular cysts (laser exposure) are being developed, but so far they are not widely used..
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