Radicular Cyst: Surgical Therapy

In principle, any radicular cyst should be surgically removed and submitted to histologic (fine tissue) examination.

1. dental surgery

  • Root apex resection (surgical procedure in which the root apex and the inflamed area surrounding the root apex are removed) with cystectomy (complete cyst removal).
    • For small apical (“tooth rootward”) or lateral (“lateral”) cysts.
  • If necessary, tooth extraction (tooth removal) for larger cyst and depending on the overall periodontal situation of the tooth.
  • Deciduous tooth extraction in case of inter-/radicular deciduous tooth cyst.

2. oral and maxillofacial surgery.

  • Cystostomy (Partsch I, Marsupialization: the edges of the cyst are sutured to form an open pocket).
    • Indications:
      • Large cysts, particularly in the mandible, when complete cyst removal is accompanied by devitalization (killing of the interior of the tooth (dental pulp)) of adjacent teeth and damage to the inferior alveolar nerve (“mandibular nerve”)
      • Fracture risk (risk of bone fracture) after cystectomy.
      • Inflammatory altered large cyst
      • Cyst of the hard palate with risk of nasal floor perforation.
    • Procedure:
      • Extensive opening of the cyst lumen.
      • Consecutive drainage (drainage of body fluids).
      • Conversion of the cyst lumen into a subsidiary bay of the oral cavity/maxillary sinus (antrocystostomy)/nasal cavity.
      • Keeping the cyst entrance open for several weeks by obturator.
      • Bone growth lumenward, concomitant reduction of the obturator.
      • After reduction of the lumen, if necessary, subsequent cystectomy to remove remaining pathological (pathological) tissue.
  • Cystectomy (Partsch II)
    • Complete removal of cyst bellows and cyst contents.
    • For small apical or lateral cysts in conjunction with apicoectomy.
    • In the case of larger cysts, especially in the mandible, if necessary, stabilization of the blood coagulum by collagen insertion or transplantation of autologous (“belonging to the same individual”) cancellous bone/spongy bone (punch biopsy iliac crest).
  • Deciduous tooth extraction for inter/radicular deciduous tooth cyst.