Saturday, 25 February 2017

Sclerotherapy of Mandibular Bone Cyst

Injection Only Sclerotherapy for Mandibular Bone Cyst Without Surgery, as an Outpatient Treatment

What Are the Types of Mandibular Bone Cysts?

A Cyst is a fluid-filled cavity, enclosed within a sac/capsule, arising in soft tissues or bones. The common type of Mandibular Bone Cyst is Odontogenic Cyst. Ondonto meaning tooth/teeth and
genic mean arising/originating from. These cysts are formed or arise from the structures that form the tooth/teeth. The common type of Odontogenic Cyst is the Dentigerous Cyst. This cyst usually contains a tooth within its cystic cavity. A Cyst that has no tooth within it, is regarded as a Non-Dentigerous Cyst. All other Mandibular Bone Cysts are classified as Non-Odontogenic Cysts, arising from structures other than those related to tooth formation.

What is the Standard Treatment Method for Mandibular Bone Cysts?

The standard treatment method is either Marsupialization (create a pouch) or Enucleation (shell out). Marsupialization means surgically making a window and keeping it open with sutures, so that the fluid may drain out into the oral cavity and eventually the cyst may shrink. Sometimes the window will close up on its own & the cyst will not shrink. Enucleation means shelling out the entire cystic sac. However, sometimes the sac is not well defined and it may be difficult to shell out completely, giving rise to recurrences.

What Are the Advantages of Injection Only Sclerotherapy for Madibular Bone Cysts?

Injection only sclerotherapy is an outpatient treatment allowing the patient to go home on the same day. The injection (sclerosant) may chemically destroy the cystic sac, induce scar tissue and bone formation over time, thus shrink the cystic cavity for good. The overlying teeth may be preserved as well, as a result of sclerosis compared  to standard treatment methods. The injections can simply be repeated until this effects (sclerosis) is achieved.

What Are the Complications of this Method? 

Pain of injection and slight swelling for 3 days.

How is Injection Only Sclerotherapy for Mandibular Bone Cysts Carried Out or Done? 

Application of a spray or cream to numb the overlying skin, followed by insertion of a large Intra-venous canula, into the bony cavity through the overlying skin. Keeping the canula in place, all the cystic fluid is drained and replaced with the sclerosants. The patient is reviewed and the procedure is repeated once a week for 3-4 sessions. Clinical assessments and Plain Mandibular X-Rays are done, before and after the procedures to assess the outcomes of this treatment method

Indications for Injection Only Sclerotherapy:

Mandibular Bony Cyst with a Single Cavity, With No Tooth and/or Calcifications Within the Cystic Cavity and No Fistula (connection of cystic cavity to the outside skin or oral mucosa) & the Bony shell must be easy to pierce & canulateThe patient must have no other medical conditions and must fully consent to the procedure after thorough explanations of all available treatment procedures and their advantages and disadvantages

*The details of our technique will not be disclosed yet, until after publication

*Below are diagrams of General Anatomy of a Subcutaneous Tissue Mass including a Cyst &

The Anatomy of a common Mandibular Bone Cyst

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