Therapeutic goal of any ablative
surgical procedure is to remove
the entire lesion and leave no
cells that could proliferate and
cause recurrence of the lesion.
Surgical therapy for oral lesions
involves the following methods:
1- Enucleation 2-Marsupialization
3- Combination of the above 4-
Curettage 5- Resection
o The removal of a tumor or other body entire
without rupture, as one shell out of the kernel of
o Enucleation allows the cystic cavity to be
covered by a mucoperiosteal flap and the space
fills with blood clot, which will eventually
organize and form normal bone.
o Treatment of choice for the removal of cysts
of the jaws in one piece without
o Dentigerous cyst
o Young patients with erupting teeth
o Proximity to vital structure
o Entire pathology is removed.
o Pathological examination of the entire cyst can
o Chances of recurrence are reduced.
o Normal tissue may be jeopardized.
o Fracture of the jaw could occur.
o Devitalization of the tissue could result.
An operation in which the sac of the tumor is
opened and emptied of its contents then the
edges are stitched to the edges of external
incision, which is kept open while inferior of the
cyst suppurates and granulation occurs.
To make it simple it refers to creating a surgical
window in the wall of a cyst and evacuation of
the cystic contents.The process decreases
intracystic pressure and promotes shrinkage of
the cyst and bone fill.
Marsupialization - Technique
Initial Incision circular, extending into cystic
Removal of window of cyst lining
Perimeter of the cystic lining is sutured to oral
mucosa/ Pack the cavity with strip of gauze
o Amount of tissue injury- Proximity of a cyst
to a vital structure could produce damage by
o Undertaken if surgical access is limited.
o As it is simple and less stressful so its
recommended for debilitated patients.
o Also if size of the cyst is very large
marsupialization is preferred because
enucleation can cause jaw fracture.
o Simple procedure to perform.
o Spares vital structures.
o Even quite large cysts can be dealt with local
o Prevent pathological fractures.
o Prevent oronasal, oroantral fistulas.
o Pathology is left in situ.
o Need for regular postop care.
o Secondary surgery may be needed.
Which one is better?
Enucleation is definitely a better alternate than
marsupulization because of complete removal of
pathologic cystic lining.
Marsupulization could be preferred in cases with
increased morbidity and mortality. Employed in
cases of large cysts, proximity to vital structures
and young patients with a dentigerous cyst.
While enucleation should be used in cysts having
high recurrence potential.
Enucleation after Marsupialization:
Enucleation is frequently done after
marsupialization. Enucleation is undertaken
when objectives of the marsupialization
procedure are accomplished.
This combined approach reduces morbidity
and accelerates complete healing.
Enucleation with Curettage:
Means that after enucleation a curette or bur
is used to remove 1 to 2mm of the bone
around the entire periphery of the cystic
cavity. Its done to remove any remaining
epithelial cells that could result in a
Use is indicated for removing an odontogenic
keratocyst due to its aggressive nature or a
cyst that is known to recur after complete
Removal of a tumor by incising
through uninvolved tissue around the
tumor, thus delivering the tumor
without direct contact during
Marginal resection- Resection of a
tumor without disruption of the
continuity of bone.
Partial resection- Resection of a tumor
by removing a full thickness portion of
Total resection- Resection of a tumor by
removal of the involved bone.
Composite resection-With bone,
adjacent soft tissues, and contagious
lymph node channels(used commonly
for malignant tumors)
Resection is indicated when the lesion is
determined to be aggressive or removal
by curettage or enucleation is difficult .