The document discusses different surgical techniques for treating cysts, including enucleation which completely removes the cyst, marsupialization which creates a window to drain the cyst contents while leaving the lining intact, and enucleation with curettage which uses a bur to remove 1-2mm of bone around the cyst cavity after enucleation to eliminate any remaining epithelial cells that could cause recurrence. Marsupialization is indicated when access is difficult, a vital structure is at risk, or the patient is in poor health, while enucleation with curettage is preferred for aggressive cysts like keratocysts due to

1. Biopsy

3. Enucleation
• Enucleation means complete removal of a cyst. This can be
done by currettage (using currette),or by blind sections of
cystic lining (we put a blunt instrument and you sort of
‘peeling’ the bony lining).
• Appical cystoectomy

4. • For a cyst that has a recurrence potential, you
need to do peripheral osteoctomy after removing
the cyst. How? By removing the 3-4mm of bone
surrounding the cavity with a big, sharp bur.
Make sure that the bur are big enough to remove
any remaining cyst or daughter cyst (if dealing
with keratocyst).
• Opening a wide flap or window and remove all
the cyst as one sac(with the lining intact). Then
we close the window and leave it to be fill up
with bone over time.

5. • In the case of dentigerous cyst, when you open the area you
can see a bluish sac which is the cyst. Then you need to
enlarge the bone around it. You bluntly remove the whole cyst
with the causative impacted tooth. You can see that this is
obviously a dentigerous cyst because the crown was
completely covered with the dentigerous sac

8. MARSUPIALIZATION
Marsupialization, decompression,
and the Partsch operation refer
to creating a surgical window in
the wall of the cyst, evacuating
the contents of the cyst, and maintaining
continuity between the cyst and the oral
cavity, maxillary sinus, or nasal cavity .The only
portion of the cyst that is removed is the piece
removed to produce the window. The remaining
cystic lining is left in situ. This process decreases
intracystic pressure and promotes shrinkage of
the cyst and bone fill.Marsupialization can be
used as the sole therapy for a cyst or as a
preliminary step in management, with
enucleation deferred until later.

10. Indications
• Factors to determine weather to do masupialization or not as as
follow
• 1.Amount of tissue Injury- Close Proximity of a vital structure
will indicate for marsupialization to avoid unwanted removal of
adjacent vital tissue. Ex- If removal of cyst will result in formation
of oroantral fistula then it's better to go for Marsupialization.
• 2.Surgical Access- If access to all portion of cyst is difficult and
there is chance of leaving a piece of cyst wall.
• 3.Assistance in eruption- If cyst is associated with a unerupted
tooth then marsupialization will help in eruption of tooth.
• 4.Extent of surgery- In a unhealthy and debilitated patient
marsupialization is good alternative to extensive removal.
• 5.Sizeof cyst- A risk of Jaw fracture in a very large cyst, it may be
better to go for Marsupialization.

12. Technique
1.Prophylactic antibiotic is needed if patients health condition warrents.
2.Anesthetize the area.
3.Cyst is Aspirated.
4.Aspiration conforms the diagnosis then proceed for marsupialization.
5.Initial incision is circular or eleptical and create a large window in the cyst cavity.
6.If bone have been thinned or exposed then incision goes through bone into cavity.
7.If bone is thick then a surgical window is created by removing bone with help of
bur.
8.Piece of tissue is submitted to the lab for further tests.
9.Content of the cyst are evacuated.
10.Cyst cavity is irrigated with normal saline to remove and residual fragment.
11.If access permits then perimeter of the cyst wall can be sutured with the oral
mucosa.
12.Or you can pack the cavity with a strip of gauze impregnated with tincture of
benzoin or antibiotic ointment and leave it for 15 days it will prevent the oral
mucosa to heal over window.
13.Give careful instructions to the patients about cleansing of the cavity.

13. Enucleation with Curettage
• Enucleation with curettage means that after
enucleation a curette or bur is used to remove
1 to 2 mm of bone around the entire
periphery of the cystic cavity. This is done to
remove any remaining epithelial cells that may
be present in the periphery of the cystic wall
or bony cavity. These cells could proliferate
into a recurrence of the cyst.

14. Inidcation
• odontogenic keratocyst. In this case the more aggressive
approach of enucleation with curettage should be used
because odontogenic keratocysts exhibit aggressive clinical
behavior and a considerably high rate of recurrence.
Daughter, or satellite, cysts found in the periphery of the main
cystic lesion may be incompletely removed, which contributes
to the increased rate of recurrence.‘
• any cyst that recurs after what was deemed a thorough
removal. The reasons for curettage in this case are the same
as those outlined previously

15. Advantages
• If enucleation leaves epithelial remnants, curettage
may remove them, thereby decreasing the likelihood of
recurrence.
Disadvantages
• Curettage is more destructive of adjacent bone and
other tissues. The dental pulps may be stripped of their
neurovascular supply when curettage is performed
close to the root tips. Adjacent neurovascular bundles
can be similarly damaged. Curettage must always be
performed with great care to avoid these hazards.