Fibro-osseous lesions of the jaws
Fibrous dysplasia
Cemento-osseous dysplasia
Focal cemento-osseous dysplasia
Periapical cemento-osseous dysplasia
Florid cemento-osseous dysplasia
Ossifying fibroma
Juvenile aggressive ossifying fibroma
Cherubism
Fibro-osseous lesions (FOL) are characterized by replacement of normal bone architecture by collagen fibers and fibroblasts containing calcified tissue.
They include a wide variety of lesions of developmental, dysplastic and neoplastic origins with clinical and radiographic presentation and behavior.
Because of the histological similarities between diverse diseases, proper diagnosis requires correlation of history, clinical and radiographic findings.Fibrous Dysplasia
2. Reactive (dysplastic lesions arising in the tooth-bearing area (presumably of periodontal origin).
a. Periapical cemento-osseous dysplasia
b. Focal cemento-osseous dysplasia
c. Florid cemento-osseous dysplasia
3. Fibro-osseous neoplasms (widely designated as cementifying fibroma, ossifying fibroma or cemento-ossifying fibroma.Bone dysplasias
a. Fibrous dyspla i. Monostoticii. Polyostotic
iii. Polyostotic with endocrinopathy (McCune-Albright)
iv Osteofibrous dysplasia
b. Osteitis deformansc. Pagetoid heritable bone dysplasias of childhood
d. Segmental odontomaxillary dysplasia
2. Cemento-osseous dysplasias
a. Focal cemento-osseous dysplasia b. Florid cemento-osseous dysplasia
3.Inflammatory/reactive processes
a. Focal sclerosing osteomyelitisb. Diffuse sclerosing osteomyelitis
c. Proliferative periostitis
4. Metabolic Disease: hyperparathyroidism
5. Neoplastic lesions (Ossifying fibromas)
a. Ossifying fibromab. Hyperparathyroidism jaw lesion syndrome
c. Juvenile ossifying fibroma i. Trabecular typeii. Psammomatoid type
d. Gigantiform cementomas
Fibro-osseous lesions of the jaws
Fibrous dysplasia
Cemento-osseous dysplasia
Focal cemento-osseous dysplasia
Periapical cemento-osseous dysplasia
Florid cemento-osseous dysplasia
Ossifying fibroma
Juvenile aggressive ossifying fibroma
Cherubism
Fibro-osseous lesions (FOL) are characterized by replacement of normal bone architecture by collagen fibers and fibroblasts containing calcified tissue.
They include a wide variety of lesions of developmental, dysplastic and neoplastic origins with clinical and radiographic presentation and behavior.
Because of the histological similarities between diverse diseases, proper diagnosis requires correlation of history, clinical and radiographic findings.Fibrous Dysplasia
2. Reactive (dysplastic lesions arising in the tooth-bearing area (presumably of periodontal origin).
a. Periapical cemento-osseous dysplasia
b. Focal cemento-osseous dysplasia
c. Florid cemento-osseous dysplasia
3. Fibro-osseous neoplasms (widely designated as cementifying fibroma, ossifying fibroma or cemento-ossifying fibroma.Bone dysplasias
a. Fibrous dyspla i. Monostoticii. Polyostotic
iii. Polyostotic with endocrinopathy (McCune-Albright)
iv Osteofibrous dysplasia
b. Osteitis deformansc. Pagetoid heritable bone dysplasias of childhood
d. Segmental odontomaxillary dysplasia
2. Cemento-osseous dysplasias
a. Focal cemento-osseous dysplasia b. Florid cemento-osseous dysplasia
3.Inflammatory/reactive processes
a. Focal sclerosing osteomyelitisb. Diffuse sclerosing osteomyelitis
c. Proliferative periostitis
4. Metabolic Disease: hyperparathyroidism
5. Neoplastic lesions (Ossifying fibromas)
a. Ossifying fibromab. Hyperparathyroidism jaw lesion syndrome
c. Juvenile ossifying fibroma i. Trabecular typeii. Psammomatoid type
d. Gigantiform cementomas
Odontogenic keratocyst (OKC) is the cyst arising from the cell rests of dental lamina. It can occur anywhere in the jaw, but commonly seen in the posterior part of the mandible. Radiographically, most OKCs are unilocular when presented at the periapex and can be mistaken for radicular or lateral periodontal cyst.
Odontogenic keratocyst (OKC) is the cyst arising from the cell rests of dental lamina. It can occur anywhere in the jaw, but commonly seen in the posterior part of the mandible. Radiographically, most OKCs are unilocular when presented at the periapex and can be mistaken for radicular or lateral periodontal cyst.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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Vestibuloplasty /certified fixed orthodontic courses by Indian dental academy Indian dental academy
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
DOI:10.21276/ijlssr.2016.2.4.12
ABSTRACT- Mucocele is a commonly found benign, mucus-containing cystic lesion of the minor salivary gland caused
due to the damage or blocking of the glands. The damaged duct causes the saliva to build up and a cyst like swelling
ensues. Histologically they are of two types: Extravasation cyst and Retention cyst. Clinically they present themselves as
soft, bluish and transparent cyst like swelling especially on the lower lip. This case report presents a case of a 35 year old
male patient reporting with a soft bluish swelling on the inside of the lower lip. The history revealed the patients habit of
biting on the lower lip hence a differential diagnosis of mucocele, oral hemangioma, oral lympangioma, lipoma, and soft
tissue abscess was made. Fine needle aspiration cytology showed increase in amylase and protein content. A final
diagnosis was formulated as mucocele from the history of trauma, clinical features, and investigation (chemical analysis).
Complete excision of the lesion was done and sent for histopathological investigation which revealed a mucin-filled
cyst-like cavity beneath the mucosal surface. The patient was kept under observation for 3 months. The healing was
devoid of any scar formation commonly associated with such surgery’s. There was no recurrence of the cyst after 6
months. Alternative treatment modalities are cryosurgery, intralesional steroid injections. Key-words- Mucocele, Cyst, Salivary Retention, Salivary glands, Duct
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
3. CYST OF THE JAWS
A cyst is defined as an abnormal cavity in
hard or soft tissue which contains fluid,
semifluid or gas and is often encapsulated
and lined by epithelium (Killey and Kay
1966).
In 1974, Kramer defined cysts as a
pathological cavity having fluid, semi-fluid
or gaseous contents that are not created by
the accumulation of pus, frequently but not
always, is lined by epithelium.
4. Classifications
Various classifications have been given to describe
these lesions:
1. Robinson (1945)
2. WHO classification (1971)
3. Shear's classification (1983)
WHO Classification
Epithelial cysts
A. Developmental cysts
1. Odontogenic
a) Primordial cyst (keratocyst)
b) Gingival cyst
c) Eruption cyst
5. d) Dentigerous cyst (folificular)
2.Non-odontogenic
a) Nasopalatine (incisive canal)
b) Globulomaxillary
c) Nasolabial
Inflammatory cysts
Radicular cysts
6. Robinson „s Classification
Developmental
From odontogenic tissue
1. Periodontal cysts
a) Radicular cysts
b) Lateral cyst
c) Residual cyst
2. Dentigerous cyst
3. Primordial cyst
From non-odontogenic tissues
1. Median cyst
2. Incisive canal cyst
3. Globulomaxillary cyst
7.
8. Shear‟s classification
1.Cysts of the jaws
2.Cysts associated With maxillary antrum
a)Benign mucosal cyst of maxillary antrum.
b)Surgical ciliated cyst of the maxilla.
3. Cysts of soft tissues of mouth, face
and neck
a)Dermoid and epidermoid cyst
b) Branchial cyst
c)Thyroglossal duct cyst
e)Cystic hygroma
f)Cysts of salivary glands
11.
PATHOGENESIS
Steps in Cyst Formation
The formation of a cyst takes place in
generally three stages:
1. Initiation
2. Cyst formation
3. Enlargement or expansion of cyst cavity
Cyst Initiation
The factors initiating the formation of the
cyst may be different depending on the type
of cyst that is formed.
12.
A chronic low grade infection due to the
bacterial invasion of the pulp may cause
activation of the usually dormant cell rests of
Mallessez. This causes initiation of the cyst
process.
Cyst Formation
It is proposed that during this stage, the cyst
cavity gets lined by stratified squamous
epithelium.The blood supply is rich at the
periphery and the cells present in the centre
lack nutrition. As a result, these cells tend to
desquamate into the centre of the mass. This
produces a fluid with increased osmolarity in the
centre surrounded by an epithelial lining
13.
Cyst Enlargement
The basic mechanism for enlargement is the same for most
cysts.
Various factors involved are:
1. Production of raised internal hydrostatic pressure
The most commonly accepted mechanism is that the
desquamated epithelial cells undergo autolysis and release
a large number of low molecular weight molecules. This
increases the osmolarity of the fluid within the cyst.
2. Attraction of fluid into the cystic cavity
This increased osmolarity of the fluid draws fluid from the
surrounding tissue spaces into the cystic cavity due to the
osmotic differences. It is also believed that acute
inflammation makes the capillaries in the region highly
permeable
14.
This results in exudation of protein rich fluids into the
cystic cavity. This is considered another mechanism
for accumulation of fluids into the cyst cavity.
3. Retention of fluid within the cystic cavity
It is believed that the cyst lining acts as a semipermeable membrane allowing fluid to enter the
cavity .but preventing it from going out.
Toller's experiments have shown that the osmotic
imbalance resulted in the inability of the large
molecules in the fluid to escape because of lack of
access to the lymphatic system.
4. Epithelial growth
Mural growth or the growth of the cells of the cystic
lining itself helps in expansion of the size of the cyst.
15.
5. Resorption of surrounding hone
A positive internal pressure transmitted to the adjacent
bone causes resorption and enables enlargement,
Osteoclastic factors such as PGE.
Further enlargement of the cystic lesion within the bone
produces microcracks on the further thinned out cortical
plates. When the cortical plates are palpated, it produces a
grating noise described as 'egg shell crackling'.
In a later stage, thinned out alveolar bone completely
resorbs and the cyst lining lies just beneath the oral
mucosa. Fluctuation may be elicited at this stage.
Later perforation of the cyst lining and oral mucosa may
cause drainage of cyst contents into the oral cavity
producing a salty taste2, PGE3 play a role in bone
resorption
16. Signs of cyst:
Examination findings
1. Bone expansion
2. Fluctuant swelling under oral mucosa
3. Non vital tooth (if radicular cyst)4. Missing tooth in normal series
5. Sinus formation with discharge
6. Large cyst distortion of adjacent
structures
7. Hollow sound on percussion
17. Radiographs for cyst
1. IOPA for small periapical cyst to see
tooth involved
2. Occlusal view to check lingual cortical
expansion/perforation
3. PNS view (occipitomental) to show
relation to maxillary antrum and nasal
cavity
4. Lateral oblique (mandible) to check
proximity to lower border
5. PA view to check expansion of ramus of
mandible
6. OPG recommended in most cases; entire
extent, size etc. can be assessed
18.
Dentigerous cyst-unilocular ,well defined
radiolucency with sclerotic border around the
crown of an unerupted tooth.
Three radiographic typecircumcoronal,circumferential and lateral.
Odontogenic keratocyst-multilocular
radiolucency and give “soap bubble
appearance”.
Radicular cyst-solitary well circumscribed
radiolucency attached to the apex of the nonvital tooth.
19. Diagnosis based on type
of aspirate
1. Clear, pale, straw coloured fluid with
cholesterol crystals. Dentigerous cyst
2. Creamy white, thick aspirate
Odontogenic keratocyst
3. Yellowish, foul smelling fluid (pus)
Infected cyst
4. Blood on aspiration Needle in a blood
vessel Vascular lesion ABC
5. Air on aspiration Maxillary antrum
Traumatic bone cyst
6. Negative aspiration Solid tumor
21. Marsupialisation or
Partsch I Operation (cystotomy)
• In 1892 Partsch described a type of
decompression procedure for the treatment of
cysts.
• In this procedure, a window or a fenestration is made in the bone and the cystic con-tents
are evacuated. The cyst lining is left behind.
• Once the cyst contents are evacuated, the
intracystic pressure reduces. The hollow cavity is
then packed till it gets obliterated by bone
slowly over a period of time.
• The cystic lining then becomes continuous
with the normal oral mucosa
22.
23. Advantages of
Marsupialisation
1. Once the liquid contents of the cyst are re-leased,
there is an inherent tendency for the cyst lining to
contract probably due to myofibrils in the walls. This
stimulates endosteal bone formation.
2. As the cyst lining shrinks, there is a marginal
ingrowth of normal mucoperiosteum which replaced
the capsule with its resorptive potential.The
ingrowing mucoperiosteum may provide it with
additional bone re-generation factors.
3. This is a more conservative method.
4. Not much surgical skill is required.
5. There is no risk of oroantral or oronasal fis-tula.
6. No damage to the adjacent vital structures.
7. No risk to adjacent vital teeth.
24.
Disadvantages of Marsupialisation
. Entire pathological tissue is left behind.
2. High chances of recurrence of the cyst.
3. As the bony cavity is large, healing and
fill-ing up with normal bone takes a long time.
4. Use of cyst plug is required with repeated
cleansing.
5. Time consuming and repeated appointments
for the patient.
Indications for Marsupialisation
1. Extremely large cyst
2. Risk of cyst opening into maxillary sinus or
nose due to surgical removal of complete lesion
25. Enucleation (Partsch
ll/cystectomy)
Enucleation is the surgical removal of the
entire cystic lining in toto.
By definition, it means shelling out of the
entire cystic lining without rupture.
This surgical procedure leaves behind a
hollow cavity in bone covered by oral
mucoperiosteum. This gets filled up with
blood clot which even-tually organizes to
form healthy bone.
26.
27.
28. Advantages of
Enucleation
1. Entire pathological tissue is removed
from the lesion.
2. Tissue available for hi stopathological
exami-nation.
3. Chances of recurrence are less.
4. Healing time is faster and less
appointments for the patient
5. Enucleation with primary closure
eliminates the need for repeated
appointments for pack-ing medicated
gauze, irrigation, fabrication of plug etc.
29. Disadvantages of
Enucleation
1. Relatively radical procedure
2. Chances of devitalising the adjacent teeth
3. Chances of fracture of the jaw
4. Risk of creation of oroantral/oronasal
communication.
Indications for Enucleation
Enucleation is the treatment of choice for
re-moval of cysts of the jaws and should be
employed with any cyst of the jaw that can
be safely removed without unduly sacrificing
the under-lying structures.
30. Enucleation
Small cysts can be removed under local
an-esthesia whereas large cysts close to vital
structures and blood vessels should be taken out
under general anesthesia.
After achieving adequate anesthesia, a
mucoperiosteal incision is made such that the
incision rests on sound bone.
Mucoperiosteal flap is reflected taking care not to
perforate the cystic lining.
If the bone is perforated by the cyst, the lining will
be adherent to the periosteum and will be difficult
to reflect it.
Cystic lining is exposed and now carefully teased
away from bone. Its easy to separate the cystic
lining from bone because there is a layer of fibrous
tissue between the two.
31.
After the cyst is removed completely the cavity is
irrigated throughly,hemostasis ensured,sharp bone
margin are filed and flap replaced and sutured.
Enucleation open packing:Gauze impregnated with bismuth iodoform parraffin
paste (BIPP) or whitehead varnish.
Enucleation with bone grafting:• Bone grafting with autogenous cancellous bone
grafts can be done in case of large bony defects.
• The bone graft obliterates the cavity and
stimulates osteogenesis.
• There is, however, a risk of wound breakdown
and infection of the bone graft which may lead to
failure.
32. Composition of carnoy's
solution
1. Glacial acetic acid
2. Chloroform
3. Absolute alcohol
4. Ferric chloride
It is indicated mainly in cases of odontogenic
keratocyst. Afterenucleation, to remove any
re-maining lining of the cyst chemical
cauterising agent Carnoy's solution is applied
along the walls of the cystic cavity. It is left for
about 5-7 minutes and then irrigated
thoroughly with saline.
33. Complications of cyst
management
1. Injury to inferior alveolar nerve
2. Injury to adjacent teeth
3. Fracture of jaw
4. Oro antral fistula communication
5. Hematoma formation
6. infection
7. Dead space
8. Incomplete removal
9. Recurrence
10. Malignant transformation