Conservative reduction of large periapical lesions

By Freedland JB.

Date: 07/1970
Journal: Oral Surg Oral Med Oral Patho

Summary

Aim:

(1) to question the need for surgical treatment of the extensive periapical lesion

(2) to present a method of treating the lesion with minimal surgical intervention and injury to any of the related

structures in cases of extensive regions of rarefaction.

6 case reports

Frequency of Radicular Cysts:

•the size of a radiographic lesion is no diagnostic criterion of a radicular cyst.

•In cases of extensive periapical rarefaction , the frequency of cystic lesions range from 42 to 54%.

Marsupialization of Large Cysts:

•using Polyvinyl or polyethelyne tube to reduce larger periapical lesions. •Under local anesthesia, Incision is made, reflection of the mucoperiostuem, bone removal to accomedate the tube.

•Content of the lesion is aspirated, a saline lavage is used to irrigate the area.

•The sterile tube is inserted into the prepared opening till it contacts the base of the lesion.

•The exposed margins of the tube should be smooth to prevent irritation of the soft tissue.

•Epithelization of the margins of the surgical window usually takes place within 5 to 7 days.

•The patient is instructed in the use of a hand syringe of saline solution (patent).

•The patient is seen at intervals of 2 to 4 weeks for reduction of the length of the polyethylene tube as resolution of the lesion progresses.

Most highlighted Results: 

-All patients treated exhibited marked resolution of the radiographic lesion without surgical curettement.

-Cysts can heal without extensive surgical curettement.

– •Conclusion: Decompression should be considered when cystic lesion is large or adjacent to vital structure.