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12 February 2020

Surgical removal of intrabone cysts and their post-operative complications

Giulia Palandrani

Intrabony cista in the jaw are the most common benign findings in the oral and maxillofacial area. The best treatment option to manage intrabony cystic lesions is surgical removal  (enucleation).
Cysts that encompass vital anatomic structures might require decompression using procedures such as marsupialization.  However, surgery often results in postoperative complications: infection, recurrence, paresthesia, and pathologic fractures.
However, it is still challenging for surgeons to predict various preoperative factors that can affect the complication rate.

Material and Methods
In this study 249 patients composing 262 cases underwent surgical removal of intrabony cysts were retrospectively reviewed. All cystic lesions were removed by enucleation by a single surgeon. After enucleation, bone grafting with xenogeneic bone material or autogenous iliac bone was considered based on the size and configuration of the defect area. If the resultant defects were small or preoperative infection persisted at the time of surgery, then bone grafting was usually not performed. Outcome variables were postoperative pathologic infection, fractures and recurrence. Predictor variables included demographic data (age and gender), comorbidities (diabetes and osteoporosis), anatomic factors (cyst location and size), pathologic diagnoses, and perioperative conditions (preoperative infection history, previous marsupialization, and bone graft methods).  

Cystic lesions were most frequently detected in the posterior mandible (132 cases), followed by the anterior maxilla (74 cases), posterior maxilla (29 cases), and ramus (16 cases). The most frequent lesion was a dentigerous cyst (135 cases), followed by a periapical cyst (57 cases), an OKC (37 cases), and a nasopalatine duct cyst (26 cases). Marsupialization was performed in 20 cases, Autogenous bone grafting was performed in 11 cases (4.2%). Xenogeneic bone graft ing was performed in 41 cases (15.6%). Primary closure without filling material was performed in 210 cases (80.2%).       

INFECTION: Postoperative infection occurred in 59 cases (22.5%). Autogenous bone grafting was a meaningful predictor of postoperative infection. (odds ratio [OR] = 7.56; P = .008). Xenogeneic bone grafting also was associated with a higher infection rate compared with no bone grafting, although this result was not statistically significant (OR = 2.13; P = .094). The postoperative infection rate was 63.6% (n = 7 of 11) when autogenous bone was grafted, 26.8% (n = 11 of 41) in xenogeneic bone graft cases, and 19.5% (n = 41 of 210) in no bone graft cases. Maxillary and mandibular locations of cystic lesions were meaningful predictors of the infection rate. The infection rate was highest in lesions located at the mandibular ramus, followed by those in the posterior mandible. The presence of a preoperative infection was not statistically associated with the incidence of post- operative infection

RECURRENCES: Recurrence was observed in 7 cases (2.6%). Five of these cases were diagnosed as OKC, 1 as a periapical cyst, and 1 as a dentigerous cyst . Cyst size was meaningfully correlated with recurrence rate.

PARESTHESIA AND PATHOLOGIC FRACTURES: Paresthesia after enucleation occurred in 38 cases (14.5%). Of these, 11 cases were associated with sacrifice or damage to the nasopalatine nerve, The other 27 cases occurred after enucleation of lesions that were encroaching on the mandibular canal. There were 4 (1.5%) pathologic fractures occurred at the angle of the mandible. In these patients the mean thickness of the remaining bone on the panoramic radiographs was 7.3 mm.                        

For additional informations: 
Investigation of Postoperative Complications of Intrabony Cystic Lesions in the Oral and Maxillofacial Region

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