The radicular cyst of the upper jaw is a cavity formation in the area of the apex of the tooth root, internally lined with epithelial tissue and filled with a special cystic fluid. Represents the completion of periapical chronic inflammation. A person with a radicular cyst of the jaw (ICD 10 K09) sometimes does not feel anything, does not complain about anything, inconvenience occurs when it grows into the maxillary sinus or when suppuration of the contents. The continued existence of the cyst causes deformation of the bone tissue and increases the likelihood of a jaw fracture. The treatment is carried out mainly by surgery.
Description of the disease
A root or radicular cyst of the upper jaw is understood to mean fluid formation with fibrous walls, which forms in the apical region of the tooth root and limits the focus of inflammation from healthy periodontal tissues. This is the most common type of cystic jaw pathology - it occurs in 95% of patients. Dental cysts of the upper jaw are more common when compared with the lower. Both women and men, usually between the ages of twenty and forty-five, are equally affected by the appearance of formations. Radicular cysts of the upper jaw can be more than five centimeters in diameter. The root cyst is formed from epithelial cells under the influence of the process of inflammation in periodontal tissues. It has thin fibrous surfaces, is lined with a flat layered epithelium from the inside, filled with a clear yellow liquid with cholesterol crystals. The formation appears either directly on the upper part of the tooth root (the so-called apical cyst), or on the lateral root surface and is then referred to as a periodontal lateral cyst.
Why is a cyst formed? Causes
The main reason for the formation of a radicular cyst of the upper jaw is the presence of an inflammation process, as a result of which a connective tissue capsule appears in the body that isolates the infectious focus. Mostly cysts are formed in people with a long-term process of caries, periodontitis, pulpitis or due to incompetent dental intervention. Among the most common diseases, the precursors of cysts, is granulomatous periodontitis - an inflammatory chronic pathology of periodontal disease with the formation of specific connective tissue granulomas, which gradually grow and turn into cysts. The cause of an infectious lesion is often a dental injury, a person’s infectious disease: sinusitis, otitis media or tonsillitis, and a deterioration in immunity. Also, a malocclusion, difficult eruption of eights can be accompanied by a cystic process.
Symptoms
The maxillary radicular cyst (ICD 10 K09) for a long time can occur completely without symptoms or be accompanied by signs that are insignificant for the patient, and therefore they are often simply ignored. During the examination, the dentist will notice a darkening of the tooth (the inflamed tooth may be under the crown, in which case it is much lighter than the tooth itself) or the carious process is in a neglected state. The sounding of the root canals does not cause pain and is accompanied by the release of a yellowish liquid. As a rule, percussion infrequently causes discomfort. With a large cyst, displacement of adjacent teeth, deformation of the alveolar process, palpation in this area is accompanied by a sign of “parchment crunch” and a feeling of compliance of the surface under the fingers of the dentist. Deformation of the face of people with a radicular cyst is observed in 36.4 percent of cases. Due to the growth of the formation, bone tissue is destroyed, as a result, the likelihood of a jaw fracture increases.
Symptoms are much brighter if there is cystic suppuration. Such a phenomenon can provoke a blow to the tooth or a maxillofacial injury, sinusitis, an unsuccessful intervention by a dentist, etc. Inflammation begins with a cystic wall, the infected contents transform into pus. There are complaints of pain in the area of the causative tooth, signs of intoxication (chills, malaise, fever). An objective examination determines the swelling of adjacent tissues and hyperemia.
The lack of competent medical care in this case leads to significant complications, for example, phlegmon of soft tissues, fistula, maxillary osteomyelitis. The infectious process can go to the paranasal sinuses and inner ear, due to which inflammatory pathologies of the ENT organs are formed. Also in dentistry, the phenomenon of cystic germination in the maxillary sinus is found. Because of this, the walls are seriously deformed, the spongy bone substance atrophies, and the patient develops sinusitis.
Diagnostic Methods
The most reliable diagnostic method is dental radiography. A radicular cyst is often determined randomly during the treatment of other teeth. Such a formation is an x-ray oval or round shadow with clearly visible boundaries located at the top of the tooth root or near the lateral root wall. The bone structure of the periodontal fissure is not visualized in the image, since it is destroyed. The roots of adjacent teeth are displaced. Sometimes the cyst cannot be identified even with the help of an X-ray, as the root of the diseased tooth does not fully reach the visibility range. To clarify the diagnosis, the method of electroodontometry is used. In a causative tooth, the threshold of excitability varies between 100-120 μA, that is, indicates pulp necrosis.
To determine if the cystic formation is malignant, a puncture is made with a thick needle. The contents of a radicular non-suppurative cyst is a yellow fluid in which there are cholesterol grains. To exclude the germination of the formation in the cavity of the nasal sinuses, it is necessary to additionally carry out x-ray of the latter. Radiological symptoms of a cyst are deformity of the sinus bone bottom and protrusion of a domed shape. In doubtful situations, it is desirable to conduct computed tomography or contrast radiography of the bone of the upper jaw.
Differential diagnosis of this type of cyst is carried out with other jaw cystic formations and tumors (osteoblastoclastoma and ameloblastoma). With a follicular cyst, there is no connection between the disease and the process of inflammation in the causative tooth, while radiography in the cystic cavity determines the crown of the permanent tooth. The study of the dental arch reflects the absence of a permanent tooth or the presence of a milk tooth in its place. Follicular cysts are most often found in children and young men. Cysts of the incisor channel are formed precisely in the midline of the hard palate, behind the central upper incisors. In the region of the nasolabial beard under the base of the nasal wing are nasolabial cysts, in the space between the maxillary canine and the lateral incisor - globulomaxillary.
Ameloblastoma is characterized by the presence in the area of the body and the angle of the lower jaw, while its development is not associated with inflammatory pathology of the periodontium. During X-ray analysis, the tumor looks like a polycystic formation with an unbreakable figure of eight inside or a single-chamber cyst. To clarify the diagnosis, puncture is required, as well as a cytological analysis of the material obtained. The difference between osteoblastoclastoma from a radicular cyst is in less clear boundaries and a cellular structure in an x-ray. The roots of the teeth, falling into the area of the tumor, are most often resorbed. If a puncture is performed, then get a little brown liquid without cholesterol impurities.
Conservative treatment of the radicular cyst of the upper jaw
Treatment of an altered cystic tooth root requires cleaning and disinfection of the tooth, filling. Another alternative method of treatment is the introduction of a healing suspension containing calcium and honey, with the further effect of small electric discharges on the tooth. The main indications for drug therapy are: poor filling in the root canals (not along the entire length); the absence of fillings on the root canals; the size of the cyst barely reaches eight millimeters.
In the treatment of radicular cysts of the jaw, special means are used that adversely affect the cystic capsule and its contents. Then the purulent exudate is completely removed, and instead a dental paste is introduced into the cystic cavity, restoring the bone structure. Manipulations end with filling the crown and the canal. Relapses are possible. What operations with a radicular cyst of the upper jaw are performed?
Surgery
There are two methods of surgical treatment of such a pathology: cystectomy and cystotomy. With cystotomy, a specialist makes an opening so that the cystic cavity communicates with the external environment, thereby reducing hydrostatic pressure inside the formation after outflow of fluid into the oral, nasal cavity or sinus. Such an intervention to remove the radicular cyst of the upper jaw is desirable for large formations that destroy the surface of the maxillary sinus and touch several dental roots, while not having radiological symptoms of an enlarged periodontal gap, and extensive mandibular cysts that thin the jaw bone. The operation is performed under local anesthesia as follows: the doctor cuts out the mucoperiosteal semi-oval flap in the area of the cystic formation, exposes the bone wall and makes a trepanation, then the cystic cavity is washed and filled with an iodoform swab. In order to prevent the return of the disease during the procedure, it is advisable to carefully check the tissue and eliminate areas with necrosis. After a week, the tampon changes, and subsequently the dressing changes 3-4 times. Such an operation with a radicular cyst of the upper jaw is well tolerated by patients, but is accompanied by a long existence of a defect after surgery.
With cystectomy, the cyst is completely removed by separating the fibrous membrane from the adjacent tissues. Then a cavity tamponade or rapprochement of the edges of the mucous membrane disturbed during the procedure is done. Such manipulation is desirable for people with small cysts or large formations in places where there are no teeth, if a fairly thick layer of bone tissue is preserved. In some cases, surgeons consider the combination of both surgical procedures to remove the radicular cyst of the upper jaw to be correct.
Due to the lack of obvious clinical signs, the disease is diagnosed late, when its course, as a rule, is complicated by deformation of the anatomical structure of the oral cavity or the attachment of an infection. For the timely determination of a radicular cyst, you need to constantly visit the dentist. Preventive measures are to ensure the health of the oral cavity and high-quality treatment of various diseases, for example, periodontitis, pulpitis and caries.
With a radicular cyst of the upper jaw, how long does healing take?
Rehabilitation and healing time
Removal of the cyst is always followed by a rehabilitation period during which rehabilitation treatment is used. In order to accelerate the regeneration process of tissues, a special drug is administered to the patient in the cavity that remains from the eliminated cyst. Tangible recovery is observed approximately six months after the intervention.
Complications with a radicular cyst of the upper jaw are not excluded.
Prognosis and consequences of jaw cysts, complications
With small education in the early stages, the prognosis is positive. In such cases, dentists most often manage to eliminate a benign cyst and preserve the tooth.
With a significant size of the cystic cavity, the prognosis becomes satisfactory. Patients will have to lose one or even several teeth.
The negative consequences of jaw cysts are associated with a violation of the walls of the maxillary and nasal sinuses, the appearance of spontaneous jaw fractures, purulent lesions of the bone and periosteum, sudden bleeding. The success of the surgeon’s intervention with the follicular and radicular cysts largely depends on the time of diagnosis and the radical intervention performed at the right time.
Reviews about the operation with a radicular cyst of the upper jaw
Patients say that in rare cases, surgical treatment can be dispensed with. If you follow all the recommendations of a doctor, then you can get rid of the pathology and restore health.
Reviews of operations are mostly positive. Complications after surgery are very rare.
People report that during the rehabilitation period, one should carefully monitor the condition of the oral cavity, use antiseptic rinses, and carry out all hygiene procedures in a quality manner. If there are signs of intoxication and the temperature rises, you need to urgently go to the dentist surgeon.
Disease Prevention
There are no specific measures that guarantee to exclude the possibility of the appearance of a radicular cyst of the upper jaw (ICD K09). Prevention is based on regular oral hygiene, timely treatment of caries and various complications, and numerous infectious diseases. It is necessary to regularly clean the plaque from the teeth so that it does not harden and does not transform into tartar.
It is very important to visit the dentist at least once a year for the purpose of a routine examination, which will prevent the appearance of various pathologies of the oral cavity.