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Cystostomy

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Cystostomy is one of the treatment options for a cyst. A cyst is a tissue cavity enclosed by a thin membrane (epithelium), and it may consist of several chambers that usually contain liquid or soft content. Cystostomy means opening the cyst, whereby the volume of the cyst is reduced.

The Video illustrates a skull X-ray. In the left region of the lower jaw, a swelling can be clearly seen, which is representative of a follicular cyst. The cyst is too large to be removed as the lower jaw could fracture in the process. A cystostomy is first performed. A hole is drilled into the cyst and a drain, in this case a tube, is inserted for communication with the oral cavity. In this way, the cyst will reduce in size over the months, similar to a balloon from which air is released bit by bit. The tube remains in the mouth until the cyst becomes small enough to be completely removed along with the tube. When the cyst (the balloon) has reached a certain size, the cystectomy – means cyst removal – is performed. Apart from large cysts, cystostomy is also recommended when important anatomical structures, which could be damaged by cyst removal, lie in close proximity to the cyst. When the cyst is reduced in size, and when it no longer lies in immediate proximity to important anatomical structures, cystectomy may be performed.

In general, the removal of larger cysts carries a certain risk of wound healing problems because cyst removal creates a large bone defect that normally fills with blood immediately after surgery. As the blood dries, the clot shrinks. A large blood clot contracts more than a small one; it may contract to such a degree that it no longer touches the walls of the wound. In such a case, it is not possible for blood vessels to grow from the walls into the blood clot. This prevents the clot from being supplied with oxygen, nutrients, and finally, with bone cells, which is an important prerequisite for bone regeneration. Consequently, the blood clot disintegrates, pus develops, and a wound infection results. In order to avoid these complications with large cysts, dentists attempt to stabilize the blood clot and reduce its contraction by filling the bone defect with bone substitute materials. This prevents contraction of the blood clot, allowing vessels to grow in from the walls and aiding in subsequent bone regeneration.

The only alternative to planned surgery – cystostomy – is immediate cyst removal; i.e., cystectomy. Left untreated, cysts in the mouth, jaw, or facial area will increase to a considerable size over the years and sooner or later cause the expected complications.

The risks of surgery are negligible with an experienced surgeon. Nevertheless, there could be complications in isolated cases, possibly requiring additional measures. With every additional measure, further complications, which could even be life threatening, may develop. Here we will discuss the specific complications encountered with cystostomy. These include the following:

  • injury to surrounding structures, such as nerves, cheeks, blood vessels, tooth roots, and teeth, with the relevant consequences;
  • incorrectly performed cystectomy on malignant masses that should be removed with a safety margin;
  • wound infection;
  • recurrence in the case of deep and/or multiple-chambered cysts that are incorrectly pierced;
  • drain blockage, necessitating a second surgery;
  • and drainage loss, which may lead to cyst healing and necessitate a second surgery.

Fortunately, such complications are becoming very rare because of improvements in the field of medicine over the past few decades.

Cystostomy