Jaw cysts. Diagnosis & Treatment

As part of my NHS work, I regularly undertake removal of benign cysts and tumours of the jaws. I can also offer staged treatments where appropriate to decompress larger cysts using techniques such as grommets or marsupialisation (opening the cyst lining to the oral cavity) to “shrink” larger cysts and reduce the possibility of untoward side effects and complications, whilst still treating the condition safely.

How are cysts of the jaws commonly diagnosed?

Cyst can often grow slowly within the bone, undetected. They are not uncommonly discovered as incidental findings on radiographs taken for other reasons. If your dentist uncovers a cyst as part of a routine investigation, they are welcome to refer you to me for rapid diagnosis and definitive management.

I will arrange for plain film radiographs and cross-sectional (3D) images of the cyst (such as a cone beam computed tomography scan or CBCT for short) to ensure that we carefully plan treatment together, laying the groundwork for the optimum chances of success and minimising the potential for damage to adjacent vital structures. These can include the maxillary sinuses and nerves that supply sensation to the lower lip, chin and/or tongue (the inferior alveolar and lingual nerves respectively).

What are the treatment options for jaw cysts?

At the simpler end of the spectrum, some of the cysts that are most commonly seen are radicular cysts. These are at the tips of the roots of teeth and commonly related to chronic apical infections. In such cases, dealing with the offending tooth is of paramount importance. The options will generally include either an extraction or endodontic (root canal) treatment to salvage the tooth. In combination with this, the cyst will need to be enucleated or removed, being submitted for analysis. As part of this, if the tooth is retained and root canal treated, an apicectomy may become necessary. This involves uncovering the tip of the tooth root through carefully placed incisions inside the mouth, removing the tip and sealing it with a retrograde filling material.

In some instances, the cyst is associated with an impacted, unerupted tooth, being referred to as a follicular cyst (named for the follicle which forms the tooth). These take careful planning with cross-sectional imaging (such as cone beam computed tomography or CBCT scans) to avoid injury to adjacent structures. The impacted tooth will need to be surgically removed or decoronated (removal of the crown), along with enucleation or decompression of the cyst, once again submitting this for analysis.

What about keratocysts?

Keratocysts can show much higher recurrence rates than other cyst types. Simple enucleation can lead to a higher propensity for recurrence. Add to this the fact that keratocysts can escape to involve adjacent soft tissues, and more definitive treatment is often warranted to minimise the chance of things coming back. Adjuncts that have traditionally been used include peripheral ostectomy (removal of the surrounding bone) and/or chemical agents such as Carnoy’s solution. In particularly aggressive lesions, segmental resection may be required. The case shown required a custom alloplastic extended temporomandibular joint replacement (eTMJR) from Stryker Ventura TMJ Concepts for a multiply recurrent odontogenic keratocyst with associated pathological fracture on the condyle. As a comprehensively trained specialist in Oral and Maxillofacial Surgery with a subspecialty interest in TMJ surgery, all the options are available to make sure there is the best chance of success in even the most challenging cases.