Cyst of the mandible is the most common clinical condition dealt by oral and maxillofacial surgeons in routine practice. Dentigerous cyst is associated with unerupted or impacted tooth.
In the conventional technique of removal of the cyst, a large amount of thinned-out buccal bone is removed. When the cyst is located lingually, a large amount of sound buccal bone is removed to gain access to the cyst. This can lead to further resorption of bone and mobility of teeth. It may compromise the prosthetic rehabilitation of the patient. Sagittal split osteotomy (SSO) has been reported in the literature for the removal of lingually placed mandibular cysts.
This technique requires surgical skill and expertise and is associated with postoperative disturbances of the inferior alveolar nerve (IAN).
The authors have described a technique, “Repositioning of Buccal Corticotomy (RBC)” to overcome the complications associated with SSO and preserve the sound buccal bone for removal of the lingually placed cyst.
Three patients with the diagnosis of mandibular cysts were selected. Cone-beam computed tomography (CBCT) of the lesion revealed lingually placed cyst [Figure 1a]. The cyst caused expansion and perforation of the lingual cortex with sound buccal cortex. In RBC, the mucoperiosteal flap was reflected and the buccal cortex was exposed. The bony window was made in the region of 46 and 47. Care was taken to avoid injury to the roots of 1st and 2nd molars. Osteotomy was completed with osteotome and osteotomized buccal segment was stored in saline. The cystic lining was visible after the removal of the buccal cortex. The cyst was enucleated entirely along with the removal of 3rd molar [Figure 1b]. Hemostasis was achieved. Platelet-rich fibrin was placed into the surgical defect. Osteotomized buccal segment was repositioned and fixed with a titanium plate with five (2 mm × 8 mm) monocortical screws and two (2 mm × 12 mm) bicortical screws [Figure 1c]. CBCT was taken after 6 months which showed a reduction in the size of radiolucency and the presence of hardware in situ. Patients were followed up for 1 year [Figure 1d]. There were no postoperative complications such as wound dehiscence, IAN injury, implant exposure, delayed infection, and mobility/loss of vitality of teeth.
RBC provides excellent surgical access to the lingually placed mandibular cyst. The sound buccal bone was preserved in this technique. It is relatively simple; there were no postoperative neurosensory disturbances of IAN. Therefore, we recommend this technique for beginners/young surgeons as an alternative to SSO.
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