Mandibular Cyst Removal from the Viewpoint of a Dental Patient

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Last winter, a routine X-ray at the dentist’s office revealed a Mandibular cyst in my upper jaw that would need to be surgically removed...

Mandibular Cysts are Easily Treatable by Surgical Removal

It was a difficult fall and winter in terms of my dental care. An upper molar caused problems and my right cheek swelled up rather drastically and unexpectedly overnight. An impromptu visit to my dentist revealed I had an infected root, and that I would require a root canal.

The dentist opened-up the tooth and drained the abscess, prescribed an antibiotic for me to take and instructed me to come back in 5 days to continue with the procedure.

At the five day request, I returned. Upon examining the tooth he indicated that there was still infection present, which he flushed-out again. He added two more antibiotics; a 10-day regimen, and asked me to return when these medications were finished. These were very strong antibiotics and he indicated that if these didn't work, I might be required to spend an overnight in the hospital with an IV of antibiotics, pointing out that the root canal procedure cannot continue until the infection is halted.

Nearing the end of the 10-prescription, the winter weather turned severe and I was unable to get to the dentist's office (and as it turned out, he was also unable to get there himself due to a massive snowstorm) so I ended up having to wait several days beyond the end-of-prescription to resume the procedure. Essentially, off of antibiotics and susceptible to getting another infection due to this tooth being 'open' to drain. There was no pain because the root had been extracted, but the tooth cannot be sealed or closed-off until the infection inside of the tooth and up through the end of the tooth's structure had ceased.

I finally got back in to the dentist some four days after the antibiotics had been exhausted, and the infection was in fact, halted. But I had an inquiry into another matter that revealed itself in the previous day or so. Even though the swelling had gone down on my cheek and ear and I felt fine, there was the new development in the form of a bulbous lump near where the root canal was being performed, one tooth further back. I could feel it against my cheek, and with my tongue. I couldn't really see it in the mirror though. He palpated the area with a finger and revealed that there was an abscess coming out from under the gum-line. It was an unrelated but also another potentially serious issue. An X-ray was taken (shown below) and this revealed a Mandibular Cyst in the upper mandible.

Mandibular Cyst as seen in an X-Ray Image

X-ray of mandibular cyst. Two views, second image has wire probe inserted

(both images of the same site; 2nd image has a wire probe inserted for identifying the cyst parameters, arrows and outline by author)

Upon comparing the above X-Ray image with another scan taken several years earlier, only a very mild suggestion of a cyst wall was visible, and smaller. Yet another X-ray two years old showed absolutely no trace of this cyst development. So this started to develop about three years ago, but didn't become a problem until last winter.

There are many dozens of scientific papers written on the subject of Mandibular cysts, their pathology and treatment posted on the web for professional peer review so I won’t go into explaining or even pretend to understanding any of it. But here is what I was told;

Mandibular cysts are cavities (not of the same type as dental caries) in the jawbone or mandible. These usually occur in people a bit younger than me, generally occurring in the 20s but they can occur at any age and there is no gender predominance although males seem to get these slightly oftener. Mandibular cysts tend to occur most often in the lower jaw between the canine and first premolar, and also around the back molars if there is an impacted tooth involved. Impacted teeth are prime suspects and causative for mandibular cyst formation, but these cysts can occur without impacted teeth being the cause, and they tend to grow larger if not removed. Apparently mine was close to be septic as it caused facial swelling. It could have sent me to the hospital if not treated right away.

To remove these cysts, an orthodontist opens-up the jaw or mandible and through surgical exploration and curettage of the bony walls, scrapes-out the cyst material and saves a portion of the cyst into a preserving solution for lab examination. Procedurally, my dentist said that he could remove this himself but his office does not have the proper lab connections for performing biopsy of these types of cyst. So, I was referred to an orthodontist-surgeon.

Orthodontist Visit

My visit to the orthodontist went far easier than expected. A general anesthetic was given and he opened up the jawbone at the gum-line with a small V-shaped incision. Speaking as he worked, he explained that by using various tools he was going to scrape-out the cavity of the cyst and send it for sampling. There were some disconcerting metal-on-bone scraping sounds and vibrations as he worked, but I was comfortable with it and the procedure was totally painless.

The cyst to him appeared to be of the benign type. This portends of having to do with characteristics of the cyst such as membrane-wall thickness, density, color, shape of the cavern, etc. The lab would have to confirm his contentions through biopsy of the submitted material of course, but his prognosis was that this was a benign cyst. From what I was shown after removal (most of the cyst was in a small sample vial with preserving solution) the cyst was about the size of a small oblong shelled peanut kernel.

Closing-up the incision site was simple. In some circumstances, the hollow cavity left by the cyst removal would be filled with a 'paste' that is sometimes called 'liquid bone.' It fills-in the cavity and either becomes bone or is eventually replaced by real bone. Either way, he said that I did not require this and it would have added additional cost to the procedure. He could have used it, but the naturally-occurring blood clot would fill the cavity anyway and the site would heal itself by growing new bone all by itself.

I didn't require any stitches to close the flap in the incised gum either. He told me to not eat anything too chewy or drink anything through a straw though for several days until the gum flap healed completely. The vacuum that would be caused by drinking through a straw could be enough to pull-out the blood clot that would form. Removing or having this clot otherwise 'fall out' would leave a cavernous hole that otherwise might not heal correctly. Likely, the gum-flap would fold inward on the vacuous concavity and food particles would quickly become trapped in there as well, causing further complications. So, do follow the instructions you are given.

The entire cyst-removal procedure only lasted about 10-minutes.

Within a week, the very slight concavity of the surgery site had fully 'plumped up' to normalcy in both shape and color and I have had no trouble from this surgical site ever since.

If you are facing an impending Mandibular cyst removal, the procedure is really no more stressful than having a filling or routine cleaning done and is nothing to be fearful of.


shareen wahid
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