J Korean Assoc Oral Maxillofac Surg.  2012 Oct;38(5):276-283. 10.5125/jkaoms.2012.38.5.276.

Comparison of surgical approach and outcome for the treatment of cystic lesion on lower jaw

Affiliations
  • 1Department of Oral and Maxillofacial Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. hongjr@skku.edu
  • 2Department of Oral and Maxillofacial Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

Abstract


OBJECTIVES
Curettage and enucleation are two of the most common procedures performed in oral and maxillofacial surgery units. To access a cystic lesion, the buccal cortical plate is removed. The no reposition (NR) group underwent surgery without repositioning the buccal cortical plate. The reposition (R) group underwent surgery with a repositioning of the buccal cortical plate. This study compared the two surgical procedures in terms of bone healing and complications.
MATERIALS AND METHODS
Patients who underwent curettage and enucleation surgery were enrolled in this study. Panoramic radiographs of the patients in both the NR group (n=26) and R group (n=34) were taken at the baseline and at 6, 12 and 24 months after surgery. The radiolucent area was calculated to evaluate bony healing in each radiograph. The complications were analyzed through a review of the medical records.
RESULTS
The correlation between bony healing and surgical approach was not significant in the 6th, 12th, and 24th month (P<0.05). The complication rate was not associated with gender, graft material, bone graft and drain insertion (P<0.05). On the other hand, the R group had a higher complication rate (35.3%) than the NR group (0%). The difference in the mean lesion size between the NR group (37,024+/-3,617 pixel) and R group (92,863+/-15,931 pixel) was significant (independent t test, P=0.004).
CONCLUSION
Although the reposition method is chosen when the lesion size is large, it is associated with more complications. Indeed, infection, discomfort and recurrence of the lesion were the most common complications in the R group. Furthermore, the R method does not have a strong point in terms of bone healing compared to the NR method. Therefore, the R method cannot be considered an ideal approach and should be used in limited cases.

Keyword

Repositioning; Buccal cortical plate; Cysts; Mandible

MeSH Terms

Curettage
Hand
Humans
Jaw
Mandible
Recurrence
Surgery, Oral
Transplants

Figure

  • Fig. 1 A. Bony grinding was performed without reposition (no reposition, NR group). B. Bony window was relocated (reposition, R group).

  • Fig. 2 A, B. Surgical approach with bony grinding on the buccal side. C. Surgical approach with bony window formation, followed by repositioning of bony window (fixed with VICRYL). D. Surgical approach with bony window formation, followed by repositioning of bony window (fixed with wire). E, F. Surgical approach with bony window formation, followed by repositioning of bony window (fixed with miniplate and screw).

  • Fig. 3 Lesion size for each surgical approach (no reposition [NR]: 37,024±18,446, reposition [R]: 92,863±15,931 pixel dimension).


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