Category II cystectomy

Category II cystectomy is surgery for a large jaw cyst, or a cyst that lies close to the maxillary sinus, the mandibular nerve or the roots of several teeth. These operations need careful CT planning and sometimes staged treatment and bone grafting. At UKRMED Maxillofacial Surgery, large jaw cyst removal is performed by surgeon Anna Kravchenko.

What category II means

Category II covers complex cases:

• a large cyst that has destroyed a significant part of the bone;
• a cyst growing into the maxillary sinus or displacing its floor;
• proximity to the mandibular nerve;
• several teeth involved at once;
• recurrence after previous surgery;
• the need for bone grafting after removal.

Small cysts at the tip of one tooth are simpler to treat — see category I cystectomy.

Why CT is essential for large cysts

A large cyst can grow painlessly for years until it destroys the jaw wall or causes a fracture. CT shows the cavity borders, the remaining wall thickness and the relationship to the sinus, nerve canal and roots. The surgeon then chooses the access and extent of complex jaw cyst removal.

One-stage removal or staged treatment

• Complete cystectomy — removal of the entire lining in one operation. The choice for most cysts when it is safe for neighbouring structures.
• Decompression — when the cyst is very large and one-stage removal would endanger the nerve, teeth or jaw integrity. A small drainage tube is placed, pressure inside falls and the cyst gradually shrinks. A systematic review of keratocysts — aggressive jaw cysts — showed that such conservative methods reduce the cavity, after which definitive removal becomes simpler and safer.

What happens to the teeth? Teeth whose roots extend into the cavity are treated and kept if possible. Extraction is needed only when a tooth is destroyed or has no support.

When the cyst is near the sinus or nerve

If the cyst has displaced the sinus floor, the surgeon carefully separates its lining from the sinus mucosa and closes any communication with the mouth. Near the mandibular nerve, the surgeon works especially carefully, as otherwise temporary or lasting lip numbness is possible. More about sinus surgery — maxillary sinus surgery.

Is bone grafting needed?

Small cavities fill with bone on their own. Large defects, especially before future implants, are filled with graft material under a membrane. More about jaw bone grafting.

Histology

The removed tissue is always examined: an ordinary-looking cyst may turn out to be a keratocyst or tumour that needs different follow-up. This is a key part of odontogenic cyst removal.

Recovery

Swelling lasts a few days, and stitches are removed after 7–10 days. With decompression, the tube is rinsed at home as instructed. Bone recovers over months, so follow-up CT scans are scheduled.

Category II cystectomy price at UKRMED

The surgeon gives the cost of surgery after the CT scan.

Sources

1. Tabrizi R., Hosseini Kordkheili M. R., Jafarian M., Aghdashi F. Decompression or Marsupialization; Which Conservative Treatment is Associated with Low Recurrence Rate in Keratocystic Odontogenic Tumors? A Systematic Review. J Dent (Shiraz), 2019. https://doi.org/10.30476/dentjods.2019.44899
2. AO Foundation. AO Surgery Reference: CMF. https://surgeryreference.aofoundation.org/cmf/trauma