A cyst is a fluid-filled and chronically inflamed cavity located in the jawbone.
Most jaw bone cysts arise from devitalized roots (dead marrow and root-treated teeth) – They are referred to as “radicular cysts". Other cysts appear in the area of crowns of ectopic teeth ("follicular cysts"). There are also jaw cysts which emerge without the participation of teeth.

Why do cysts have to be removed?

  • A continuously growing cyst leads to swelling of the jaw bone.
  • The cyst can become infected and turn into an abscess.
  • Its size increase can displace or damage neighboring teeth.
  • If they become very large, a spreading into the maxillary sinus or sinuses is possible. This can lead to a progressive weakening of the jawbone and an increased risk of fracture.
  • Cysts are generally benign and are almost never malignant. Nevertheless, we do send out tissue samples to be examined in order to eliminate the prospect of malignant processes in the bone.

What happens during the procedure?

An incision in the jaw just above the cyst is made (under local anesthesia). Two surgery methods are available depending on the size of the cyst:

  • A scraping out - with smaller cysts (cystectomy)
    In a cystectomy, the bone above the cyst is cut and the entire sac is scraped out. A "purulent" tooth can be usually saved by an apicoectomy. If that is not possible, an extraction becomes inevitable. The wound is then sutured and allowed to heal for 10-14 days. A replenishment of the cavity with new bone substance takes about 3 months. The cavity may be filled with collagen or bone replacement material, in cases of larger cysts.
    The cyst is routinely sent to a laboratory for a histological examination.
  • Cystostomy - with very large cysts
    When for anatomical reasons a complete removal of the cyst tissue is not possible, a cystostomy is carried out. By creating an canal through the bone, the cyst is opened to the oral cavity. This eliminates further growth of the cyst and encourages the healing of the bone. The cyst cavity is then dressed and packed with gauze for the length of several weeks.
    The cyst is routinely sent to a laboratory for a histological examination.

What about complications?

  • Recurrence (return of cysts months, or years later) - especially possible if full removal of the cyst was not accomplished during surgery. Anatomical conditions are great factors in those cases.
  • Improper wound healing and local inflammation can be dealt with by the administration of antibiotics.
  • During the removal of a cyst in the maxillary, an opening to the sinuses may be created (which is immediately sealed).
  • Injury of adjacent teeth.
  • When large enough, abutting teeth can protrude into the cyst. Those have to be treated with a root resection (and root canal) during the course of the procedure.
  • On very rare occasions may the nerves located in the upper jaw become damaged (symptoms on the outside: dysesthesia of the lip, cheek, nose / on the inside: numbness and bad taste in the mouth).
  • Injury to the main nerve in the lower jaw (inferior alveolar nerve) is also possible, resulting in temporary (rarely permanent) loss of sensation in teeth, lower lip, and the chin, on the applicable side.
  • In exceedingly rare instances, very large cysts may cause a broken jaw (especially with a pre existing condition).
  • Hypersensitivity (allergy) to anesthetics or drugs are very rare: they cause local symptoms like itching and redness, convulsions, respiratory distress, and cardiac arrest. Those are immediately treated.

After Surgery