Extraoral approach for cystectomy of jawbone

Treatment of diseases: oral and maxillofacial cysts Indication Extraoral route for the extraction of jaw cysts is suitable for large mandibular cysts, especially those located in the mandibular angle and mandibular branch. Preoperative preparation The extraoral route for the removal of the jaw cyst is the same as the preoperative preparation for the removal of the oral jaw cyst. However, large mandibular cysts often require postoperative intermaxillary fixation to prevent pathological fractures, so the upper and lower jaw arch splints should be ligated before surgery. Surgical procedure Incision Below the earlobe, the mandibular branch is in the middle of the posterior fossa, bypassing the mandibular angle, and then along the lower edge of the mandible 2 cm, parallel to the lower edge of the mandible, and reach the ankle forward. ). 2. Flap Cut the skin, subcutaneous tissue, platysma and deep cervical fascia along the design incision, ligation of the external and external veins of the jaw, and separate upward along this plane to reveal the lower edge of the mandible, and then cut the chewing muscle along the lower edge of the mandible. Attached to the periosteum and periosteum, the periosteal separator is used to peel under the periosteum and the tissue flap is turned up to reveal the mandibular angle and the mandibular humerus. 3. Open the window Use the osteotome or rongeur to remove the bone surface of the cyst. For the operation method and precautions, refer to the intraoral method. If the bone wall of the cyst surface is thick, you need to use a small bone to open a small window, and then use a rongeur to enlarge the opening; if the bone wall is very thin or worn, you can directly use the rongeur to bite the bone of the cyst surface. Wall to reveal cysts. The extent of bone wall removal on the surface of the cyst is such that it can reveal cysts and facilitate the removal of cysts. Avoid bone damage when bone is removed, and avoid breaking the wall. 4. Stripping cysts The wall of the capsule was carefully separated by a periosteal stripper between the wall of the capsule and the wall of the bone. Avoid damaging the inferior alveolar nerve vascular bundle when peeling off. When the medial plate of the ascending branch of the jaw is damaged, it is necessary to prevent damage to the important internal anatomy such as the internal jaw artery and the pterygoid plexus. Other precautions and operating points can be referred to the intraoral mandibular cystectomy. However, it should be emphasized that after removal of the mandibular ascending cyst, the upper part of the ascending branch should be carefully examined to completely remove the residual wall. In addition, odontogenic keratocysts are prone to recurrence and even malignant transformation. Therefore, after the cyst is removed, the bone wall can be cauterized with 50% zinc chloride. If the lesion range is too large, the mandibular destruction is more serious or multiple recurrences, it can be used for partial mandibular resection of the mandible. 5. Dental treatment If the root of the tooth is exposed to the cavity and the tooth can be retained, the apical resection should be performed. The bone can be used to remove 2 to 3 mm, but the root canal should be treated before surgery. The teeth in the tooth cyst should be removed together with the cyst. 6. Wound treatment Trim the edge of the bone wall, remove the bone debris, flush the bone cavity, and then suture the periosteum, the chewing muscle, place the half of the rubber tube in the wound cavity, and finally suture the deep fascia, platysma, subcutaneous tissue and skin incision . Facial compression bandage. For other treatments, refer to the intraoral method. complication The main complication of extraoral route for the removal of jaw cyst is postoperative infection. The preventive measures can be removed from the buccal bone plate in cases of large mandibular cysts and thinner buccal bone plates, as described in the oral method. The lower margin of the mandible and the lingual bone plate are preserved, and the face is pressure-wrapped to shrink the wound cavity. At the same time, intermaxillary fixation is used to prevent pathological fractures. There is also a case where the buccal bone plate, the periosteum, and the buccal tissue flap are turned together and the cyst is removed, so that the buccal bone plate can be retained. It is worth emphasizing that keeping circulation is an important measure to prevent postoperative infection.