Jaw cyst surgery

Surgery of maxillary or mandibular cysts is a procedure to treat cystic lesions located in the upper or lower jaw.

Surgical removal of these cysts is necessary not only to treat the symptoms but also to prevent future complications and to allow a precise histological diagnosis.

A cyst is a cavity lined with a membrane and filled with fluid, which develops in the jaw bone. The most frequent are the radicular cyst (at the tip of the root of a root-treated or infected tooth) and the dentigerous cyst (around the crown of an impacted tooth, often a wisdom tooth). They are most often discovered by chance on a panoramic X-ray, without any symptoms.

Why operate on a cyst?

Surgery is indicated for:

• Treatment of symptoms: relieving the pain or discomfort caused by the cyst.

• Prevention of complications: avoiding damage to the surrounding teeth or bone (a growing cyst weakens the bone and can displace or resorb neighbouring teeth).

• Histological diagnosis: analysing the cyst tissue to rule out more serious conditions.

Imaging and planning

Three-dimensional imaging is frequently required for precise planning of the procedure. It gives an idea of the probable diagnosis and a detailed view of the position of the cyst and of its relationship with the adjacent structures, which makes it possible to determine the most suitable treatment.

Types of anaesthesia

Depending on the position and size of the cyst, several anaesthesia options are available:

Local anaesthesia — numbing of the area; there is no pain, but pressure and noises are still perceived. For small cysts. You go home immediately.

Sedation — a light sedative given intravenously, combined with local anaesthesia: deeply relaxed, drowsy, unaware of noises or pressure, while breathing on your own. As day surgery at Molière; discharge in the late afternoon, accompanied.

General anaesthesia — total absence of sensation and consciousness during the procedure; for large cysts or cysts that are difficult to reach, as day surgery at Molière.

Techniques

• Enucleation: the cyst is removed entirely with its membrane, in a single procedure. This is the reference treatment. The bone cavity fills in spontaneously over a few months; a bone filling is sometimes added.

• Marsupialisation (decompression): for very large cysts or cysts close to the nerve, the cyst is opened and kept drained by a small device for several months, while the bone re-forms and the cyst shrinks; it is then removed during a second, simpler procedure.

• The tooth responsible for a radicular cyst is either treated by your dentist (root canal treatment, apicoectomy) or extracted if it cannot be saved. An impacted tooth responsible for a dentigerous cyst is extracted at the same time.

• The removed tissue is systematically sent for histological analysis; the result is available within 2 to 3 weeks.

Risks and complications

Although the surgery is generally safe, potential complications may include:

• Infection: a risk associated with any surgical procedure.

• Bleeding: minor post-operative bleeding is possible.

• Damage to neighbouring structures: possible injury to teeth or nerves close to the surgical site; numbness of the lip is possible for mandibular cysts in contact with the nerve, almost always temporary.

• Recurrence: rare after complete enucleation; an X-ray check at 6 months and then 1 year verifies the rebuilding of the bone.

Recovery day by day

Day 0

• Bruising of the gum appears a few hours after the procedure and resolves after several days.

• Cold on the cheek, most effective during the first 48 hours.

• Take painkillers before the anaesthesia wears off. The prescription is registered on your identity card and usually includes an antibiotic, an anti-inflammatory, a painkiller and a mouthwash, three times a day after meals; complete the course of antibiotics.

• Do not spit, do not rinse vigorously.

• Do not smoke.

• Sleep on your back, head raised on two pillows.

• Gentle brushing from this evening taking care with the stitches, prescribed mouthwash from the first evening.

• Diet: soft and cold or lukewarm. Yoghurt, fruit compote, smoothies, lukewarm blended soup, purée.

Days 1–3

• Swelling peaks on days 1 and 2, then decreases, in proportion to the size of the cyst.

• Diet: soft and lukewarm. Purée, scrambled eggs, flaked fish, pasta, custard.

Days 4–14

• Pain clearly decreasing. The stitches dissolve within two weeks.

• Avoid intense physical activity for two weeks. For large cysts of the mandible, avoid hard foods for 4 to 6 weeks: the bone is weakened while it rebuilds.

• Diet: normal but tender, chewing on the opposite side.

When to ask for a check-up

A quick check-up is possible without an appointment in case of: significant pain that increases after day 3; swelling that increases after day 3, fever above 38.5 °C, discharge; heavy bleeding that does not stop after 30 minutes of pressure.

FAQ — Jaw cysts

Is a jaw cyst serious?

In the vast majority of cases, no: these are benign lesions. Systematic histological analysis provides certainty.

Is surgery always necessary?

Yes, as soon as the diagnosis of a cyst is made: a cyst does not disappear on its own and keeps growing slowly, at the expense of the bone and the neighbouring teeth.

How long does the procedure take?

From 30 minutes for a small cyst to 1 h 30 for a large cyst.

Does the bone rebuild?

Yes, the cavity fills in spontaneously over 6 to 12 months. A bone filling is sometimes added for large cavities.

When do I get the analysis result?

Within 2 to 3 weeks. It is communicated to the patient and to the dentist or family doctor.

Is cyst surgery reimbursed?

Yes, removal of a jaw cyst is reimbursed by the INAMI/RIZIV (national health insurance).