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MARSUPIALIZATION &

ENUCLEATION IN TREATMENT
OF CYSTS OF ORAL CAVITY
CONTENTS
Definition
Principle
Indications
Contraindications
Advantages
Disadvantages
Conclusion
MARSUPIALIZATION
(Partsch I
operation,Decompression,Cysto
tomy)
Marsupilium = Pouch
First introduced by Partsch in 1892
Definition – “An operation for the cure of a hydatid or other cyst ,
the sac of tumour is opened & emptied of its contents and then its
edges are stiched to the edges of external incision ,which is kept
open while inferior of cyst suppurates & closes by granulation”
-Stedman’s medical dictionary
PRINCIPLE
Marsupialization refers to creating a
surgical window in the wall of cyst &
evacuation of cystic contents. This
process decreases intracystic pressure &
promotes shrinkage of cyst & bone fill.
INDICATIONS
Amount of tissue injury – Proximity of cyst to vital
structures could create an oronasal or oroantral fistula,
injure neurovascular structures or vital teeth during
enucleation.
Surgical access – If access to all portions of cyst is
difficult ,portion of cystic wall may be left behind.
Assistance in erupton of teeth – In a young patient with a
dentigerous or pseudofollicular keratocyst, it permits
eruption of unerupted teeth.
Extent of surgery – Marsupialization is preferred in a
unhealthy or debilited patient , because it is simple &
less stressful for patient.
Size of cyst – in very large cyst,there is a risk of fracture
of jaw during enucleation.
CONTRAINDICATIONS

ODONTOGENIC KERATOCYST
RECURRING CYSTS
SMALLER CYSTS( < 2X2 cm)
ADVANTAGES
Simple procedure to perform.
Spares vital structures eg. blood vessels,nerves
Even quite large cyst can be dealt under Local anaesthesia as
anaesthesia of deeper recesses is not essential.
Simplest way to treat a fracture complicating a large cyst of
mandible, as ribbon gauze & Whitehead’s varnish pack will splint
the fragments.
Allows eruption of teeth.
Prevents oronasal,oroantral fistulae.
Prevents pathological fractures.
Reduces operating time.
Reduces blood loss,helps in shrinkage of cystic lining.
Allows for endosteal bone formation to take place.
Alveolar ridge is preserved.
DISADVANTAGES
Pathologic tissue is left in situ.
Histologic examination of entire cystic lining is not done.
The need for regular postoperative care, occurs a substantial period
of time.
The change in voice may occur when cavity is not obturated
Unpleasant taste and smell may occur due to accumulation of
stagnant saliva & food debris in cavity.
Regular adjustment of plug.
Periodic changing of pack.
Secondary surgery may be needed.
Formation of slit like pockets that may harbour foodstuffs.
Risk of invagination & new cyst formation.
Longer healing time.
ENUCLEATION
(Parsch II , Cystectomy)
DEFINITION – “The removal of a tumour
or other body entire without rupture,as one
shell out the kernel of a nut”
-Stedman’s medical dictionary
Introduced by Partsch in 1910.
PRINCIPLE
Enucleation allows for cystic cavity to be
covered by a mucoperisteal flap & the
space fills with blood clot,which will
eventually organize & form normal bone.
INDICATIONS
Treatment of odontogenic keratocysts.
Recurrence of cystic lesions of any cyst
type.
Should be employed with any cyst of jaw
that can be safely removed unduly
sacrificing adjacent structures.
CONTRAINDICATIONS
Dentigerous cyst.
Young patients with erupting teeth.
Medically compromised or debilited
patients.
Proximity to vital structures.
Very large cysts,may cause fracture of
jaw.
ADVANTAGES
Entire pathological tissue is removed.
Tissue available for histopathological
examination.
Chances of recurrence are less.
Healing time is reduced.
Enucleation with primary closure
eliminates need for repeated
appointments for
packing,irrigation,adjustment of plug etc.
DISADVANTAGES
After primary closure,it is not possible to observe
healing of cavity.
In young patients,the unerupted teeth in a
dentigerous cyst will be removed with the lesion.
Removal of large cyst may make mandible more
prone for fracture.
Damage to adjacent vital structures.
May lead to pulpal necrosis.
Adjacent tooth may be devitalized.
CONCLUSION
Enucleation is definately a better alternate than
marsupialization because of complete removal of
pathological cystic lining.
Marsupializaton could be preferred in cases with
increased morbidity & mortality and impaired host
defense mechanism.
Marsupialization can also be employed in cases of large
cysts, promixity to vital structures & young patients with
a dentigerous cyst as it allows eruption of unerupted
tooth & prevents tooth bud injury.
While enucleation should be used for cyst having high
recurrence potential as odontogenic keratocyst & other
recurring cyst.