MARSUPILIZATION & ENUCLEATION
OF JAW CYST
What is a Cyst?
A cyst is a pathological cavity having fluid,
semifluid or gaseous contents and which is not
created by accumulation of pus and lined by
epithelium -Kramer 1974
Surgical Treatment Options
for Jaw Cysts
Treatment options for jaw tumors and cysts vary,
depending on the type of lesion you have, the
lesion's stage of growth and your symptoms.
Treatment of jaw tumors and cysts generally
involves surgical care. In some cases, treatment
may be medical therapy or a combination of
surgery and medical therapy.
Cysts of jaws are treated in one of the following
four basic methods:
1. Enucleation
2. Marsupialization
3. A staged combination of two procedures, and
4. Enucleation with curettage
Objectives of Cyst Treatment
It involves the removal of pathological lining with
the conservation of erupted, partially erupted and
unerupted teeth. Preservation of adjacent vital
structures are crucial including the restoration of
the affected area to its original form. Eradication of
the jaw cyst remains the goal of any treatment; this
goal must be achieved ensuring prevention of
recurrence along with minimum morbidity by
preserving mandibular continuity and nerve
function, wherever possible.
ENUCLEATION
It’s the process by which the total removal of a cystic
lesion is achieved without rupture of the lining if
possible. Enucleation has traditionally been the
standard method of management of odontogenic jaw
cysts.
TECHNIQUE
A mucoperiosteal flap over the cyst is raised and a
window is opened in the bone large enough to give
adequate access. The soft tissue wall is then
separated from the bony wall. The entire cyst is
removed intact and should be sent for histological
examination.
INDICATIONS
• Accessible cyst
• Small to moderate size cysts
• Cysts which do not encroach vital
structures.
• Cysts that do not involve the soft tissues
CONTRAINDICATIONS
• Large cyst, surgical access would weaken
the jaw that a fracture might occur
• Dentigerous cyst in a young person involving
erupting teeth or tooth
• Cyst with a friable thin membrane
• Eruption cyst
ADVANTAGES
• The cavity usually heals without complications
• Little aftercare is necessary
• The complete lining is available for histological
examination

POSSIBLE DISADVANTAGES
• Possibility of damaging surrounding vital
structures & teeth
• Complete removal of the cyst lining may not be
possible when it extends to involve soft tissue
• Damage to inferior dental nerve
• Serious hemorrhage (primary or secondary) ♦ ENUCLEATED SPECIMEN
• Infection of the clot filling the activity
• Recurrence due to incomplete removal of the
lining
MARSUPIALISATION
Marsupialization of odontogenic cystic lesions was
described by Partsch in 1892; it is a technique where a
large window is made in cystic wall and then sutured to
the oral mucosa. Evacuating the contents of the cyst,
and maintaining continuity between the cyst and the
oral cavity, maxillary sinus or nasal cavity.
The only portion of the cyst that is removed is the piece
removed to produce the window, the remaining cystic INDICATIONS
lining in situ.
This method has fewer complications than enucleation
regarding the preservation of important anatomical
structures and developing permanent tooth germs.
♦ Marsupialization of a floor-of-the-mouth
ranula.
TECHNIQUE
• Release the intracystic fluid and pressure.
• The functional stresses will be allowed to
stimulate new bone formation beneath the
cyst membrane
• Causes gradual obliteration of the cyst cavity &
manifestation of the cyst lining
• Post-surgery, the packed and medicated gauze
strips can be left in situ for two weeks usually
• The postoperative care of the open bone cavity
involves treatment with surgical packs until
the wound margins undergo epithelialization.
This usually takes about two to three weeks.
• One indication for marsupialization is to create
a new accessory tract for drainage of a gland.
• Eruption cysts to allow tooth to erupt
• Large cysts encroaching on the soft tissue
• Another indication is when continuous
decompression of a lesion is desired, such as
in the management of an odontogenic cyst.
LIMITATIONS
• Fissural cyst
• Use of marsupialization is limited to cystic
lesions that require continuous drainage and
therefore cannot be utilized to manage solid
lesions.
• Marsupialization is contraindicated when
previous attempts at conservative treatment
have failed and when complete or marginal
resection is indicated.
ADVANTAGES
• The surgical intervention is of short time
interval and causes minimal trauma.
• Swelling and postoperative complications
observed in most cases are minimized.
• Neighboring structures like the teeth, alveolar
dental nerve, the floor of the nose, and the
floor of the maxillary antrum cannot be
damaged during this procedure.
• Reduce risk of mandibular fracture
DISADVANTAGES
• Shrinkage is very slow, over weeks and
months.
• Tendency for the opening to shrink faster than
the cavity.
• Complete bony healing will not occur in
patients, especially the elderly,
immunosuppressive patients, or patients with
an underlying systemic disease.
• No complete lining for histological
examination
CONCLUSION

To conclude, marsupialization is still a preferred surgical procedure by maxillofacial surgeons to decrease the
intracystic pressure and gradually shrink the cyst. It is a preferred procedure to study the nature of the cyst
histopathologically before complete removal and it allows complete natural drainage of the cystic contents.
Marsupialization is however definitely contraindicated when previous attempts at conservative treatment may have
failed or when complete or marginal resection is indicated absolutely.