Endoscope-assisted enucleation of mandibular dentigerous cysts

Abstract

We demonstrate a reliable and minimally invasive treatment with endoscopically-assisted surgery for enucleation of a posterior mandibular dentigerous cyst with an intraoral approach.

A 28-year-old Japanese man had a bilateral mandibular dentigerous cyst that was contiguous with the third molars. Surgical enucleation of the cyst was performed with an endoscope-assisted field of view. The alveolar nerve was identified endoscopically, and continuity of the nerve was carefully preserved. In addition, it was clearly confirmed in the endoscopic visual field that the root apex of the mandibular second molar was not completely exposed.

The use of an endoscope made it possible to clarify the operative field and to preserve the surrounding tissues. Surgery in the mandible was safer and less invasive with endoscopic assistance than it would have been without such assistance.

Introduction

Odontogenic cysts are among the most common cystic lesions in the jaws. These cysts arise as a result of inflammatory or developmental pathogenic causes associated with epithelium of tooth-forming apparatus [1]. Radicular cysts are the most common type of odontogenic cyst, followed by dentigerous cysts (DCs) and then odontogenic keratocysts [2].

DCs arise from the crowns of unerupted teeth and are thought to result from the proliferation of enamel epithelium after enamel formation during tooth development [3]. Most DCs are asymptomatic, and they are usually discovered incidentally on radiographs [4]. In the experience of dentists and maxillofacial surgeons, such cysts can affect the surrounding important tissues, such as the adjacent teeth and can cause the mandible to expand to the point of impinging on the inferior alveolar nerve [5] and the maxilla to expand into the maxillary sinus [6]. In the case of a large lesion, a sufficient surgical field is necessary for complete lesion removal, and a highly invasive operation is required.

Since the introduction of endoscopic technology into cranial and maxillofacial surgery in the latter half of the 20th century [7], surgery with an endoscope-assisted visual field has become popular, with advantages such as minimal surgical invasiveness, fewer surgical complications and decreased damage to surrounding tissue [[8], [9], [10]].

We report a reliable and minimally invasive method of endoscopically-assisted surgery for intraoral enucleation of a DC in the posterior mandible.