MARSUPIALIZATION

MARSUPIALIZATION:
PARTSCH(1892) described a type of compression procedure for treatment of cyst.
• Also k/a PARTSCH I OPERATION & CYSTOTOMY.
• In this procedure a window/fenestrations made in the bone and cystic content is evacuated.
• The cyst lining is left behind.
• Once the cyst contents are evacuated, the intracystic pressure reduces.
• Hollow cavity is packed till it gets obliterated by bone over a period of time.
• The cystic lining then becomes continuous with normal oral mucosa.


INIDICATIONS:
• In extremely large cysts.
• Risk of cyst opening into maxillary sinus/nose due to surgical removal of complete lesion.
• In very young patients, where it will permit eruption of enclosed tooth,underlying developing tooth.
• Patient with poor general condition for allowing minimal surgical procedure.
• In cases, where surgical procedures may cause pathological fracture of jaws.

TECHINQUE:


1) Anaesthesia
2) Aspiration
3) Incision:
Circular, oval or elliptical. Inverted U Shaped incision with broad base the buccal sulcus. Mucoperiosteum is reflected in this case.
4) Removal of bone
5) Removal of cystic lining specimen
6) Visual examination of residual cystic lining
7) Irrigation
8) Suturing of cystic cavity
.
• Cystic lining sutured with the edge of oral mucosa.
• In Y Shaped incision the mucoperiosteal flap can be turned into cystic cavity covering the margin.
• The remaining is sutured to oral mucosa.

9) Packing- Prevents food contamination & covers wound margins. Done with ribbon gauze soaked with WHITEHEAD VARNISH

COMPOSITION
• Benzoin – 10g
• iodoform-10g
• Storax -7.5g Balsam of Tolu -5g
• Solvent ether to 100ml

Pack removed after 2 weeks.
10) Maintenance of cystic cavity
Instruct the patient to clean and irrigate the cavity regularly with oral antiseptic rinse with a disposable syringe.
11) Use of plug:
• Prevents contamination, Preserves patency of cyst orifice.
• Plug should be stable, retentive and safe design.
• Should be made of resilient material (to avoid irritation) like acrylic.
12) Healing:
• Cavity may or may not obliterate totally. Depression remains in the process.

ADVANTAGES:
• Once the cystic lining is evacuated, there is a tendency of the cystic lining to contract. This stimulates endosteal bone formation.
• Marginal ingrowth of normal mucoperiosteum occurs as the cystic lining shrinks. It provides with additional bone regeneration factors.
• Not much surgical skill is required.
• No risk of oroantral/oronasal fistula.
• No damage to adjacent vital structures.
• No risk to adjacent vital tooth.

DISADVANTAGES:
• Entire pathological tissue is left behind.
• High chances of recurrence.
• As the bony cavity is large, healing and filling up with normal bone takes longer time.
• Use of cyst plug is required with repeated cleansing.
• Time consuming & repeated appointment for patients.

REFERENCES:

  • Textbook of Oral & Maxillofacial Surgery, Chitra Chakravarthy(2nd Edition)
  • Slideshare
  • cartooncollection.com

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