**15. Prognosis**

Healing capacity of involved tissues after periapical surgery is considered as good. Under the conditions that the diagnosis and treatment planning is held carefully and the intraoperative procedures achieved successfully most of the cases reveals long term uneventful follow up.

## **16. Sample cases**

#### **16.1. Case 1**

The patient applied to our our clinic with the complaint of swelling at right maxillar buccal area. Via radiographic and clinical examination, an intrabony lesion was observed between right maxillary lateral and first molar tooth apices about 5x2 cm in size. All teeth related to lesion were devital. An aspiration biopsy performed and characteristic yellowish fluid which has kollesterin crystals in it was gained which lead us to define the lesion as a radicular cyst due to necrose pulp tissues.

Treatment plan was to have endodontic treatment after that to enucleate the cyst totally, achieve apicoectomies to all related teeth apexes and reconstruct the intrabony defect by cancellous-bone grafts and membranes. We receipt postoperative antibiotic theraupy per os (amoxicillin 875 mg+clavulanate 125 mg 2x1) for ten days. Defect area started to filled with healing tissue from the base of the cavity and the complaints of the patient disappeared considerably.

**Figure 8.** OPTG view before surgery

**Figure 9.** Incision

has kollesterin crystals in it was gained which lead us to define the lesion as a radicular cyst

Treatment plan was to have endodontic treatment after that to enucleate the cyst totally,

achieve apicoectomies to all related teeth apexes and reconstruct the intrabony defect by

cancellous-bone grafts and membranes. We receipt postoperative antibiotic theraupy per os

(amoxicillin 875 mg+clavulanate 125 mg 2x1) for ten days. Defect area started to filled with

healing tissue from the base of the cavity and the complaints of the patient disappeared

due to necrose pulp tissues.

218 A Textbook of Advanced Oral and Maxillofacial Surgery Volume 2

considerably.

**Figure 8.** OPTG view before surgery

**Figure 10.** Exposure of Cystic Lesion

**Figure 11.** Elevation of Cyst Epithelium

#### **16.2. Case 2**

**Figure 10.** Exposure of Cystic Lesion

220 A Textbook of Advanced Oral and Maxillofacial Surgery Volume 2

**Figure 11.** Elevation of Cyst Epithelium

A 43-year-old female patient referred to our clinic with incidental OPTG examination finding of a homogenous radiolucent, sharply lined lesion located between canine teeth in anterior maxilla. On clinical examination, oral mucosa was intact and there was no evidence of bony expansion on both buccal and palatal sides. Pulp vitality testing was performed for all maxillary anterior teeth, 12 and 22 were found to be non-vital. With an inital diagnosis of inflammatory dentigerous cyst, enucleation of the lesion was planned. Prior to surgery, endodontic treatment of all involved teeth were completed. On surgical exploration, there was no expansed buccal bone was observed. After reaching the cyst capsule and performing resection of the involved roots, two seperate cystic cavities extending palatally behind the roots that have been seperated on the midline with a bony septa were encountered. Lesions were totally enucleated and submitted to histopathological examination. Result of histopathological examination was fibrotic capsule with medium degree of mononuclear cell infiltration, hyperplastic stratified squamous epithelium. In the postoperative period, healing was uneventful.

**Figure 12.** Cystic cavity

#### **Figure 13.** Graft material

**Figure 14.** Application of collagen membrane

**Figure 15.** Adaptation of flap

**Figure 13.** Graft material

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**Figure 14.** Application of collagen membrane

**Figure 16.** Primary closure of area

**Figure 17.** OPTG view

**Figure 18.** CT image

**Figure 19.** CT image

**Figure 17.** OPTG view

224 A Textbook of Advanced Oral and Maxillofacial Surgery Volume 2

**Figure 18.** CT image

**Figure 20.** CT image

**Figure 21.** Cystic cavity

**Figure 22.** Histopathologic evaluation

#### **16.3. Case 3**

**Figure 21.** Cystic cavity

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**Figure 22.** Histopathologic evaluation

36-year-old female patient admitted to our clinic with complaints of pain.Clinical and radio‐ graphic examination revealed a demarcated radiolucent leson at the the apexes of the teeth no: 25,26,27. An electrical vitality test examination related to the teeth 24, 25and 27 was performed which found that teeth are non-vital, and these findings suggest that lesion was caused by non vital pulp tissues of related teeth. CT results showed that maxillary sinus bone compact and buccal cortex were perforated elevated and sinus floor was elevated by the lesion. After completion of endodontic treatment of related teeth patient have been operated under intravenous conscious sedation. During the operation, primarily by aspiration of cyst fluid pressure is reduced and the 2,3x2x1 cm sized radicular cyst was enucleated. Apical resections of relevant teeth were performed an operation region was primarily closed by 3.0 silk suture. Enucleated lesionwas sent to histopathologic examination for definitive diagnosis sent for and diagnosis was confirmed as periradicular cyst epithelium.

**Figure 23.** OPTG view

**Figure 24.** CT image

**Figure 25.** CT image

#### **Figure 26.** Exposure of lesion area

**Figure 24.** CT image

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**Figure 25.** CT image

**Figure 27.** Aspiration of cystic liquid

**Figure 28.** Enucleation of cyst epithelium

**Figure 29.** Cyst epithelium

**Figure 30.** Cystic cavity

**Figure 28.** Enucleation of cyst epithelium

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**Figure 29.** Cyst epithelium

**Figure 31.** Primary closure of lesion area

**Figure 32.** Histopathologic evaluation
