Infected Dentigerous Cyst, Complete Enucleation and Alveolar Bone Reconstruction with Rib Graft

An introduction to dentigerous cysts and their etiology

A dentigerous cyst forms around the crown of buried or unerupted teeth. They are most often found in relation to mandibular third molars. These teeth are the ones that are most often found impacted. Accidental discovery is the common with dentigerous cysts. This happens when x-rays taken for other mundane issues reveal their presence. They sometimes become infected and cause pain or swelling, leading to their discovery.

Young man with long standing pain presents for treatment

This young man developed pain in the right posterior mandibular region. He then presented to our hospital for treatment. Radiographs and 3-D axial CT scans were first obtained. These showed a bony lesion in the right mandibular ramus and third molar region. A biopsy showed it to be an infected dentigerous cyst. Dr SM Balaji, Cranio-maxillofacial surgeon formulated a treatment plan. This was to enucleate the dentigerous cyst. Reconstruction of the ramus would follow with rib grafts. The patient agreed to surgery and was then taken to the operating room.

Dentigerous cyst removal surgery

Under general anesthesia, a rib graft was first harvested. A Valsalva maneuver was then performed before closure of incision. This was to ensure that there was no perforation into the pleural cavity. A sulcular incision was then made in the right mandibular posterior region. This was next followed by raising a gingivomucoperiosteal flap to expose the lesion. The dentigerous cyst was then completely enucleated and the entire cyst lining removed. The involved region of the jaw was then reconstructed using the rib graft. Sutures were then used to close the incision. The patient made a complete recovery from the surgery before discharge home.

Surgery Video