MARSUPIALIZATION

Marsupialization, Decompression, Partsch operation 

Refer to creating a surgical window on the wall of the cyst which results in maintaining continuity between the cyst and the oral cavity or maxillary sinus or nasal cavity after evacuating the contents of the cyst cavity.Only portion of cyst wall which is removed is the part to create the surgical window, other then that all the cystic lining is left in situ. This causes release in intracystc pressure and promote healing and bone fill.

Marsupialization of ranula

 Indications-

 

Factors to determine weather to do masupialization or not as as follow:

1.Amount of tissue Injury-Close Proximity of a vital structure will indicate for marsupialization to avoid unwanted removal of adjacent vital tissue. Ex- If removal of cyst will result in formation of oroantral fistula then it's better to go for Marsupialization.

2.Surgical Access- If access to all portion of cyst is difficult and there is chance of leaving a piece of cyst wall.

3.Assistance in eruption- If cyst is associated with a unerupted tooth then marsupialization will help in eruption of tooth.

4.Extent of surgery- In a unhealthy and debilitated patient marsupialization is good alternative to extensive removal.

5.Size of cyst- A risk of Jaw fracture in a very large cyst, it may be better to go for Marsupialization.

Advantages.

1.     Simple to perform

2.     May spare vital tructure

Disadvantages

1.     Pathologic tissue is left in situ.

2.     Patient inconvenience.

3.     Cyst cavity must be kept clean.

Technique

1.     Prophylactic antibiotic is needed if patients health condition warrents.

2.     Anesthetize the area.

3.     Cyst is Aspirated.

4.     Aspiration conforms the diagnosis then proceed for marsupialization.

5.     Initial incision is circular or eleptical  and create a large window in the cyst cavity.

6.     If bone have been thinned or exposed then incision goes through bone into cavity.

7.     If bone is thick then a surgical window is created by removing bone with help of bur.

8.     Piece of tissue is submitted to the lab for further tests.

9.     Content of the cyst are evacuated.

10.Cyst cavity is irrigated with normal saline to remove and residual fragment.

11.If access permits then perimeter of the cyst wall can be sutured with the oral mucosa. 

12.Or you can pack the cavity with a strip of gauze impregnated with tincture of benzoin or antibiotic ointment and leave it for 15 days  it will prevent the oral mucosa to heal over window.

13.Give careful instructions to the patients about cleansing of the cavity.