Oral Surgery/Keratocyst


Hi, I had a cyst in 1999 and had surgery  during the surgery 4 teeth were removed. The cyst again came back in 2001 and had it removed again and after the biopsy it was reported as Keratocyst. Then again in 2003 it came back the cyst was removed and the biopsy came as keratocyst. Since then I was well but recently I had some problem and found out that the cyst came back and this time it has spread a lot of are in my right mandible. The doctor is now saying that it will need a big surgery maybe a jaw replacement. The doctor took out as much possible of the cyst and sent out for biopsy and the same result it's a keratocyst. But before the jaw replacement the doctor went for a conservative way of treatment by putting a antiseptic pouch in the area and she suggested that this will pull the cyst towards it and then she can remove the cyst later on to avoid jaw replacement. What is the chance of this working. Can the jaw replacement surgery be avoided? Really worried. Is there any other way to remove the cyst or destroy it so it doesn't come back again. My First surgery was done in Bangladesh. The 2nd and 3rd one was done in Toronto General Hospital by the head of Maxilofacial and Dental Department. My recent one is done in Mount Elizabeth Hospital Singapore. Thanks and waiting for your reply.

Joel - Keratocyst is one of the most difficult lesions to simply remove.  The nature of the cyst wall is easily torn.  Because of that, the removal of the lesion can be difficult and satellite cell can remain attached to the bone to reform new cysts in the future (probably what happened to you).  What your doctor now suggests is a process called decompression.  By creating an opening into the cyst and keeping that small opening open, any fluids or pressure normally caused by the cyst is now released.  This procedure can produce a decompression of the cyst wall and hopefully a collapse in and new bone forming behind.  This can possibly work to make it smaller, but it can recur because of the easy break off of cells during the removal of the smaller cyst.  So there is no guarantee, but it might work.  The good part, if the decompression works, is that the jaw becomes stronger.  

The only other way removal of cyst and placing medication in the hole to kill any remaining cells, but that solution can possibly destroy and weaken the bone.  There is always removing a large section of bone, but that is fraught with its own problems.  

So what this doctor plans might work, but no guarantee.  I wish you well and hope it works.  If I can help in any way by referring you to other doctors, if needed, feel free to contact me again.

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Joel S. Teig, DMD, Diplomate ABOMS, retired


I am a board certified oral and maxillofacial surgeon available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.


Board Certified Oral and Maxillofacial Surgeon practicing for over 20 years. Assistant Clincal Professor at State University School of Dentistry.

American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

BA- University of Connecticut DMD-University of Pennsylvania School of Dental Medicine Oral and Maxillofacial Surgical Residency - Roosevelt Hospital, NYC

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