Bone-lid technique for cystic enucleation using piezosurgical unit

A 20 yr old male† presented to the department of Oral and Maxillofacial Surgery, AMC Dental College, Ahmedabad, India, in August 2018, with the diagnosis of a cystic lesion of mandible (Fig. 1) was operated at using a novel bone-lid technique with the use of piezoelectric unit. Conventionally, the cysts or benign tumours in maxillofacial region are enucleated with a method where the approach to reach the pathology included creating a bony window using electric micromotor burst. This resulted in inadvertent bone loss. This case is presented show a novel method to use piezoelectric unit to create a bony lid (Fig. 2) to get the access to the pathology for enucleation (Fig. 3), and the same bony lid can be fixed back after the enucleation of the pathology leading to preservation of normal bony architecture and further sound prosthetic rehabilitation (Figs 4 and 5). This novel technique can benefit the preservation of the natural bony contour, and obviates the necessity for additional procedure of bone grafting, and aids to better prosthetic rehabilitation.

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Fig. 1

Pre-operative orthopantomogram showing a multilocular radiolucency with a well-defined sclerotic margin and an impacted left mandibular canine suggestive of cystic lesion or odontogenic origin present covering the entire symphyseal region of mandible.

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Fig. 2

The bony lid created using the piezoelectric unit, which helps in precise cutting of the cortex and the lid preservation.

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Fig. 3

The enucleated cystic lining with extracted teeth.

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Fig. 4

The bony lid fixed back and stabilized with resorbable sutures maintaining the buccal cortical contour of mandible.

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Fig. 5

Postoperative orthopantomogram showing the shadow of bony lid.

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