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Module 03

Surgery Notes

Operative approaches, principles and post-op protocols — planning, procedure, reconstruction, complications and recurrence.

82 topics

Abfraction

Dental Diseases

Complications

  • Sensitivity
  • Pulp exposure if progressive
Full atlas page →

Actinic Cheilitis

Premalignant Disorders

Complications

  • Progression to lip SCC (up to 10–20%)
  • Cosmetic deformity after vermilionectomy
Full atlas page →

Adenomatoid Odontogenic Tumour

Odontogenic Tumors

Treatment planning

  • Enucleation is curative
  • Preserve adjacent teeth when possible
  • Orthodontic traction of impacted canine after removal

Surgical procedure

  • Enucleation with careful capsule removal

Reconstruction

  • Small defects heal spontaneously; occasional bone graft

Complications

  • Loss of associated tooth
  • Recurrence extremely rare

Recurrence

  • < 1% — essentially cured by enucleation.
Full atlas page →

Ameloblastoma

Odontogenic Tumors

Surgical procedure

  • Resection with reconstruction plate + fibula free flap
  • Enucleation + peripheral ostectomy for select lesions

Complications

  • Recurrence (curettage 50–90%, resection 10–15%)
  • Malignant transformation to ameloblastic carcinoma
Full atlas page →

Amelogenesis Imperfecta

Developmental Disorders

Complications

  • Rapid attrition
  • Caries susceptibility
  • Aesthetic and psychosocial impact
Full atlas page →

Aneurysmal Bone Cyst

Non-odontogenic Cysts

Treatment planning

  • MRI to confirm fluid–fluid levels and exclude malignancy
  • Incisional biopsy with pre-op cross-match (expect brisk bleeding)
  • Pre-operative selective arterial embolisation for very vascular / large lesions
  • Choose curettage vs en-bloc resection based on size and cortical involvement

Surgical procedure

  • Careful mucoperiosteal exposure → wide bony window → aggressive curettage → adjuvant (cryotherapy / Carnoy) → primary closure or reconstruction
  • Meticulous haemostasis (brisk bleeding common)
  • Immediate reconstruction with iliac crest or fibula flap for segmental defects

Reconstruction

  • Autogenous cortico-cancellous graft (iliac crest) for small–moderate defects
  • Free vascularised fibula for segmental mandibular resections
  • Titanium reconstruction plate as interim

Complications

  • Intra-operative haemorrhage (significant risk)
  • IAN injury with lower lip paraesthesia
  • Recurrence (10–60% after curettage alone)
  • Pathological fracture
  • Malignant transformation (very rare, usually radiation-associated)

Recurrence

  • 10–60% after simple curettage; < 10% with aggressive curettage + adjuvant; near 0% after en-bloc resection.
Full atlas page →

Attrition

Dental Diseases

Complications

  • Pulp exposure
  • Sensitivity
  • Loss of vertical dimension
Full atlas page →

Behçet Disease

Ulcerative Diseases

Complications

  • Blindness (uveitis)
  • CNS disease
  • Arterial aneurysms
  • DVT/PE
Full atlas page →

Burkitt Lymphoma

Malignant Tumors

Complications

  • Tumour lysis syndrome
  • Airway obstruction
  • CNS relapse
Full atlas page →

Cemento-osseous Dysplasia

Fibro-osseous Lesions

Complications

  • Secondary infection → chronic osteomyelitis
  • Diagnostic confusion with periapical pathology leading to unnecessary endodontics
Full atlas page →

Cementoblastoma

Odontogenic Tumors

Treatment planning

  • Extraction of tooth with attached tumour is standard as lesion is fused to root
  • Root amputation with retention of remaining root and endodontic treatment attempted in select cases

Surgical procedure

  • En-bloc tumour + tooth extraction with peripheral ostectomy
  • Segmental resection reserved for very large aggressive lesions

Reconstruction

  • Alveolar preservation graft after socket curettage; implant placement after healing

Complications

  • Recurrence if incompletely removed
  • Loss of adjacent teeth in aggressive lesions

Recurrence

  • Up to 22% if removed without associated tooth; < 5% after tooth + tumour extraction.
Full atlas page →

Cervicofacial Actinomycosis

Maxillofacial Infections

Complications

  • Osteomyelitis of mandible
  • Sinus tract fistulisation
  • CNS extension (rare)
  • Recurrence with short antibiotic course
Full atlas page →

Cervicofacial Necrotising Fasciitis

Maxillofacial Infections

Complications

  • Descending mediastinitis
  • Sepsis, MODS
  • Airway compromise
  • Death
Full atlas page →

Chondrosarcoma of the Jaws

Malignant Tumors

Complications

  • Local recurrence common if margins positive
  • Distant metastases (lung) in high-grade
Full atlas page →

Cleft Lip & Palate Repair

Maxillofacial Surgery

Treatment planning

  • Neonatal: feeding assessment, pre-surgical orthopaedics (NAM)
  • 3 months: lip repair — 'rule of 10s' (10 lb, 10 g/dL Hb, 10 weeks)
  • 9–12 months: palate repair before speech development
  • Speech therapy and audiology from 18 months
  • 5–7 y: fistula closure, speech surgery (pharyngoplasty) if VPI
  • 8–11 y: alveolar bone graft (iliac crest) before canine eruption
  • Skeletal maturity: orthognathic surgery, rhinoplasty

Surgical procedure

  • Millard rotation-advancement for unilateral cleft lip
  • Bilateral repair: Mulliken or Cutting technique
  • Furlow palatoplasty for velar lengthening in VPI
  • Secondary alveolar bone graft: cancellous iliac crest

Complications

  • Fistula (5–20%)
  • Velopharyngeal insufficiency
  • Maxillary hypoplasia requiring Le Fort I
  • Nasal deformity
  • Scarring, dehiscence
Full atlas page →

Cleft Lip and Palate

Developmental Disorders

Surgical procedure

  • Millard rotation-advancement (lip)
  • Furlow double-opposing Z-plasty (palate)
  • Alveolar bone grafting (iliac crest)

Complications

  • VPI and hypernasality
  • Eustachian tube dysfunction → OME/hearing loss
  • Maxillary hypoplasia
  • Dental anomalies
Full atlas page →

Cleidocranial Dysplasia

Developmental Disorders

Surgical procedure

  • Removal of supernumerary teeth
  • Surgical exposure & bonding of impacted permanents
  • Orthognathic surgery for skeletal disproportion

Complications

  • Failure of eruption
  • Malocclusion
  • Recurrent sinusitis
  • Deafness (rare)
Full atlas page →

Condylar Hyperplasia

TMJ Disorders

Complications

  • Recurrence if condylectomy inadequate during active phase
  • Facial nerve injury
  • Malocclusion relapse
Full atlas page →

Deep Neck Space Infections

Maxillofacial Infections

Complications

  • Airway obstruction
  • Descending necrotising mediastinitis (via retropharyngeal/danger space)
  • Cavernous sinus thrombosis (via canine space and pterygoid plexus)
  • Lemierre syndrome (internal jugular thrombophlebitis)
  • Septic shock
Full atlas page →

Dental Erosion

Dental Diseases

Complications

  • Sensitivity
  • Pulp exposure
  • Aesthetic concerns
Full atlas page →

Dental Implantology

Maxillofacial Surgery

Treatment planning

  • Medical & dental history, smoking, bruxism, occlusion
  • CBCT with radiographic guide/digital planning
  • Assess bone volume (ITI SAC classification: Straightforward, Advanced, Complex)
  • Prosthetically driven implant position
  • Consider grafting: GBR, sinus lift, ridge split, block graft

Surgical procedure

  • Aseptic technique, copious irrigation (keep bone <47°C)
  • Sequential drilling per manufacturer protocol
  • Primary stability ≥ 30 Ncm for immediate loading
  • One-stage (transmucosal) vs two-stage (submerged) protocol
  • Guided surgery with surgical stents for accuracy

Complications

  • Early: haemorrhage, nerve injury (IAN, mental, lingual), sinus perforation, primary instability
  • Late: peri-implant mucositis, peri-implantitis, fracture, screw loosening, aesthetic failure
Full atlas page →

Dentigerous Cyst

Odontogenic Cysts

Complications

  • Recurrence rare
  • Neoplastic transformation to ameloblastoma, mucoepidermoid carcinoma, or SCC (rare)
Full atlas page →

Dentinogenesis Imperfecta

Developmental Disorders

Complications

  • Severe attrition
  • Spontaneous pulp exposure
  • Periapical pathology
Full atlas page →

Dento-alveolar Trauma

Trauma

Complications

  • Pulp necrosis
  • Pulp canal obliteration
  • Root resorption (surface, inflammatory, replacement/ankylosis)
  • Loss of tooth
Full atlas page →

Distraction Osteogenesis

Maxillofacial Surgery

Treatment planning

  • Latency phase 5–7 days
  • Activation 0.5–1 mm/day (usually 1 mm split into 2 turns)
  • Consolidation ≥ 2× activation period (8–12 weeks)
  • Vector planning with 3D CT and stereolithographic models

Surgical procedure

  • Corticotomy preserving medullary blood supply and periosteum
  • Placement of distractor with correct vector
  • Rigid fixation; activation begins after latency

Complications

  • Device failure, screw loosening
  • Vector deviation, malocclusion
  • Nerve injury (IAN)
  • Infection at pin site
  • Premature consolidation
  • TMJ ankylosis
Full atlas page →

Epulis Fissuratum

Soft Tissue Lesions

Complications

  • Recurrence if denture not corrected
Full atlas page →

Erythema Multiforme

Vesiculobullous Diseases

Complications

  • Dehydration
  • Secondary infection
  • Scarring (rare)
Full atlas page →

Erythematous (Atrophic) Candidiasis

Red Lesions

Treatment planning

  • Identify and correct predisposing factor
  • Topical antifungal for localised; systemic for extensive/refractory disease
  • Denture hygiene reinforcement

Surgical procedure

  • Not indicated

Complications

  • Progression to chronic hyperplastic candidiasis
  • Denture-bearing bone resorption in chronic denture stomatitis
  • Recurrence

Recurrence

  • Very common (up to 70%) if predisposing factors persist.
Full atlas page →

Erythroplakia

Red Lesions

Treatment planning

  • Immediate biopsy of every red patch persisting > 2 weeks after removing irritants
  • Complete surgical excision regardless of grade due to high malignant potential
  • Neck assessment if invasive SCC found

Surgical procedure

  • Wide local excision with clear margins
  • CO2 laser or cold-knife based on size and site
  • Reconstruction with primary closure, secondary intention or graft

Complications

  • Progression to invasive SCC
  • Recurrence at margins
  • Post-excisional scarring, tethering

Recurrence

  • Recurrence 20–30% even after complete excision; new lesions common due to field cancerisation.
Full atlas page →

Fibrous Dysplasia

Fibro-osseous Lesions

Complications

  • Optic nerve compression (craniofacial)
  • Malignant transformation < 1%
Full atlas page →

Geographic Tongue

Red Lesions

Treatment planning

  • Reassure — benign, no malignant potential
  • Symptomatic treatment for burning

Surgical procedure

  • Not indicated

Complications

  • None significant; anxiety from cosmetic appearance

Recurrence

  • Chronic and recurrent by nature; may resolve spontaneously and recur.
Full atlas page →

Haemangioma

Benign Tumors

Complications

  • Ulceration, bleeding
  • Airway or visual obstruction
  • High-output cardiac failure (large hepatic)
  • Kasabach–Merritt phenomenon (with kaposiform haemangioendothelioma)
Full atlas page →

Hemifacial Microsomia

Developmental Disorders

Surgical procedure

  • Mandibular distraction
  • Costochondral rib graft
  • Microvascular free flap for soft tissue
  • Auricular reconstruction

Complications

  • Obstructive sleep apnoea
  • Malocclusion
  • Hearing loss
Full atlas page →

HPV-associated Oropharyngeal SCC

Oral Cancer

Complications

  • Mucositis, xerostomia, dysphagia, ORN, hypothyroidism
Full atlas page →

Kaposi Sarcoma

Malignant Tumors

Complications

  • Airway obstruction (laryngeal)
  • Bleeding, disfigurement
  • Systemic dissemination
Full atlas page →

Lateral Periodontal Cyst

Odontogenic Cysts

Treatment planning

  • Confirm vitality of adjacent teeth
  • Plan flap access to preserve tooth vitality and periodontal support

Surgical procedure

  • Full-thickness mucoperiosteal flap, careful enucleation, primary closure

Reconstruction

  • Small defects heal spontaneously; occasional bone graft for larger defects

Complications

  • Loss of tooth vitality (rare)
  • Recurrence in botryoid variant

Recurrence

  • Classical LPC < 5%; botryoid variant up to 30% — merits closer follow-up.
Full atlas page →

Le Fort Fractures

Trauma

Complications

  • Airway obstruction
  • Malunion, malocclusion, facial elongation
  • Enophthalmos, diplopia
  • CSF leak, meningitis
  • Infraorbital numbness
  • Non-union
Full atlas page →

Leukoedema

White Lesions

Treatment planning

  • Reassure and educate the patient — no treatment required

Complications

  • None — benign condition

Recurrence

  • Not applicable — condition is permanent and benign.
Full atlas page →

Leukoplakia

White Lesions

Treatment planning

  • Confirm diagnosis histologically
  • Assess dysplasia grade and size
  • Stop all habits before definitive therapy
  • Multidisciplinary review for PVL and severe dysplasia

Surgical procedure

  • Cold-knife excision with 5 mm margin for dysplastic lesions
  • CO2 laser ablation / excision — good haemostasis, minimal scarring, but no specimen if ablation
  • Cryosurgery — limited use
  • Photodynamic therapy (5-ALA) for large field lesions

Complications

  • Malignant transformation to SCC
  • Recurrence after excision (10–35%)
  • Post-surgical scarring, restricted mouth opening
  • Missed dysplasia if inadequate biopsy site

Recurrence

  • 10–35% after surgical excision; higher for PVL (up to 70%). Lifelong surveillance required.
Full atlas page →

Ludwig's Angina

Maxillofacial Infections

Complications

  • Airway obstruction
  • Descending necrotising mediastinitis
  • Sepsis
  • Cavernous sinus thrombosis
Full atlas page →

Mandibular Fracture

Trauma

Complications

  • Malunion / non-union
  • Infection
  • IAN paraesthesia
  • TMJ ankylosis (undertreated condylar #)
Full atlas page →

Median Rhomboid Glossitis

Red Lesions

Treatment planning

  • Identify predisposing factors (smoking, diabetes, HIV, denture)
  • Antifungal therapy first line; monitor response

Surgical procedure

  • Excision of persistent nodular lesion after failed medical therapy — mainly to exclude neoplasm

Complications

  • Persistent lesion
  • Rare pseudo-epitheliomatous hyperplasia mistaken for SCC

Recurrence

  • Common if predisposing factors not addressed.
Full atlas page →

Medication-Related Osteonecrosis of the Jaws

Bone Diseases

Complications

  • Pathological fracture
  • Oro-antral/oro-cutaneous fistula
  • Chronic osteomyelitis
  • Loss of function
Full atlas page →

Mucoepidermoid Carcinoma

Salivary Gland Disorders

Complications

  • Facial nerve injury
  • Recurrence (high grade)
  • Distant metastases (lung, bone) in high-grade
Full atlas page →

Mucous Membrane Pemphigoid

Vesiculobullous Diseases

Complications

  • Symblepharon, trichiasis, blindness
  • Laryngeal stenosis
Full atlas page →

Mumps (Epidemic Parotitis)

Salivary Gland Disorders

Complications

  • Orchitis (30% post-pubertal males) → rarely infertility
  • Aseptic meningitis, encephalitis
  • Sensorineural deafness (unilateral)
  • Pancreatitis
Full atlas page →

Nasolabial Cyst

Non-odontogenic Cysts

Treatment planning

  • Confirm extra-osseous location on MRI/CT
  • Assess for nasal floor involvement
  • Choose sublabial vs endoscopic transnasal marsupialisation approach

Surgical procedure

  • Sublabial incision → careful dissection preserving the nasal floor mucosa → complete cyst removal
  • Alternative: endoscopic transnasal marsupialisation — creates a permanent window into the nasal cavity, faster recovery
  • Meticulous haemostasis; primary closure

Reconstruction

  • Not usually required as no bony defect
  • Nasal floor mucosa closed primarily if perforated

Complications

  • Nasal floor perforation (oronasal fistula)
  • Infection
  • Post-op oedema and paraesthesia of upper lip
  • Recurrence if incomplete excision
  • Rare mucocele formation

Recurrence

  • < 5% after complete sublabial excision; slightly higher after marsupialisation but with lower morbidity.
Full atlas page →

Nasopalatine Duct Cyst

Non-odontogenic Cysts

Treatment planning

  • Confirm ≥ 6 mm and vitality of centrals
  • Rule out radicular cyst by EPT / cold test
  • CBCT to plan surgical approach (palatal vs labial)

Surgical procedure

  • Palatal mucoperiosteal flap → bony window → enucleation
  • Careful protection of the nasopalatine neurovascular bundle → expected transient anterior palatal paraesthesia post-op
  • Primary closure over the defect

Reconstruction

  • Small defects heal by clot organisation
  • Larger defects: xenograft ± collagen membrane

Complications

  • Transient/permanent anterior palatal paraesthesia (numbness of upper labial gingiva behind incisors)
  • Oronasal communication if nasal floor perforated
  • Wound dehiscence in palatal closure
  • Recurrence (rare) if lining incompletely removed
  • Extremely rare squamous cell carcinoma arising in cyst lining

Recurrence

  • Very low — < 2% after complete enucleation.
Full atlas page →

Odontogenic Keratocyst

Odontogenic Cysts

Treatment planning

  • Confirm diagnosis by biopsy/aspiration
  • Assess for syndromic features → dermatology + genetics referral
  • CBCT for surgical planning
  • Balance recurrence risk (up to 60% with enucleation alone) against morbidity of resection

Surgical procedure

  • Meticulous enucleation with intact lining is key
  • Modified Carnoy's applied 3 min after enucleation
  • Peripheral ostectomy 1–2 mm
  • Marsupialisation with obturator for decompression
  • Segmental resection with reconstruction plate + fibula flap for recurrent aggressive lesions

Reconstruction

  • Guided bone regeneration for medium defects
  • Iliac crest graft for large mandibular defects
  • Free fibula flap for continuity defects after resection

Complications

  • Recurrence (especially syndromic)
  • IAN paraesthesia after aggressive treatment
  • Pathologic fracture
  • Ameloblastoma-like transformation (rare)
  • Malignant transformation to SCC — reported but rare

Recurrence

  • Enucleation alone 25–60%; enucleation + adjunct 8–20%; resection < 2%. Peak recurrence within first 5 years; late recurrences up to 10 years described. Syndromic OKCs recur more often.
Full atlas page →

Odontogenic Myxoma

Odontogenic Tumors

Treatment planning

  • Balance recurrence risk (25% with curettage) against morbidity of resection
  • Small (< 3 cm) lesions may permit enucleation with peripheral ostectomy in select cases
  • Large or recurrent lesions → resection with reconstruction

Surgical procedure

  • Segmental mandibulectomy with reconstruction plate + free fibula/iliac graft
  • Marginal resection preserving inferior border where feasible

Reconstruction

  • Reconstruction plate + free fibula osseocutaneous flap for continuity defects
  • Iliac crest graft for smaller marginal defects

Complications

  • Recurrence
  • Cortical perforation with soft-tissue infiltration
  • Pathologic fracture
  • Facial deformity

Recurrence

  • Curettage: 25%; resection: < 10%. Long-term follow-up mandatory.
Full atlas page →

Odontoma

Odontogenic Tumors

Treatment planning

  • Assess associated impacted tooth for orthodontic salvage vs sacrifice
  • Small odontoma → surgical enucleation; larger requires bone removal
  • Screen for Gardner if multiple

Surgical procedure

  • Conservative surgical excision, sparing developing teeth
  • Piezosurgery useful in young patients

Reconstruction

  • Small defects heal spontaneously; occasional bone graft for large complex odontoma cavities

Complications

  • Failure of eruption of associated tooth
  • Infection of an erupted odontoma
  • Recurrence extremely rare

Recurrence

  • < 1% after complete excision.
Full atlas page →

Oral Candidiasis

White Lesions

Treatment planning

  • Identify and correct predisposing factors
  • Topical antifungal for mild/localised disease
  • Systemic antifungal for extensive/refractory disease
  • Denture hygiene / replacement for denture stomatitis

Surgical procedure

  • Excision of chronic hyperplastic candidiasis lesions if dysplasia present

Complications

  • Oesophageal candidiasis (immunocompromised)
  • Systemic candidaemia
  • Malignant transformation of chronic hyperplastic candidiasis
  • Azole resistance

Recurrence

  • Common if predisposing factors persist. Denture stomatitis relapses in >50% without denture replacement.
Full atlas page →

Oral Lichen Planus

White Lesions

Treatment planning

  • Confirm diagnosis histologically + DIF
  • Identify and eliminate lichenoid triggers (drugs, dental materials)
  • Symptomatic control based on severity
  • Long-term surveillance for malignant transformation

Surgical procedure

  • Excision only for isolated dysplastic plaque-like lesions
  • CO2 laser for refractory erosions (limited evidence)

Complications

  • Malignant transformation to oral SCC
  • Secondary candidiasis (from steroid use)
  • Steroid mucosal atrophy
  • Chronic pain and impaired quality of life

Recurrence

  • Chronic relapsing–remitting course; complete remission uncommon. Requires long-term maintenance.
Full atlas page →

Oral Lipoma

Benign Tumors

Complications

  • Recurrence very rare after complete excision
Full atlas page →

Oral Manifestations of CKD

Systemic Diseases

Complications

  • Bleeding after extraction
  • Infection
  • Impaired healing
  • Cardiovascular events during treatment
Full atlas page →

Oral Manifestations of HIV/AIDS

Systemic Diseases

Complications

  • Systemic opportunistic infections
  • Progression to AIDS
  • Pain, dysphagia, weight loss
Full atlas page →

Oral Manifestations of Leukaemia

Systemic Diseases

Complications

  • Life-threatening haemorrhage
  • Septicaemia from oral source
  • Chemotherapy-induced mucositis
Full atlas page →

Oral Schwannoma

Benign Tumors

Complications

  • Nerve injury if excision incomplete
  • Rare recurrence
Full atlas page →

Oral Squamous Cell Carcinoma

Oral Cancer

Complications

  • Loco-regional recurrence
  • Distant metastasis (lung most common)
  • Second primary (field cancerisation)
Full atlas page →

Oral Tuberculosis

Ulcerative Diseases

Complications

  • Spread to other sites
  • Destruction of local tissue
Full atlas page →

Orthognathic Surgery

Maxillofacial Surgery

Complications

  • IAN injury (BSSO)
  • Malunion / relapse
  • Bad split
  • Avascular necrosis (Le Fort)
Full atlas page →

Ossifying Fibroma

Fibro-osseous Lesions

Complications

  • Recurrence <10% for adult OF, higher for juvenile variants
Full atlas page →

Osteomyelitis of the Jaws

Bone Diseases

Complications

  • Pathological fracture
  • Systemic sepsis
  • Extraoral fistula
  • Malignant transformation (rare, chronic osteomyelitis)
Full atlas page →

Paget Disease of Bone

Bone Diseases

Complications

  • Pathological fracture
  • Osteosarcoma (<1% but grim prognosis)
  • Cranial nerve palsies
  • Post-extraction haemorrhage or osteomyelitis
Full atlas page →

Pemphigus Vulgaris

Vesiculobullous Diseases

Complications

  • Sepsis
  • Fluid & electrolyte imbalance
  • Steroid side effects
Full atlas page →

Periapical Abscess

Dental Diseases

Complications

  • Cellulitis
  • Fascial space spread
  • Ludwig's angina
  • Cavernous sinus thrombosis
  • Sepsis
Full atlas page →

Peripheral Giant Cell Granuloma

Soft Tissue Lesions

Complications

  • Recurrence (~10%)
  • Superficial bone loss
Full atlas page →

Pleomorphic Adenoma

Salivary Gland Disorders

Complications

  • Recurrence (multinodular)
  • Facial nerve injury
  • Frey syndrome (gustatory sweating)
  • Carcinoma ex pleomorphic adenoma (malignant transformation ≈ 6% in long-standing PA)
Full atlas page →

Primary Herpetic Gingivostomatitis

Vesiculobullous Diseases

Complications

  • Dehydration (pain → poor intake)
  • Herpetic whitlow
  • Herpes keratitis
  • Encephalitis (rare)
Full atlas page →

Pulpitis

Dental Diseases

Complications

  • Pulp necrosis
  • Periapical abscess
  • Cellulitis
  • Space infection
Full atlas page →

Radicular Cyst

Odontogenic Cysts

Treatment planning

  • Confirm non-vitality of associated tooth
  • Small (< 2 cm) cysts amenable to endodontic therapy alone
  • Large cysts or failed RCT → surgical management
  • Assess relation to vital structures on CBCT before surgery

Surgical procedure

  • Enucleation (Partsch II) — cyst removed en bloc with lining
  • Marsupialisation (Partsch I) — decompression via window
  • Apicoectomy with retrograde filling
  • Guided bone regeneration with membrane + graft for large defects

Reconstruction

  • Small defects: heal by secondary intention with clot
  • Medium: xenograft (Bio-Oss) or autogenous chin/ramus graft
  • Large: iliac crest graft; rarely microvascular flap

Complications

  • Secondary infection → cellulitis
  • Pathologic fracture of atrophic mandible
  • Displacement into maxillary sinus or IAN canal injury
  • Recurrence if lining incompletely removed
  • Very rare: SCC or mucoepidermoid carcinoma arising in cyst lining

Recurrence

  • < 2% after complete enucleation; residual cyst if incomplete removal.
Full atlas page →

Sialolithiasis

Salivary Gland Disorders

Complications

  • Recurrent sialadenitis
  • Ductal stricture
  • Gland atrophy
Full atlas page →

Sjögren Syndrome

Salivary Gland Disorders

Complications

  • Rampant cervical caries
  • Candidiasis
  • Non-Hodgkin MALT lymphoma of parotid (15–20× risk) — persistent unilateral swelling warrants biopsy
  • Corneal ulceration
Full atlas page →

Solitary Bone Cyst

Non-odontogenic Cysts

Treatment planning

  • Confirm diagnosis with imaging + vitality tests
  • Plan surgical exploration under LA/GA
  • Warn patient of possibility of finding empty cavity

Surgical procedure

  • Small buccal cortical window → aspirate / observe empty cavity → gentle curettage of walls to encourage bleeding → primary closure
  • Bone graft only for very large lesions

Reconstruction

  • Rarely required; spontaneous bony infill expected within 6–12 months

Complications

  • Pathological fracture (rare)
  • Recurrence if incomplete exploration (< 10%)
  • Injury to IAN canal in posterior mandible

Recurrence

  • < 10%; typically responds to a second curettage.
Full atlas page →

TMJ Ankylosis

TMJ Disorders

Complications

  • Re-ankylosis
  • Facial nerve injury
  • Growth disturbance
  • OSA
Full atlas page →

Torus Palatinus & Mandibularis

Benign Tumors

Complications

  • Post-op haematoma, wound dehiscence, palatal fistula, sensory disturbance
Full atlas page →

Traumatic Ulcer

Ulcerative Diseases

Complications

  • Secondary infection
  • Chronic traumatic ulcer if cause persists
Full atlas page →

Verrucous Carcinoma

Oral Cancer

Complications

  • Local recurrence if margins inadequate (10–20%)
  • Anaplastic transformation to conventional SCC (5–10%)
Full atlas page →

White Sponge Nevus

White Lesions

Treatment planning

  • Reassure — benign condition
  • Genetic counselling for family

Surgical procedure

  • Not indicated

Complications

  • None — no malignant transformation

Recurrence

  • Persistent lifelong; not applicable.
Full atlas page →

Zygomatic Complex Fracture

Trauma

Complications

  • Persistent infraorbital paraesthesia
  • Enophthalmos / diplopia
  • Malar flattening
  • Ectropion (subciliary approach)
  • Sinusitis, malunion
Full atlas page →