Difficulties of the diagnosis and treatment of traumatic and aneurysmal cysts of the jaws

Abstract

The great diversity of the jaw cysts makes the issues of their diagnosis, differential diagnosis and treatment quite important, always requiring individual approach, given the features of each clinical case. Although the jaw cysts were first mentioned by Scultetus in 1654, the researchers still have different views on the semiotics and group belonging of individual nosological forms in the classifications and, consequently, on120 the choice of treatment method, prevention of possible complications and recurrences, and making prognosis. Asymptomatic clinical course and absence of characteristic clear clinical manifestations of the jaw cysts, similarity of their signs at separate stages of the development, regardless the nosological form and site of origin, make this pathology relevant in the practice of maxillofacial surgery. Traumatic and aneurysmal pseudocysts are common in the nomenclature of tumor-like formations of the jaws. The paper is concerned the etiology and pathogenesis, clinical morphological features and modes of treatment of traumatic and aneurysmal jaw cysts, based on the generalization of the findings of the scientific researches, to emphasize the above nosological forms to the medical community. The study encompassed the thorough analysis of the fundamental scientific works and publications in periodicals on above issues. The clinical part of the study concerned a comprehensive examination of 46 children with traumatic and aneurysmal jaw cysts who received treatment at the surgical unit of the Poltava Municipal Children’s Clinical Hospital during the period of 5 years. In addition, 8 adult patients with traumatic cysts were examined and received outpatient treatment at the Department’s clinic. Common clinical and additional examination methods, diagnostic puncture, EOD, radiography, CT and MRI were used to make the clinical diagnosis in serious cases. The microscopic structure of the specimens made from the postoperative material using conventional techniques, was studied. During 2014-2019, 46 children with neodontogenic jaw cysts (NJC) were treated at the Department of Children’s Oral Surgery, including 24 patients (52.2%) with traumatic cysts (TC) and 15 patients (32.6%) with aneurysmal cysts (AC). That is, TC and AC were accounted for 39 cases (84.8%) of NJC. At the same time, if the general age of patients with NJC ranged from 5 to 15 years, then TC and AC were most common in children aged 10-15 years, which is in concordance with the data of other researchers, who mark their highest percentage in puberty. 25 (64,1%) boys and 14 girls (35.9%) have been involved into study. Generalized statistical analysis revealed that traumatic cysts accounted for 52.2% of children, 32.6% for aneurysmal, 15.2% for other types of non-odontogenic jaw cysts. Among patients, boys predominated, and even121 trauma in the past medical history does not always correspond and confirm the type of cystic formation. The presented material suggests a rather conditional diagnostic «boundary» between traumatic and aneurysmal cysts, when, in fact, the main differential diagnostic criterion is a carefully gathered anamnesis, even at the prehospital stage. The given material can be the basis for further in-depth scientific and practical studies on the study of immunohistochemical structural features of traumatic and aneurysmal jaw cysts.