What Is Partsch I Technique or Marsupialisation in Maxillofacial Surgery?
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Partsch - Technique or Marsupialisation in Maxillofacial Surgery

Published on Aug 19, 2022 and last reviewed on Aug 09, 2023   -  5 min read


Partsch technique is a process in maxillofacial surgery that relies on the principle of incomplete removal of cyst lining to facilitate drainage of the lesions.

What Is a Cyst?

The cyst is basically a tissue space-occupying sac with a cavity in the center (lumen). This cavity is surrounded by an outer fibrous connective tissue wall. This tissue wall separates the cyst from the surrounding normal tissues. On the inner aspect of the cystic wall, a cystic lining of epithelium that is composed of stratified squamous epithelium is commonly seen. Most cysts have a more common occurrence in the oral cavity or within maxillofacial regions in comparison to the other parts of the body.

What Is Marsupialization?

Marsupialization is also known as Partsch I Technique or the cystostomy procedure. This is a common surgical procedure in dentistry wherein the cystic sac is modified or deroofed as though it is being converted to a pouch. This results in a sustainable stoma or opening or outlet that reduces intracystic hydrostatic pressure. The principle of nationalization is based on the surgical externalization of the cystic cavity. This creates an opening in the superficial aspect of the cyst. The resected portion is then sent for histopathological study to evaluate the type and prognosis attached to the cyst. The borders of the cystic wall are then sutured by the surgeon to the surrounding edges of the oral mucosa converting this into an open pouch-like structure or rather as an enclosed sac in turn exposing the cystic lining or epithelium to the oral environment. This procedure not only decreases the volume and size of the lesion but also promotes the speedy healing of the jaw bone along with the formation of new bone. This option is considered more precise by dentists than the conventional decompression methods. It can also be used as a solo treatment regime form for a cyst or as a preliminary step to the final second stage of enucleation (wherein the cystic lining is eliminated).

Why Should Cysts Be Eliminated?

Cysts can either be classified further as true cysts or pseudocysts and can be commonly found in the jaw bones or in the soft tissues when there is a source of active infection in the suspected area. The classification of cysts can help the dentist or the maxillofacial surgeon to identify each cyst, based on its origin and its clinical and histopathological features. Also, it is on the basis of this classification that a suitable treatment plan can be decided accordingly.

The majorly accepted version of cyst classification in the oral and maxillofacial regions are:

  1. Odontogenic cysts.

  2. Nonodontogenic cysts.

  3. Dental cysts.

The cyst is basically a tissue space-occupying lesion or sac with a cavity in the center (lumen). This cavity is surrounded by an outer fibrous connective tissue wall. Most odontogenic, nonodontogenic, and dental cysts continue to grow and slowly expand in size over time. If left untreated by the dentist, they will not only cause secondary jaw infections but can make the jawbone weak thereby leading to pathological fractures. Few cysts can also potentially undergo a transformation to aggressive pathological lesions (like in cases of ameloblastoma into squamous cell carcinoma) apart from their ability to interfere in the eruption of teeth (as it happens when there is a dentigerous cyst or their capacity to intrude within the structures adjacent to the teeth in the maxillofacial regions like the maxillary sinus, nasal cavity, inferior alveolar nerve).

These issues cause the patient severe oral discomfort either in the form of swelling, pain, or facial asymmetry. Certain untreated cysts with severe pathology can be a cause of cancers as well.

What Are the Goals of the Marsupialization Technique?

The goals of definitive treatment for these cystic lesions are:

  • Effective drainage to prevent the recurrence rates that are quite high in the case of certain cysts.

  • Elimination of the pathology, thus minimizing the morbidity for the patient. This can improve the quality of life for the patient postsurgically.

  • Care is also taken by the maxillofacial surgeon to a certain extent that there is minimal trauma to the adjacent important structures like dentition and nerves.

  • The other accessory goal is to restore, preserve and simultaneously maintain the function and esthetics of the area affected by post-surgical drainage of the cyst.

What Is the Surgical Procedure in Marsupialization?

In marsupialization, after locally anesthetizing the area prior to the procedure, an incision is made. This is done to create a surgical window into the cyst. The cystic lining is then eventually removed by the surgeon, and the boundaries of the cystic lining around the surgical opening are sutured back to the surrounding oral mucosa. When the surgeon may often observe a thick bony cover over a cyst, then an inverted U-shaped incision needs to be planned with a wider base in the buccal sulcus.

The mucoperiosteal flap is then reflected, and the bony window should be removed cautiously with burs or rongeurs. The excised tissue of the window created is then sent for histopathological examination (the residual lining of the cyst is inspected). The cystic contents are drained completely, and then lastly the remaining cystic cavity is irrigated thoroughly to cleanse any residual debris. Post-surgery, the packed and medicated gauze strips can be left in situ for two weeks usually. This packing is done until the line of junction between the cystic lining and the oral mucosa heals completely. The postoperative care of the open bone cavity involves treatment with surgical packs until the wound margins undergo epithelialization. This usually takes about two to three weeks. After removal of the surgical pack, a plug or obturator must be used, which keeps the cystic cavity open until bone apposition has taken place. The obturator must be reduced if needed regularly.

After removing the pack from the cystic cavity, the patient needs to follow rigorous oral hygiene and rinse or gargle with an antiseptic mouthwash daily to prevent food accumulation. This regime should be continued for the following four to five months until the bone fills and complete healing is noticeable to the surgeon.

What Are the Advantages of Marsupialization?

The advantages of this procedure include:

  • The surgical intervention is of short time interval and causes minimal trauma.

  • Swelling and postoperative complications observed in most cases are minimized.

  • Neighboring structures like the teeth, alveolar dental nerve, the floor of the nose, and the floor of the maxillary antrum cannot be damaged during this procedure.

What Are the Disadvantages of Marsupialization?

The disadvantages of the technique include the following:

  • Postoperative care of up to one year or even more may be definitely necessary.

  • Complete bony healing will not occur in patients, especially the elderly, immunosuppressive patients, or patients with an underlying systemic disease.

  • Marsupialization may necessitate the use of a plug or obturator to prevent the recurrence of the cyst thus rendering a second intervention by the surgeon again if necessary.


To conclude, marsupialization is still a preferred surgical procedure by maxillofacial surgeons to decrease the intracystic pressure and gradually shrink the cyst. It is a preferred procedure to study the nature of the cyst histopathologically before complete removal and it allows complete natural drainage of the cystic contents. Marsupialization is however definitely contraindicated when previous attempts at conservative treatment may have failed or when complete or marginal resection is indicated absolutely.

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Last reviewed at:
09 Aug 2023  -  5 min read




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