PMC10409577_01
A well-defined, unilocular radiolucent lesion in the maxillary anterior region on (a) the panoramic radiograph and (b) CBCT. The red arrows indicate the cystic lesions on the X-ray images.
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The panoramic radiograph and cone-beam computed tomography (CBCT) showed a well-defined unilocular radiolucent area beyond the nasal floor (Figure 1).
Chart of the segmentation procedure of the maxilla. (a) STL file of the scanned maxillary dental model and 3D-reconstructed CBCT volume data of maxillary bone were (b) laid to overlap each other, and (c) merged on the Amira  software.
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The volumetric data of the maxilla and dentition model data were segmented and merged, and a surgical guide was designed by 3D structural analysis software (Amira , Thermo Fisher Scientific, Waltham, MA, USA; Figure 2).
The design of surgical guide for nasopalatine cyst removal. (a) The tooth-supported one-piece surgical guide includes (1) the circle structure (blue arrow), (2) the stopper (green arrows), and (3) the nasal side of the indicator (red arrow). (b) The circle structure in the plate part indicates the maximal cyst size when observed from the occlusal plane. The indicator can slide and show the direction toward the bottom of the cyst. (c) The clear-colored surgical guide printed by the 3D printer was checked for insertion into the bone model of the maxilla (brown).
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A tooth support structure was designed without undercuts, similar to a mouthpiece (Figure 3).
The surgical procedure using the surgical guide. (a) The incision line was shown. (b) Intraoperative image showing the size of the cyst with the circle structure of the surgical guide. (c) The direction and depth of the cyst could be checked with the surgical guide. The indicator can slide the direction showing as the red arrow. (c and d) The stopper (green arrows) confirmed if the bottom part of the cyst was accurately removed. (e) The resected specimen.
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The custom-made surgical guide was placed and used (1) before and (2) after mucoperiosteal dissection and exposure of the palatine bone and (3) after cystectomy (Figures 4(a), 4(b), 4(c), and 4(d)). The cyst was carefully removed, and the specimen was sent for pathological microscopic evaluation (Figure 4(e)).