Fig 2
(A) panoramic radiograph of odontogenic keratocyst before decompression; (B) panoramic radiograph 1 year after decompression and before subsequent enucleation; (C) panoramic radiograph 1 year after subsequent enucleation; (D) panoramic radiograph obtained 2 years after subsequent enucleation; (E) panoramic radiograph 5 years after subsequent enucleation.
Source publication
Background
Decompression is an approved alternative to cystectomy in the treatment of jaw cysts. This study aimed to evaluate its effectiveness as an initial procedure, as well as factors with potential to influence outcome.
Material and Methods
The frequency of decompression was analysed, whether completed in one session or followed by enucleatio...
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Citations
... Although conventional surgical treatment with enucleation is widely applied in these clinical settings, the outcome of larger defects by simple enucleation was not satisfactory because of high risk of wound infection. 4,5 Autogenous bone grafting was considered as the priority for reconstructing larger bony defects due to osteoconductive, osteoinductive, and little immunogenic properties. 6 Limited bone quantity was the biggest disadvantage for grafting especially for several donor sites. ...
Key Clinical Message
Management of large jaw cyst is challenging since high risks including pathologic fracture, limited opening, and insufficient bone healing occur after enucleation. The current case of concentrated growth factor (CGF) gel to fill defect after enucleation of large jaw cyst is rare. A 12‐year‐old boy with pain and swelling for 4 months in the left mandible region made a medical consultation at our hospital. Computerized tomography scan indicated that cystic lesion was found in the left mandible region. In this case, we present a patient with large jaw cyst (31 mm × 44 mm × 53 mm) who received enucleation followed by CGF gel filling the defect. The patient was discharged after 13 days without discomfort symptoms. The lesion size was reduced significantly at 1‐month re‐examination. No abnormality was detected in maxillofacial region at 1‐year re‐examination. Application of CGF gel is one of the possible options for filling defect after jaw cyst enucleation.
... It begins when there is an accumulation of fluid in the rest of the enamel epithelium and extends around the crown of the unerupted tooth. [25][26][27] A dentigerous cyst can be treated by enucleation, marsupialization, or both of these surgical treatments in two steps. A decision about the management of a dentigerous cyst depends on several considerations, such as the size and location of the cyst, the removal of an unerupted tooth, and the possibility for follow-up with the patient. ...
... Concentrations of chlorhexidine that are greater than 0.1% can cause leakage of intracellular components out of the cell and undertake a bactericidal effect that prevents bacterial contamination that could hinder bone regeneration. 32 In this case, the use of two-step surgery was based on research by Marin et al. 26 that demonstrated that enucleation after marsupialization is necessary in 54.4% of cases, especially in the posterior region. In this case, the odontectomy of the mandibular third molar was also performed to eliminate the possible main cause of the cyst. ...
Background: A dentigerous cyst is the second-most frequently observed odontogenic cyst, and an ameloblastoma is one of the most frequently observed odontogenic tumors. Both are mostly associated with an impacted mandibular third molar and have similar characteristics. Diagnostic difficulties often result in misdiagnosis and remain a challenge to overcome. Comprehensive clinical, radiographic, and histopathological views are essential to correctly diagnose the problem and formulate the most suitable treatment plan. Purpose: This case report aims to present a thorough approach to the diagnostic and surgical procedures involved in treating a dentigerous cyst that resembles an ameloblastoma by using marsupialization followed by enucleation. Case: This article presents the case report of a 27-year-old male patient with an infected dentigerous cyst resembling a unicystic ameloblastoma associated with a totally impacted lower mandibular left third molar. The patient had a history of swelling, pain, and pus drainage in the retromolar area. Symptoms subsided after antibiotic and analgesic prescriptions, but the lesion remained and was slowly progressing. The diagnostic approach began with a fine-needle aspiration biopsy, and the result confirmed a benign cystic lesion that was suspected to be an odontogenic tumor. Then an incisional biopsy was conducted under local anesthesia, diagnosing an infected dentigerous cyst. Case Management: Marsupialization and decompression using an obturator was preferred, followed by enucleation. Nine months later, a radiographic examination revealed satisfactory bone regeneration without recurrence. Conclusion: An incisional biopsy plays a vital role in establishing a definitive diagnosis. Marsupialization followed by enucleation offers an excellent combination of treatments achieving complete cyst removal, anatomical structure preservation, and bone regeneration with minimal complications.
... 11 Usually, it is indicated in the cases of benign cystic lesions, such as dentigerous cyst, Odontogenic keratocyst, cystic ameloblastoma and radicular cyst. 23 Thus, it has been accepted as a first option for the treatment of large cystic lesions no matter what diagnosis it is. It had been used alone, or combined with tooth extraction, tooth traction, enucleation, curettage, resection, carnoy solution… The reintervention is often seen in the cases of odontogenic keratocyst and cystic ameloblastoma in order to eliminate the residual lesion because of their aggressive character and their high recurrence rate. ...
... In fact, they promote the eruption of teeth retained by the cyst. 23 They also offer the possibility of preserving teeth having functional interest with or without performing orthodontic traction. In case of no bone remodeling or regression of clinical symptoms, enucleation with removal of the tooth can be considered. ...
The dentigerous cyst is the second most common odontogenic. The prevalence rates ranging from 0.8% to 3.6% in the general population. It affects people especially at the second and third decade of life with a male predilection. It presents a preference for the mandibular region particularly for the second lower premolar. Surgical marsupialization or decompression are the most conservative treatment modalities as it prevents the risks of cyst removal as nerve injuries and preserves the unerupted tooth. Two clinical cases of two young patients presenting a dentigerous cyst involving impacted teeth, which were successfully treated by decompression will be reported in order to highlight the benefits and limits of cyst decompression as well as detailing its operating protocol and its instructions.
... While there is no consensus on optimal treatment, complications and morbidity need to be avoided, particularly with large cysts. [1] "Dredging" may be considered the "middle path" between conservative and radical treatment options. It comprises three entities-decompression, followed by repeated scraping of the lesion, and finally, peripheral ostectomy providing margin clearance but without significant morbidity. ...
Background:
Treatment modalities of odontogenic cystic lesions of the jaws range from conservative to radical. "Dredging" may be considered the "middle path" between conservative and radical treatment options. It comprises three entities-decompression, followed by repeated scraping of the lesion, and finally, peripheral ostectomy providing margin clearance but without significant morbidity.
Aim:
To evaluate the outcome of "dredging" in the management of large cystic lesions of the jaws, without major resections and maintaining normal functions.
Methodology:
This prospective study was conducted on 30 patients. Inclusion criteria were odontogenic cystic lesions at least 2 cm in size either in the proximity of vital structures or in children with developing tooth germs or so large that upon enucleation, can result in pathological fracture. All underwent decompression followed by dredging performed at every 2 to 3 months intervals.
Results:
Drastic decrease in size of the lesion as measured on Cone Beam Computed Tomography (CBCT) and new bone formation was evident in all patients. The total Reduction Rate (RR) of the cystic lesions was 88.79% in 9.2 months. RR was highest in Calcifying epithelial odontogenic cyst (CEOC) followed by Unicystic Ameloblastoma (UA), Odontogenic Keratocysts (OKC), Dentigerous cyst (DC), and Radicular Cyst (RC) in CBCT. The mean speed of shrinkage was fastest in CEOC, followed by OKC, UA, RC, and DC after dredging. Shrinkage was higher in patients below 20 years of age (P 0.012) and patients with large cystic lesions (P 0.00447).
Conclusion:
The results suggest that dredging with regular, long-term follow-up can be a successful treatment method for large cystic lesions in young adults. This method includes the benefits of both conservative and radical treatment methods but lacks the disadvantages of either.
... This is accomplished by the use of different devices, such as simple iodoform gauze, stents, brackets, and chains connected to impacted teeth, or detachable partial dentures that function as obturators. 17,18 . In our cases, we have made a post-surgical obturator made of acrylic, it is retained intraorally using clasps. ...
... The vertical extension is adjusted according to the clinical condition and eruption status of the permanent tooth during the check-up appointments.we did not observecommonly reported problems like infectionor obliteration of its entrance 18 . ...
Dentigerous cysts are one of the most common developmental types ofodontogenic cysts that develop in the oral cavity. They frequently appear as incidental observations on dental radiographs and/or as asymptomatic swellings. These cysts develop from remnants of decreased enamel epithelium adhering at the cementoenamel junction surrounding the crown of an unerupted or impacted tooth. The majority are considered developmental. However, in young patients, they may be inflammatory in origin, the result of caries in the primary dentition.The treatment modalities range from marsupialization to enucleation of the lesion and are based on the involvement of the lesion with the adjacent structures. However, the loss of a permanent tooth in the management of a dentigerous cyst can be devastating to a child.The present case series highlights the extraction of primary teeth involved in the lesion and marsupialization followed by the placement of a surgical obturator to maintain patient opening for drainage of cystic contents.
... Besides some adjustments performed during the checkup appointments, we did not observe commonly reported problems like infection or obliteration of its entrance. 17 Full eruption of the involved permanent teeth and healing of the cystic cavity in our patient occurred after 12 months, which is somewhat longer than Allon et al reported, where the estimated mean decompression period is 7.5 months in children under 18 years of age. 18 This outcome may be due to the lesion's size or the case's specifics. ...
Dentigerous cysts are rarely reported in young children. They are usually asymptomatic and only identified when becoming significantly large. Treatment by enucleation may damage structures like the inferior alveolar nerve, maxillary sinus, or permanent teeth, thus reducing the child’s quality of life. Therefore, conservative surgical treatment such as decompression is indicated. This case report describes the treatment and subsequent complete regression of an inflammatory dentigerous cyst based on the decompression method using a customized surgical tube in a 10-year-old girl. The innervation was preserved, and permanent teeth erupted.
... Decompression aims at creating a small epithelial pathway through the soft tissue between the cystic cavity and the oral cavity. After the surgical wound has healed, the stent is used for drainage in order to reduce the pressure in the cystic cavity and it is more comfortable for the patient (Consolo et al., 2020;Marin et al., 2019). ...
... Marsupialisation of a large dentigerous cyst before its removal or healing has the advantage of avoiding many problems such as anatomical lesions. The main disadvantages are related to the discomfort for the patient and compliance in packing and flushing the surgical wound (Marin et al., 2019). This method has been reported by other authors as the eligible approach to large dentigerous cysts (Bonavolontà et al., 2019;Oliveros-Lopez et al., 2017;Wang et al., 2020). ...
A male patient aged 11 years presented a large dentigerous cyst in the lower left quadrant associated with retained deciduous lower lateral incisor and canine and impacted, unerupted corresponding permanent ones. The treatment consisted in marsupialisation and placement of a modified lingual arch that held a tube for decompression used for irrigation of the cystic cavity in a comfortable way for the patient and for the clinician.
The same lingual arch was later used as an anchorage method for retained teeth traction. The final records showed complete resolution of the cyst and retained teeth were successfully placed in their correct position in the oral cavity.
... Knowledge of the biological characteristics, basic features, and histopathological behaviors of cystic lesions in the OMF region is key to ensuring an early clinical diagnosis, a prompt treatment, and a favorable prognosis (8)(9)(10). In most cases, diagnosis of odontogenic and non-odontogenic cysts can be challenging owing to their quiescent progression and similar clinical and radiographic characteristics (11)(12)(13). The asymptomatic nature of these cysts in the initial phase delays diagnosis and treatment and thereby leads to aggressive growth of the cysts and destruction of adjacent regions such as the maxillary sinus and mandibular nerve (14)(15)(16). ...
... Enucleation and curettage appear to be appropriate treatments for most cases (19). Nevertheless, because many factors contribute to the treatments of odontogenic and non-odontogenic cysts (12,17), its epidemiology and treatment must be examined to better understand the nature of these lesions in different populations, especially in South Sulawesi, where proper documentation and sound statistics about public health are lacking. Hence, in this study, we aimed to investigate epidemiology and treatment of odontogenic and non-odontogenic cysts in South Sulawesi, Indonesia. ...
Background:
Diagnosis of jaw cysts is challenging in general dental practice, and most cases are incidentally discovered through routine dental radiography. The aim of this study was to examine the epidemiology and treatment of odontogenic and non-odontogenic cysts to better understand the status of these lesions in populations in South Sulawesi, Indonesia.
Material and methods:
This retrospective study was conducted on patients treated at four different hospitals in Makassar between January 2011 and June 2017. Patients diagnosed as having odontogenic or non-odontogenic cysts were included in the study. Information on variables such as sex, age, histopathological, and anatomical distributions was collected. Statistical analyses were performed using an independent T-test and the Pearson chi-square test (p< 0.05).
Results:
A total of 173 samples were collected, of which only 60 were histopathologically analyzed. The patients' mean age was 30.3 years. The cysts occurred more frequently in women and in the anterior maxilla, followed by the posterior mandible. The radicular cyst was the most prevalent type, followed by the dentigerous cyst. Most cysts were treated with enucleation. Of the patients, 72.8% were followed up, of whom 3.2% had a recurrence and only 19.1% had complaints of clinical symptoms.
Conclusions:
Our findings indicate that odontogenic and non-odontogenic cysts widely vary in terms of incidence, with some exhibiting a predilection for specific ages and sites and specific sex. Knowledge of these factors could be useful for both clinicians and pathologists in the diagnosis and choice of the appropriate treatment plan. Key words:Cyst, epidemiology, odontogenic, non-odontogenic, treatment.
... The extent of the treatment protocol of jaw cysts depends on the biological behaviour and proximity of the cystic lesion to anatomically vital structures. [1,2] Preservative methods such as decompression and marsupialization can be used when simple enucleation may pose several difficulties such as damage to the nervus alveolaris inferior or mental nerve during instrumentation or unnecessary extraction of an impacted permanent tooth which is enclosed by the cystic cavity. [3] Decompression is a treatment method used to decrease the volume of the cystic cavity by decreasing the internal pressure with the aid of a catheter or stent placed into the cystic lumen in the treatment of odontogenic cysts and cystic tumours. ...
Introduction:
To compare the treatment methods of enucleation and decompression with regards to reduction of the dimension of the cystic defect with the aid of a software program.
Materials and methods:
Thirty patients with regular controls of 3, 6, and 12 months treated between January 1, 2013, and January 1, 2021, were selected and included in the study. Sixteen patients were treated with enucleation and 14 patients with decompression. All preoperative and control radiographic and clinical data were retrieved from the archives. The area measurement of cystic cavities was made on panoramic radiographs taken at preoperative (T0), 3-month (T1), 6-month (T2), and 12-month (T3) control periods with a software program. Intra-group and inter-group analyses were made to compare the reduction of cystic defects between two treatment methods.
Results:
The mean age of study patients was 45.2 ± 7.3. Eighteen of them were male and 12 of them were female. Statistically, a significant difference was not observed between decompression and enucleation groups at T0, T1, T2, and T3 control periods (P > 0.05). There was a statistically significant difference in the defect dimensions between all control periods in both decompression and enucleation groups (P < 0.05).
Discussion:
Decompression and enucleation of jaw cysts are both successful in reducing cystic cavities. However, there is no superiority between the two treatment modalities regarding the defect reduction at the 12-month control period.
... Also, the size and the positioning of the cyst determine the ideal surgical approach (palatal or labial). However, marsupialization has been proposed as an alternative treatment for large cysts (5,11,18,19). In the current study, most NDCs were treated by excision surgical (excisional biopsy). ...
Background:
Nasopalatine duct cyst (NDC) is the most common non-odontogenic cyst in the oral cavity. Clinically it is not difficult to suspect these lesions based on clinical and radiographic appearance. However, the histopathological diagnosis may be difficult due to the broad morphological diversity of these lesions. The objective was to analyze the clinicopathological features of NDCs diagnosed in two oral and maxillofacial pathology services in the Brazilian northeast.
Material and methods:
A retrospective clinicopathologic study was performed. A total of 18,121 clinical records of oral lesions from two oral and maxillofacial pathology services in Brazil were analyzed (2000-2020). All NDCs cases were revised and demographic, clinical, radiographic, and histopathological data were collected.
Results:
Among 18,121 diagnoses in the oral pathology services, 45 (0.2%) were NDCs. The series comprises 24 males (53.3%) and 21 females (46.7%), with a mean age of 43.2 years-old. Most lesions were asymptomatic (n = 27, 60%) with an mean size of 2.1 cm. Microscopically, the non-keratinized stratified squamous epithelium was the most common (66.7%). However, in 88.9% of cases, the epithelial lining was varied and composed of two or more types of epithelium. There was no significant association between the type of epithelium and the size of the cysts (p = 0.389). Nerve, blood vessels, hemorrhage, and chronic inflammatory infiltrate were commonly observed. In contrast, there was a low frequency of mucous glands, sebaceous glands, cholesterol clefts, and multinucleated giant cells.
Conclusions:
The clinical, radiographic, and microscopic findings observed in this study are similar to those reported in the literature. Due to the morphological diversity of NDC, it is needed to correlate its histopathological features with the clinical and radiographic findings to establish a correct diagnosis.
