Conservative Management of Odontogenic Cysts by Surgical Decompression: Treatment Outcomes of 9 New Cases

Traditional management of odontogenic cysts, such as enucleation or resection, can lead to complications, particularly in larger cysts or those near vital structures. Surgical decompression offers a more conservative approach, reducing the size of the cyst gradually by creating a small opening in the cyst wall. This method aims to minimize the risk of complications while preserving surrounding tissues. Despite its advantages, there is a need for more evidence on the long-term outcomes of decompression.

Objective: The aim of the present study was to assess the extent of cyst size reduction, healing time, and potential recurrence rates in nine newly treated cases, providing further evidence on the viability and limitations of decompression as an alternative to more invasive surgical approaches for managing odontogenic cysts.

Materials and Methods: This prospective study focused on 9 patients diagnosed with cystic lesions and treated between January 2015 and June 2019. Patients involved in this study had a point in common which was the presence of a radiolucent image in the mandibular or the maxilla bone with well-defined margins. Some of them enclosed the crown of an impacted permanent tooth. These images were suggestive of the diagnosis of dentigerous cyst, keratocyst or even inflammatory cyst. The treatment consisted of marsupialization or decompression requiring or not a second surgical time. Patients attended follow-up visits at regular intervals (every week for one month then every month) to monitor cyst size and ensure proper stent function. The study protocol adhered to ethical standards, with informed consent obtained from all participants, ensuring confidentiality and adherence to safety protocols.

Results: Nine healthy patients were included in the study. The histopathological diagnosis concluded with 7 dentigerous cysts, 1 inflammatory cyst, and one keratocyst. Among the 5 patients diagnosed with dentigerous cysts who had mixed dentition, total reossification was achieved within 5 to 7 months. For the rest of the patients, a second surgical time was indicated after partial regression. Total reossification was noted for keratocyst patient after a second enucleation.

Conclusion: The clinical and radiographic investigations demonstrated the effectiveness of Marsupialization and decompression in the treatment of maxillary and mandibular cystic lesions. It reduced the size of lesions avoiding injury to adjacent structures. The reclassification of the keratocyst as an odontogenic cyst stimulates the choice of conservative treatments and reinforces the continuity of investigations on decompression and complementary treatments. However, secondary surgery is recommended.