Oral and Maxillofacial Surgery
Marsupialization for odontogenic keratocysts: Long-term follow-up analysis of the effects and changes in growth characteristics*,**,*,**,*,**

https://doi.org/10.1067/moe.2002.128022Get rights and content

Abstract

Objective. This study evaluated the effects of marsupialization on odontogenic keratocysts (OKCs) and its role in conjunction with enucleation and curettage. Study Design. Twenty-eight primary OKCs, treated by marsupialization before enucleation and curettage, were examined in this study. The effect of marsupialization and recurrence data after a follow-up period of at least 3 years were evaluated. The changes of growth characteristics during marsupialization were analyzed by means of histopathologic and immunohistochemical studies with monoclonal anti-Ki-67 antibody. Results. The effect of marsupialization was evaluated as extremely effective (64.3%), moderately effective (32.1%), and poorly effective (3.6%). In 5 lesions, the cysts disappeared macroscopically and further surgery was not done. Recurrence was observed in 6 lesions (21.4%), and there was no significant difference in recurrence rates between the lesions treated with or without marsupialization. There appeared to be a predilection for recurrence in the lesions in the mandibular ramus region and also for radiographically multilocular lesions. Microscopic examination showed substantial changes from a parakeratinized or orthokeratinized epithelium into a hyperplastic, stratified, nonkeratinizing squamous epithelium after marsupialization in many cases. There was no significant difference in labeling index between premarsupialization (20.2% ± 12.0%) and postmarsupialization (15.3% ± 10.3%). Conclusions. Marsupialization was found to be effective as a preliminary treatment for large OKCs. This procedure does not appear to affect the recurrence tendency of OKCs, and the probable changes in growth characteristics become rather less aggressive. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;94:543-53)

Section snippets

Clinical material

Twenty-four patients with 28 primary OKCs were treated by marsupialization before surgery and followed-up for more than 3 years (range, 3 to 14 years; mean, 6.6 years) during the period from 1985 to 2001. Three patients had multiple OKCs, and 2 patients (5 cysts) were associated with BCNS. Clinical information and radiographs were obtained from the records of the Department of Oral and Maxillofacial Surgery, Kyushu University Dental Hospital (Table I).

The patients' ages ranged from 11 to 70

Effect of marsupialization

The duration of marsupialization ranged from 6 to 80 months (mean, 23.5 months; median, 18 months), and RRs of OKCs ranged from 41.4% to 100% with a mean of 81.4% (Table I). Marsupialization was evaluated as extremely effective in 18 lesions (64.3%), moderately effective in 9 lesions (32.1%), and poorly effective in 1 lesion (3.6%). In 5 lesions of the extremely effective group the cysts completely disappeared during marsupialization, and no further surgical removal was performed. Average ages

Discussion

Marsupialization, as well as decompression, has the purpose of relieving the pressure within the cystic cavity and allowing new bone to fill the defect. Consequently, contiguous structures such as tooth roots, the maxillary sinus, or the inferior alveolar canal can be saved from surgical damage. These procedures have thus been widely used for non-neoplastic jaw cysts and cystic odontogenic tumors.12, 14, 17 Previously, many individual case reports and small series have described

Conclusion

We conclude that presurgical marsupialization was effective in managing OKC, minimizing the cyst size and limiting the extent of surgery, and that this procedure does not affect the recurrence rate of OKC. These present results suggested the possibility of marsupialization as a first option for the treatment of large OKCs.

References (28)

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    2021, British Journal of Oral and Maxillofacial Surgery
    Citation Excerpt :

    It should be mentioned that information regarding post-intervention follow-up periods was not available in 13 articles.10,27–38 From the remaining 18 studies that addressed follow-up periods, 11 reported recurrence rates,2,3,7,8,14,39–46 of which five reported no recurrences.2,8,39,42,44 To provide an overview of results, only the relative size/volume reduction and intervention duration were reported in the section below considering the most common pathological entities (such as DC, OKC, RC, AM, and UA).

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Reprint requests: Norifumi Nakamura, DDS, PhD, Department of Oral and Maxillofacial Surgery, Kyushu University Dental Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan, [email protected]

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aAssistant Professor, Department of Oral and Maxillofacial Surgery, Kyushu University Dental Hospital.

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bResident, Department of Oral and Maxillofacial Surgery, Kyushu University Dental Hospital.

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cPostgraduate course student, Oral and Maxillofacial Oncology, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University.

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dProfessor, Division of General Oral Clinic, Kyushu University Dental Hospital.

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eProfessor, Oral and Maxillofacial Oncology, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University.

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