Cysts and tumors of the jaws treated by marsupialization: A description of 4 clinical cases

Abstract

Since the 4th edition of the World Health Organization’s Classification of Head and Neck Tumours was published in January of 2017, the keratocystic odontogenic tumor is back into the cyst category as odontogenic keratocyst (OKC). Depending on the size of the cyst, its location and the patients’ age, several treatment options are available: curettage, enucleation, radical treatment and marsupialization. The marsupialization is a conservative technique used in early tumor stages, as curative treatment for the odontogenic cyst. Despite its disadvantages and controversies, the marsupialization remains an interesting therapeutic choice in the case of large cysts, or in very young or old patients. We describe, in this article, four clinical cases of odontogenic cysts. We report the surgical management and the subsequent evolution of the patients. The discussion focuses on the indications, advantages and limitations of the odontogenic cyst’s marsupialization. We review the specific conditions of the odontogenic cysts that could make the marsupialization the optimal therapeutic option. In our cases, the marsupialization proved to be a conservative technique which allowed the respect of neighboring anatomical structures, particularly in the case of large cysts, but requires prolonged clinical and radiological monitoring. Pathological entity for our cases was different. Thus, the treatment outcome may be different too. This series is very small and the reader should be cautious about drawing broad conclusions regarding the optimal therapeutic choice. Key words: Marsupialization, odontogenic cyst.

Marsupialization of odontogenic keratocyst using thermoform surgical splint in a pediatric patient, with 3-year follow-up

“…[ 5 ] Treatment of OKCs remains controversial because of their higher recurrence potential,[ 12 ] and options include decompression, marginal resection, en bloc resection and adjuvant therapy, like cryotherapy, peripheral ostectomy and Carnoy's solution. [ 2 ] However, marsupialization (Partsch I procedure)[ 7 ] is reported to be the treatment of choice in large cysts involving multiple unerupted teeth and anatomic structures. It aims to reduce the size of the lesion thus preventing extensive surgery, preserving vital structures.…”

“…[ 9 ] In literature, the term marsupialization is often used interchangeably with decompression, but they are distinguished as decompression is any technique that reduces the pressure within a cyst, while marsupializationis a process of converting cyst into an open pouch that communicates with the oral cavity. [ 7 ] However, both the procedures allow new bone to fill the defect. Studies have shown that more effective results were observed after marsupialization in lesions of the mandibular body than in ramus.…”

“…[ 1 3 ] According to the World Health Organization's (WHO) 1992 classification, OKCs are typed under developmental (dysembryogenetic) cysts[ 3 ] and were designated in 2005 as a keratocystic odontogenic tumor[ 4 5 ] which is defined as “a benign uni or multicystic, intraosseous tumor of odontogenic origin, with a characteristic lining of parakeratinized stratified squamous epithelium, and potential for aggressive, infiltrative behavior.”[ 5 6 ] In 2017, the fourth edition of the WHO/IARC Classification of Head and Neck Tumors were published where keratocystic odontogenic tumor is back into the cystic category as OKC. [ 1 7 ] It is frequently reported in the second to fourth decade of life and relatively less in the first decade. [ 2 ] It has a multicentric growth pattern, infiltrating through cortical bone and extending into adjacent soft tissue.…”

The Successful Use of Marsupialization of Maxillary Cysts and Benign Tumors Combined With Orthodontic Treatment

“…It is more used alone in dentigerous cysts and radicular cysts, since it can obtain good results in such lesions. The secondary treatments were often seen in odontogenic keratocyst and cystic ameloblastoma due to their high recurrence rate and local aggressiveness [52,51].…”

Unicystic Ameloblastoma Mimicking Lateral Periodontal Cyst

“…Currently, conservative and radical treatments exist for UA. The conservative approach consists of a simple enucleation (i.e., surgical removal of the whole lesion including the capsular/pseudocapsular surface), or an enucleation followed by Carnoy's solution [ 6 ], or a marsupialization followed by enucleation [ 1 , 7 ].…”