Long-term investigation of decompression as a definitive treatment for mandibular cysts associated with impacted third molars

Analysis of Marsupialization of Mandibular Cysts in Improving the Healing of Related Bone Defects

“…This minimally invasive procedure resulted in volume reduction of 48.28 to 57.95% for various types of cysts after $6 months (monthly mean rate, 11.4%) and a reduction of 70.5% after 8 months (monthly reduction rate, 8.81%) in residual bone cavities after dentigerous cyst removal. 8 Apart from Song et al, 19 who showed an association with age, no variables were found to be associated with the extent of volume reduction after decompression, excluding the treatment duration and the initial volume. Because the 2 techniques (ie, marsupialization and decompression) showed similar results in terms of cystic cavity shrinkage, the size of the communication between the cyst compartment and the oral cavity might be irrelevant.…”

“…These values are significantly lower than those reported in a previous study using 2-dimensional radiographic examinations, which reported 22.42, 46.07, and 64.69% increases at 1, 3, and 6 months after marsupialization, respectively, 14 and the previously cited results after decompression calculated from CT scans. 8 Complete closure of the soft tissues isolating the residual bone defect from the oral cavity seems to slow the osteogenic process. This supports the use of the conservative treatment option, despite the objective disadvantages related to disinfection of the newly created cavity or maintenance of the patency of the communication slit during marsupialization and decompression, respectively.…”

“…In contrast, decompression is prone to closure, with reintervention required in some cases. 8,12 However, marsupialization results in an apparently useless major loss of bone to create the pouch. The duration of treatment and preoperative cystic volume both correlated positively with volume reduction, similar to decompression.…”

“…This procedure generally requires frequent gauze packing or the application of obturators to prevent food impaction and infection. 3,[6][7][8] Apart from the release of inner pressure, the healing process with volume reduction of the lesion benefits from the creeping invasion of the oral mucosa on the cystic lining. Decompression, as proposed by Neuschmidt 9 and Thoma, 10 creates a minimal epithelial pathway through the soft tissues between the intrabony compartment and the oral environment after the mucosal flap has healed around a drainage tube or stent.…”

“…Decompression appears to be better tolerated than marsupialization 11,12 ; however, this depends on patient compliance with daily rinsing using a blunt needle through the epithelial slit to maintain patency. 8,12,13 Previous studies that used these 2 techniques have been limited, in particular, because the 2 techniques have no precise distinctions between them and they have often been used in the same trials and for approximate radiologic bidimensional evaluation of lesion shrinkage over time. [14][15][16][17] Computerized volumetric measurements of cyst reduction using computed tomography (CT) scans are known to correlate with important variables after decompression.…”