Optimum time of enucleation following marsupialization as a treatment strategy for large odontogenic keratocyst. (Radiologic and histopathologic study)

Abstract

Objectives:The aim of the current study was to estimate change of cyst volume after marsupialization, evaluate bone formation and to determine the optimum time for enucleation.Patients and methods: A total of 21 patients suffering from large odontogenic keratocyst more than 3cm in its largest diameter were treated by marsupialization followed by enucleation. The inferior alveolar nerve length and affection, as well as the overall and percentage cyst volume reduction, were the primary outcome factors. Postoperative follow-up consisted of clinical and radiographic examinations 3 months, 6 and 9 months after marsupialization.Results: Healing was uneventful in all patients, at three months, six months, and nine months postoperatively, the cyst volume had decreased by 39.05%, 65.62%, and 82.67%, respectively. The first three months showed a greater increase in bone density and decrease in cysts volume than the following three months (P < .01). The total number of patients underwent marsupialization for an average of 280 days. Up to nine months after surgery, none of the patients had an OKC recurrence. Conclusion:Within the limitations of our study, the enucleation timing after marsupialization of OKC is determined by the decrease of cyst volume and increase of its density and showed relocation of the inferior alveolar neurovascular bundle. Nonetheless, additional research is required with a larger study population and a longer follow-up period.