J Korean Assoc Oral Maxillofac Surg.  2014 Dec;40(6):260-265. 10.5125/jkaoms.2014.40.6.260.

The effectiveness of decompression for patients with dentigerous cysts, keratocystic odontogenic tumors, and unicystic ameloblastoma

• Park HS
• Song IS
• Seo BM
• Lee JH
• Kim MJ

• KMID: 1799558
• DOI: http://doi.org/10.5125/jkaoms.2014.40.6.260

Abstract

OBJECTIVES
The aim of this study was to verify the clinical effectiveness of decompression in decreasing the size of a cyst. In addition to the different types of cysts, we tried to reveal what effect host factors, such as the initial size of the lesion and the age of the patient, have on the velocity of cyst shrinkage.
MATERIALS AND METHODS
With the aid of a panoramic view, we measured the size of the cysts before and after decompression in 13 dentigerous cysts (DCs), 14 keratocystic odontogenic tumors (KTOCs), and 5 unicystic ameloblastoma (UA) cases. The velocity of shrinkage in the three cystic groups was calculated. Relationships between the age of the patient, the initial size of the cyst, and the shrinkage velocity were investigated.
RESULTS
The three types of cysts showed no inter-type differences in their velocity of shrinkage. However, there was a statistically meaningful relationship between the initial size of the lesion and the absolute velocity of shrinkage in the DC group (P=0.02, R=0.65) and the KTOC group (P=0.02, R=0.56). There was also a significant relationship between the age of the patient and the absolute velocity of shrinkage in the KTOC group (P=0.04, R=0.45) and the UA group (P=0.04, R=0.46).
CONCLUSION
There was no difference in the decrease in size due to decompression among the different types of cysts. However, the age of the patient and the initial size of the lesion showed a significant relationship with the velocity of shrinkage.

Keyword

Decompression; Odontogenic cysts; Unicystic ameloblastoma

MeSH Terms

Ameloblastoma*
Decompression*
Dentigerous Cyst*
Humans
Odontogenic Cysts*
Odontogenic Tumors*

Figure

• 

  Fig. 1 Measurement of the cystic lesion size in panoramic view. A. Investigation of the light and darkness contrast level around the boundary of the cystic lesion (circle). B. Traced boundary of the cystic lesion using a computer program in panoramic view (lined).

• 

  Fig. 2 No statistically significant difference in relative (A) and absolute velocity of shrinkage among the three groups (B) (P>0.05). (DC: dentigerous cyst, KTOC: keratocystic odontogenic tumor, UA: unicystic ameloblastoma)

• 

  Fig. 3 The relationship between the age of patients and the velocity of shrinkage in the two cystic lesion groups. A. Relationship between the age and the relative velocity of shrinkage in the UA group (P=0.04, R=0.46). B. Relationship between the age and the absolute velocity of shrinkage in the KTOC group (P=0.04, R=0.45). (UA: unicystic ameloblastoma, KTOC: keratocystic odontogenic tumor)

• 

  Fig. 4 The relationship between the initial size of the lesion and the absolute velocity of shrinkage in the KTOC group (P=0.02, R=0.56). (KTOC: keratocystic odontogenic tumor)

Reference

1. Anavi Y, Gal G, Miron H, Calderon S, Allon DM. Decompression of odontogenic cystic lesions: clinical long-term study of 73 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011; 112:164–169. PMID: 21194990.

2. Thoma KH. Oral surgery. 3rd ed. St. Louis: Mosby;1958.

3. Pogrel MA. Decompression and marsupialization as a treatment for the odontogenic keratocyst. Oral Maxillofac Surg Clin North Am. 2003; 15:415–427. PMID: 18088693.

4. Dolanmaz D, Etoz OA, Pampu A, Kalayci A, Gunhan O. Marsupialization of unicystic ameloblastoma: a conservative approach for aggressive odontogenic tumors. Indian J Dent Res. 2011; 22:709–712. PMID: 22406718.

5. Yokobayashi Y, Yokobayashi T, Nakajima T, Oyama T, Fukushima M, Ishiki T. Marsupialization as a possible diagnostic aid in cystic ameloblastoma. Case report. J Maxillofac Surg. 1983; 11:137–141. PMID: 6576089.

6. Kubota Y, Imajo I, Itonaga R, Takenoshita Y. Effects of the patient's age and the size of the primary lesion on the speed of shrinkage after marsupialisation of keratocystic odontogenic tumours, dentigerous cysts, and radicular cysts. Br J Oral Maxillofac Surg. 2013; 51:358–362. PMID: 22981336.

7. Yahara Y, Kubota Y, Yamashiro T, Shirasuna K. Eruption prediction of mandibular premolars associated with dentigerous cysts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 108:28–31. PMID: 19451007.

8. Oka S, Kubota Y, Yamashiro T, Ogata S, Ninomiya T, Ito S, et al. Effects of positive pressure in odontogenic keratocysts. J Dent Res. 2005; 84:913–918. PMID: 16183790.

9. Sampson DE, Pogrel MA. Management of mandibular ameloblastoma: the clinical basis for a treatment algorithm. J Oral Maxillofac Surg. 1999; 57:1074–1077. PMID: 10484108.

10. Lau SL, Samman N. Recurrence related to treatment modalities of unicystic ameloblastoma: a systematic review. Int J Oral Maxillofac Surg. 2006; 35:681–690. PMID: 16782308.

11. Furuki Y, Fujita M, Mitsugi M, Tanimoto K, Yoshiga K, Wada T. A radiographic study of recurrent unicystic ameloblastoma following marsupialization. Report of three cases. Dentomaxillofac Radiol. 1997; 26:214–218. PMID: 9442611.

12. Yoshiura K, Higuchi Y, Araki K, Shinohara M, Kawazu T, Yuasa K, et al. Morphologic analysis of odontogenic cysts with computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997; 83:712–718. PMID: 9195629.

13. Kubota Y, Yamashiro T, Oka S, Ninomiya T, Ogata S, Shirasuna K. Relation between size of odontogenic jaw cysts and the pressure of fluid within. Br J Oral Maxillofac Surg. 2004; 42:391–395. PMID: 15336763.

14. Kim SM, Chung SW, Cha IH, Nam W. Normal eruption guidance of unerupted permanent teeth associated with dentigerous cyst by decompression: 5 cases report. J Korean Assoc Oral Maxillofac Surg. 2009; 35:271–275.

15. Kim YH, Lee EW. Comparison of clinico-histopathologic findings before and after decompression of odontogenic cyst in the jaw. J Korean Assoc Oral Maxillofac Surg. 2005; 31:150–160.

16. Bodner L, Bar-Ziv J. Characteristics of bone formation following marsupialization of jaw cysts. Dentomaxillofac Radiol. 1998; 27:166–171. PMID: 9693529.

17. Forssell K, Sainio P. Clinicopathological study of keratinized cysts of the jaws. Proc Finn Dent Soc. 1979; 75:36–45. PMID: 93745.

18. Thomas M, Tackett JC, Desai P. The incredible odontogenic keratocyst. N Y State Dent J. 1992; 58:31–33. PMID: 1736219.

19. Peterson LJ. Contemporary oral and maxillofacial surgery. 3rd ed. St. Louis: Mosby;1998.

20. Jackson RF, Kramer HS, Hyde GM, Eisenberg E, Topazian RG. Clinicopathologic conferences. Case 45, part II: dentigerous cyst of the mandible with ameloblastomatous changes. J Oral Maxillofac Surg. 1983; 41:407–408. PMID: 6574223.

21. Marker P, Brøndum N, Clausen PP, Bastian HL. Treatment of large odontogenic keratocysts by decompression and later cystectomy: a long-term follow-up and a histologic study of 23 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996; 82:122–131. PMID: 8863300.

22. Miyawaki S, Hyomoto M, Tsubouchi J, Kirita T, Sugimura M. Eruption speed and rate of angulation change of a cyst-associated mandibular second premolar after marsupialization of a dentigerous cyst. Am J Orthod Dentofacial Orthop. 1999; 116:578–584. PMID: 10547520.

23. Gao L, Wang XL, Li SM, Liu CY, Chen C, Li JW, et al. Decompression as a treatment for odontogenic cystic lesions of the jaw. J Oral Maxillofac Surg. 2014; 72:327–333. PMID: 24071375.

24. Zhao Y, Liu B, Han QB, Wang SP, Wang YN. Changes in bone density and cyst volume after marsupialization of mandibular odontogenic keratocysts (keratocystic odontogenic tumors). J Oral Maxillofac Surg. 2011; 69:1361–1366. PMID: 21195525.

25. Shudou H, Sasaki M, Yamashiro T, Tsunomachi S, Takenoshita Y, Kubota Y, et al. Marsupialisation for keratocystic odontogenic tumours in the mandible: longitudinal image analysis of tumour size using 3D visualised CT scans. Int J Oral Maxillofac Surg. 2012; 41:290–296. PMID: 22113115.

26. Ackermann GL, Altini M, Shear M. The unicystic ameloblastoma: a clinicopathological study of 57 cases. J Oral Pathol. 1988; 17:541–546. PMID: 3150441.