Journal of the Korean Association of Oral and Maxillofacial Surgeons

The Korean Association of Oral and Maxillofacial Surgeons (대한구강악안면외과학회)
권호 표지

A COMPARATIVE CLINICAL STUDY ON DECOMPRESSION AND ENUCLEATION TO TREAT CYSTIC LESIONS OF THE JAWS

악골내 낭종성 병소의 감압술과 적출술에 관한 임상적 연구

  • Jung, Young-Soo (Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University) ;
  • Paek, Song-Hum (Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University) ;
  • Lee, Eui-Wung (Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University) ;
  • Park, Hyung-Sik (Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University)
  • 정영수 (연세대학교 치과대학 구강악안면외과학교실) ;
  • 백성흠 (연세대학교 치과대학 구강악안면외과학교실) ;
  • 이의웅 (연세대학교 치과대학 구강악안면외과학교실) ;
  • 박형식 (연세대학교 치과대학 구강악안면외과학교실)
  • Published : 2004.02.28
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Among the various surgical methods used for the effective treatment of cystic lesion in the jaws historically, decompression procedure has some of superior prognosis compare to direct enucleation. In order to propose the efficacy of decompression we performed this retrospective study to compare decompression procedure with one-stage enucleation in clinical results and prognosis. Patients and Methods: We reviewed 175 patients who had been histopathologically diagnosed cystic lesions from 1996 to 2000 in our department. Patients who had been received decompression alone or secondary enucleation after decompression were 31 cases, and enucleation alone were 144 cases. The age and sex of the patients, the area, size, and histological type of the lesions, and detailed operation and complications including recurrence were investigated. The minimal follow-up period was 2 years. Results: In 31cases of decompression, male patients were 22cases(71%) similar to male predilection(62.3%) in total 175 cases. Cystic lesions were developed evenly in all age groups totally. Decompression was mainly performed in teenagers but enucleation was used in elder decades. In decompression cases the lesions were located in mandibular posterior, maxillary posterior, mandibular anterior, and maxillary anterior in order, which had some differences in total and enucleation cases. In enucleation cases, less than 3cm in size was 77.1% but larger than 3cm was 93.5% in decompression cases. Histopathologically, dentigerous cysts(54.8%), unicystic ameloblastomas(16.1%), and odontogenic keratocysts(12.9%) were seen in decompression cases and no recurrence or metaplasia and infection was observed. On the other hand, permanent tooth loss, numbness, recurrence, and so on were accompanied after enucleation. Conclusion: Although decompression procedure has disadvantages such as many of visiting times and slow recovery of the surgical defect, decompression is the best choice of treatment for large cystic lesions of the jaws, because it prevents functional and cosmetic defect, allows bone regeneration, and makes easy secondary enucleation.

Keywords

References

  1. Kruger GO: Textbook of oral and maxillofacial surgery(ed 6). St. Louis, Toronto, The C. V. Mosby Company, 1984, pp 255-280
  2. Archer WH: Oral and maxillofacial surgery(ed 5). Philadelphia, London, Toronto, W. B. Saunders Company, 1975, pp 518-705
  3. Salman L and Salman SJ: Decompression of odontogenic cysts. N Y State Dent J 34:409-415, 1968
  4. Tucker WM et al: Decompression and secondary enucleation of a mandibular cyst: report of case. J Oral Surg 30:669-673, 1972
  5. Olson RE et al: Odontogenic keratocyst treated by the Partch operation and delayed enucleation: report of case. JADA 94:321-325, 1977
  6. Marti'nez-Pe'rez D and Varela-Morales M: Conservative treatment of dentigerous cysts in children: A report of 4 cases. J Oral Maxillofac Surg 59:331-333, 2001
  7. Bodner L and Bar-Ziv J: Characteristics of bone formation following marsupialization of jaw cysts. Dntomaxillofac Radiol 27:166-171, 1998
  8. Thomas EH: Cysts of the jaws; Saving involved vital teeth by tube drainage. J Oral Surg 5:1-9, 1947
  9. Cranin AN et al: Novel method of treating large cysts of jaws in children. N Y State Dent J 60:41-44, 1994
  10. Nakamura N et al: Marsupialization for odontogenic keratocysts: Long-term follow-up analysis of the effects and changes in growth characteristics. Oral Surg 94:543-553, 2002
  11. Marker P et al: Treatment of large odontogenic keratocyst by decompression and later cystectomy. Oral Surg 82:122?131, 1996
  12. Nakamura N et al: Marsupialization of cystic ameloblastoma: a clinical and histopathologic study of the growth characteristics before and after marsupialization. J Oral Maxillofac Surg 53:748-754, 1995
  13. Van Doorn ME: Enucleation and primary closure of jaw cysts. Int J Oral Surg 1: 17-25, 1972
  14. Murakami A et al: Eruption of an impacted second premolar after marsupialization of a large dentigerous cyst: case report. Pediatr Dent 17:372-4, 1995
  15. Miyawaki S et al: 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 116:578-84, 1999
  16. Williams TP and Connor FA: Surgical management of the odontogenic keratocyst: Aggressive approach. J Oral Maxillofac Surg 52:964-966, 1994
  17. Zhao YF et al: Treatment of odontogenic keratocysts: A follow-up of 255 Chinese patients. Oral Surg 94:151-156, 2002
  18. Nakamura N et al: Comparison of long-term results between different approaches to ameloblastoma. Oral Surg 93:13-20, 2002
  19. Furuki Y et al: A radiographic study of recurrent unicystic ameloblastoma following marsupialization. Report of three cases. Dentomaxillofac Radiol 26:214-8, 1997