Large mandibular odontogenic keratocyst treated by decompression and secondary enucleation: a case report

Odontogenic keratocyst (OKC) is a common developmental odontogenic cyst in clinic patients. Odontogenic cysts are often treated by enucleation, curettage, marsupialization and decompression. With apparent advantages, marsupialization and decompression are often the preferred option for adolescents with large jaw cysts. This article aimed to report a case of large OKC involving the left mandibular second molar and third molar in a 13-year-old adolescent. Decompression was performed to preserve the second molar and inferior alveolar nerve, and the third molar was extracted. After ten months of follow-up, cyst volume decreased significantly, and the impacted second molar erupted spontaneously through the bony window. Subsequently, the residual cyst was removed by enucleation. After 18 months, the second molar erupted to the occlusal plane and played a normal function. No evidence of recurrence was found during the entire follow-up period.

Odontogenic keratocyst; Decompression; Impacted tooth; Tooth eruption

[1] Chen P, Liu B, Wei B, Yu S. The clinicopathological features and treatments of odontogenic keratocysts. American Journal of Cancer Research. 2022; 12: 3479–3485.

[2] Philipsen H. On keratosists in the jaws. Tandlaegeblader. 1956; 60: 963–980.

[3] Thompson L. World Health Organization classification of tumours: pathology and genetics of head and neck tumours. Ear, Nose & Throat Journal. 2006; 85: 74.

[4] Wright JM, Vered M. Update from the 4th edition of the World Health Organization classification of head and neck tumours: odontogenic and maxillofacial bone tumors. Head and Neck Pathology. 2017; 11: 68–77.

[5] Li TJ. The odontogenic keratocyst: a cyst, or a cystic neoplasm? Journal of Dental Research. 2011; 90: 133–142.

[6] Rajendra Santosh AB. Odontogenic cysts. Dental Clinics of North America. 2020; 64: 105–119.

[7] Deboni MCZ, Brozoski MA, Traina AA, Acay RR, Naclério-Homem MDG. Surgical management of dentigerous cyst and keratocystic odontogenic tumor in children: a conservative approach and 7-year follow-up. Journal of Applied Oral Science. 2012; 20: 282–285.

[8] de Castro MS, Caixeta CA, de Carli ML, Ribeiro Júnior NV, Miyazawa M, Pereira AAC, et al. Conservative surgical treatments for nonsyndromic odontogenic keratocysts: a systematic review and meta-analysis. Clinical Oral Investigations. 2018; 22: 2089–2101.

[9] Chrcanovic BR, Gomez RS. Recurrence probability for keratocystic odontogenic tumors: an analysis of 6427 cases. Journal of Cranio-Maxillofacial Surgery. 2017; 45: 244–251.

[10] Karaca C, Dere K, Er N, Aktas A, Tosun E, Koseoglu O, et al. Recurrence rate of odontogenic keratocyst treated by enucleation and peripheral ostectomy: retrospective case series with up to 12 years of follow-up. Medicina Oral Patologia Oral y Cirugia Bucal. 2018; 23: e443–e448.

[11] Kwon YJ, Ko KS, So BK, Kim DH, Jang HS, Kim SH, et al. Effect of decompression on jaw cystic lesions based on three-dimensional volumetric analysis. Medicina. 2020; 56: 602.

[12] Sá MC, de Matos FR, Conceição TS, Leitão AC, Freitas RA. Immunoexpression of tumour necrosis factor-α, interleukin-1α and interleukin-10 on odontogenic cysts and tumours. International Endodontic Journal. 2017; 50: 437–445.

[13] Mohanty S, Dabas J, Verma A, Gupta S, Urs AB, Hemavathy S. Surgical management of the odontogenic keratocyst: a 20-year experience. International Journal of Oral and Maxillofacial Surgery. 2021; 50: 1168–1176.

[14] Stanbouly D, Lee KC, Fazzolari JR, Philipone E. Decompression of odontogenic keratocysts before enucleation reduces the rate of recurrence. Journal of Craniofacial Surgery. 2022; 33: 1806–1808.

[15] Hyun H, Hong S, Kim J. Recurrent keratocystic odontogenic tumor in the mandible: a case report and literature review. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2009; 108: e7–e10.

[16] Zhang Q, Li W, Han F, Huang X, Yang X. Recurrent keratocystic odontogenic tumor after effective decompression. Journal of Craniofacial Surgery. 2016; 27: e490–e491.

[17] Özkan E, Özmen B. The treatment of different odontogenic cysts in children only using acrylic appliance-guided decompression: a long-term clinical study. Anatolian Clinic the Journal of Medical Sciences. 2023; 28: 15–23.

[18] Motamedi MHK, Talesh KT. Management of extensive dentigerous cysts. British Dental Journal. 2005; 198: 203–206.

[19] Zhao Y, Liu B, Zhao Y. Controversies regarding the management of teeth associated with cystic lesions of the jaws. The Chinese Journal of Dental Research. 2019; 22: 81–92.

[20] Wise G. Cellular and molecular basis of tooth eruption. Orthodontics & Craniofacial Research. 2009; 12: 67–73.

[21] Sarrafpour B, Swain M, Li Q, Zoellner H. Tooth eruption results from bone remodelling driven by bite forces sensed by soft tissue dental follicles: a finite element analysis. PLOS ONE. 2013; 8: e58803.

[22] Sarrafpour B, El-Bacha C, Li Q, Zoellner H. Roles of functional strain and capsule compression on mandibular cyst expansion and cortication. Archives of Oral Biology. 2019; 98: 1–8.

[23] Park JH, Kwak E, You KS, Jung Y, Jung H. Volume change pattern of decompression of mandibular odontogenic keratocyst. Maxillofacial Plastic and Reconstructive Surgery. 2019; 41: 2.

[24] Nahajowski M, Hnitecka S, Antoszewska-Smith J, Rumin K, Dubowik M, Sarul M. Factors influencing an eruption of teeth associated with a dentigerous cyst: a systematic review and meta-analysis. BMC Oral Health. 2021; 21: 180.

[25] Farshidfar N, Agharokh M, Daneste H. Eruption of the permanent first premolar associated with a mandibular keratocystic odontogenic tumor after marsupialization in a 9-year-old boy: a case report with 2 years of follow-up. Journal of Dentistry. 2021; 22: 144–148.