Cysts and tumors of the jaws treated by marsupialization: A description of 4 clinical cases

Abstract

Since the 4th edition of the World Health Organization's Classification of Head and Neck Tumours was published in January of 2017, the keratocystic odontogenic tumor is back into the cyst category as odontogenic keratocyst (OKC). Depending on the size of the cyst, its location and the patients' age, several treatment options are available: curettage, enucleation, radical treatment and marsupialization. The marsupialization is a conservative technique used in early tumor stages, as curative treatment for the odontogenic cyst. Despite its disadvantages and controversies, the marsupialization remains an interesting therapeutic choice in the case of large cysts, or in very young or old patients. We describe, in this article, four clinical cases of odontogenic cysts. We report the surgical management and the subsequent evolution of the patients. The discussion focuses on the indications, advantages and limitations of the odontogenic cyst's marsupialization. We review the specific conditions of the odontogenic cysts that could make the marsupialization the optimal therapeutic option. In our cases, the marsupialization proved to be a conservative technique which allowed the respect of neighboring anatomical structures, particularly in the case of large cysts, but requires prolonged clinical and radiological monitoring. Pathological entity for our cases was different. Thus, the treatment outcome may be different too. This series is very small and the reader should be cautious about drawing broad conclusions regarding the optimal therapeutic choice. Key words:Marsupialization, odontogenic cyst.

Figure 1

a- Radiologic data: Orthopantogram (OPG) and computed tomography scan with giant cyst of the mandible involving an included canine. b: Examination before marsupilazation (a), and after 6 months (b). c: Intraoperative view after opening of cystic cavity.

Figure 2

Orthopantogram and CT scan showing bifocal mandibular fracture and mandibular cyst. Orthopantogram shows an evident fracture of the left mandibular rim and cystic cavity in the right side. Orthopantogram after the surgery.

Figure 3

Radiologic evolution on orthopantogram. Initial cystic lesion of the right mandible. Reduction of the cystic size 3 months after marsupialization.Complete ossification of the right mandibular 6 months after marsupialization.