Marsupialization as a definitive treatment for the odontogenic keratocyst.
OBJECTIVE
We sought to show that marsupialization can be a definitive treatment for the odontogenic keratocyst (OKC).


METHODS
Ten patients (10 males and 4 females) between the ages of 11 and 64 with biopsy-proven OKC (8 mandibular and 2 maxillary) measuring between 2 and 8 cm were treated by marsupialization consisting of excision of the overlying mucosa and the opening of a 1-cm window into the cystic cavity and, where possible, suturing of the cyst lining to the oral mucosa. Immunohistologic determination of bcl-2 was done for all samples of cyst lining. The cavities were kept open either by vigorous use of a home syringe by the patient or by suturing into place the flange and short length of a nasopharyngeal airway. Once the cyst had largely filled in, histologic material was taken from the base of the residual depression and studied by light microscopy and bcl-2 expression.


RESULTS
In the 10 patients, the OKCs completely resolved both clinically and radiographically. The time taken for resolution varied from 7 to 19 months. In all cases, the histologic material obtained after marsupialization showed normal epithelium only, with no signs of cystic remnants, daughter cysts, or budding of the basal layer of the epithelium. At initial biopsy, bcl-2 was expressed in the keratocyst lining, but not in the histologic material obtained after marsupialization. Follow-up time ranged from a minimum of 1.8 years to a maximum of 4.8 years. Teeth at the periphery of the cysts were observed to upright and erupt.


CONCLUSIONS
All 10 OKCs resolved completely after marsupialization. Teeth within the cyst were found to be upright and erupt. Marsupialization requires a cooperative patient who will irrigate the cavity and keep it open. It appears that the cyst lining is replaced by normal epithelium during this treatment.
Pogrel
M Anthony
MA
Department of Oral and Maxillofacial Surgery, University of California, San Francisco 94143-0440, USA. map@itsa.ucsf.edu
Jordan
R C K
RC
D000293:Adolescent; D000328:Adult; D019299:Decompression, Surgical / Q000379:methods; D003803:Dentigerous Cyst / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008336:Mandibular Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D008439:Maxillary Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D009807:Odontogenic Cysts / Q000000981:diagnostic imaging / Q000601:surgery*; D019647:Oral Surgical Procedures / Q000379:methods*; D011859:Radiography; D016896:Treatment Outcome