title: For treatment of odontogenic keratocysts, is enucleation, when compared to decompression, a less complex management protocol?
abstract: OBJECTIVE
  To determine whether the clinical management of odontogenic keratocysts (OKCs) is more complex in patients who undergo enucleation with or without adjuvant therapy than in patients who undergo decompression with or without residual cystectomy.
  
  
  METHODS
  The authors implemented a retrospective cohort study and enrolled a sample composed of patients presenting for the evaluation and management of OKCs. The predictor variable was treatment group, classified as decompression with or without residual cystectomy versus enucleation with or without adjuvant therapy (Carnoy solution, cryotherapy, or peripheral ostectomy). The outcome variables were measurements of complexity of management, including total number of procedures, venue of procedure (operating room vs office), type of anesthesia, hospital admissions, and total number of follow-up visits. Data analyses were performed using univariate and bivariate statistics and a multiple linear regression model.
  
  
  RESULTS
  The study sample was composed of 45 patients (66 OKC lesions) with a mean age of 43.3 years. Of the 66 OKCs treated, 34 (51.5%) were treated with decompression with or without residual cystectomy and 32 (48.5%) were treated with enucleation with or without adjunctive therapy. Larger lesions and lesions with radiographic evidence of cortical perforation were treated more often with decompression with or without residual cystectomy. Based on the multiple linear regression model, patients who underwent enucleation with or without adjuvant therapy compared with those who underwent decompression with or without residual cystectomy had on average 1) 1.1 fewer total procedures (P < .01), 2) 0.8 fewer total office procedures (P < .01), 3) 0.6 fewer local anesthesia procedures (P < .01), and 4) 4.8 fewer postoperative visits (P < .01). There was no difference in the number of general anesthesia procedures, office sedation procedures, or hospital admissions.
  
  
  CONCLUSIONS
  Given comparable recurrence rates, the increased complexity of managing OKCs with decompression with or without residual cystectomy might not be warranted. Enucleation with or without adjunctive therapy could be the more efficient treatment option.
authors: Resident-in-Training, Division of Oral and Maxillofacial Surgery, Department of Surgery; MD Candidate, Emory University School of Medicine, Atlanta, GA. Electronic address: bkinard@Emory.edu.
authors: Brian E
authors: BE
authors: Kinard
authors: Associate Professor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA.
authors: Sung-Kiang
authors: SK
authors: Chuang
authors: Associate Professor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA.
authors: Meredith
authors: M
authors: August
authors: Professor and Chair, Department of Oral and Maxillofacial Surgery; Associate Dean for Hospital Affairs, University of Washington School of Dentistry, Seattle, WA.
authors: Thomas B
authors: TB
authors: Dodson
mesh_terms: D019342:Acetic Acid / Q000627:therapeutic use; D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000379:methods; D000766:Anesthesia, Dental / Q000379:methods; D000772:Anesthesia, Local / Q000379:methods; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D002710:Chlorhexidine / Q000627:therapeutic use; D002725:Chloroform / Q000627:therapeutic use; D015331:Cohort Studies; D003131:Combined Modality Therapy; D016292:Procedural Sedation / Q000379:methods; D017679:Cryotherapy / Q000379:methods; D019299:Decompression, Surgical / Q000379:methods*; D000431:Ethanol / Q000627:therapeutic use; D005260:Female; D005404:Fixatives; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009807:Odontogenic Cysts / Q000601:surgery*; D009873:Operating Rooms; D010027:Osteotomy / Q000379:methods; D010343:Patient Admission; D012189:Retrospective Studies; D007507:Therapeutic Irrigation / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000891:Anti-Infective Agents, Local; C033474:Carnoy's solution; D005404:Fixatives; D000431:Ethanol; D002725:Chloroform; D019342:Acetic Acid; D002710:Chlorhexidine