The management of a large radicular cyst by cystostomy, decompression, and enucleation using a custom-made removable appliance for decompression fabricated through a hybrid workflow
Abstract
The sequence of cystectomy, decompression, and enucleation is a less invasive treatment modality compared to cystectomy
in the treatment of large odontogenic cysts, reducing complications to the anatomical landmarks included in the
cavity of large cysts. The conventional workflow of fabricating a decompression appliance commences after cystostomy
and involves several visits. However, virtual planning and computer-aided design, computer-aided manufacturing (CAD/
CAM) enable the delivery of a decompression appliance at the ti me of cystostomy, reducing the number of visits and
patient discomfort.
In the present case report, the successful treatment of a large radicular cyst is presented by the sequence of cystectomy,
decompression, and enucleation, with the delivery of a custom-made removable appliance for decompression
fabricated through a hybrid workflow.
A 49-year-old male patient presented at our Department with a large odontogenic cyst in the lower jaw spanning from
the lower right first molar to the lower left first molar. After virtual planning, the appliance was fabricated through rapid
prototyping. Denture teeth were added to the decompression device using the conventional workflow. On the day of the
first surgery, the lower incisors, which were deemed to have a hopeless prognosis, were removed, a cystostomy was
performed, and the appliance was delivered. After a 12-month-long decompression period, the bone remodeling led to
a significant reduction in the volume of the radicular cyst, strengthening the structure of the mandible. This process created
a safe zone around the mental nerves and the roots of the teeth that were originally affected by the cyst. Therefore,
during enucleation surgery, complications to these landmarks could be avoided and the risk of an intraoperative fracture
diminished. Following enucleation surgery, missing teeth were replaced by a porcelain fused to metal bridge. At the twoyear
follow-up, the bone of the lower jaw had undergone complete remodeling with no signs of recurrence.
References
Al-Moraissi EA, Dahan AA, Alwadea i MS, Oginni FO, Al-Jama li JM,
Alkhutari AS, et al: What surgical treatment has the lowest
recurrence rate following the management of keratocystic
odontogenic tumor? A large systematic review and meta-analysis.
J Craniomaxillofac Surg 2017; 45 (1): 131–144.
DOI: 10.1016/j.jcms.2016.10.013
Anavi Y, Gal G, Miron H, Calderon S, Allon DM:
Decompression of odontogenic cystic lesions: clinical long-term
study of 73 cases. Oral Surg Oral Med Oral Pathol Oral Radiol
Endod 2011; 112 (2): 164–169.
DOI: 10.1016/j.tripleo.2010.09.069
Bonavolontà P, Dell’Aversana Orabona G, Friscia M, Sani L,
Abbate V, Iaconetta G, Califano L: Surgical Management of
Large Odontogenic Cysts of the Mandible.
J Craniofac Surg 2019; 30 (7): e658–661.
DOI: 10.1097/scs.0000000000005725
Castro-Núñez J: Decompression of Odontogenic Cystic Lesions:
Past, Present, and Future.
J Oral Maxillofac Surg 2016; 74 (1): 104. e101–109.
DOI: 10.1016/j.joms.2015.09.004
Tabrizi R, Hosseini Kordkheili MR, Jafarian M, Aghdashi F:
Decompression or Marsupialization; Which Conservative
Treatment is Associated with Low Recurrence Rate in
Keratocystic Odontogenic Tumors? A Systematic Review.
J Dent (Shiraz) 2019; 20 (3): 145–151.
DOI: 10.30476/dentjods.2019.44899
Ninomiya T, Kubota Y, Koji T, Shirasuna K: Marsupialization
inhibits interleukin-1alpha expression and epithelial cell
proliferation in odontogenic keratocysts.
J Oral Pathol Med 2002; 31 (9): 526–533.
DOI: 10.1034/j.1600-0714.2002.00029.x
Slusarenko da Silva Y, Stoelinga PJW, Naclério-Homem MDG:
Recurrence of nonsyndromic odontogenic keratocyst after
marsupialization and delayed enucleation vs. enucleation alone:
a systematic review and meta-analysis.
Oral and Maxillofacial Surg 2019; 23 (1): 1–11.
DOI: 10.1007/s10006-018-0737-3
Tolstunov L: Marsupialization catheter.
J Oral Maxillofac Surg 2008; 66 (5): 1077–1079.
DOI:10.1016/j.joms.2007.11.027
Enislidis G, Fock N, Sulzbacher I, Ewers R:
Conservative treatment of large cystic lesions of the mandible:
a prospective study of the effect of decompression.
Br J Oral and Maxillofacial Surg 2004; 42 (6): 546–550.
DOI: 10.1016/j.bjoms.2004.06.020
Gao L, Wang XL, Li SM, Liu CY, Chen C, Li JW, et al:
Decompression as a treatment for odontogenic cystic lesions of
the jaw. J Oral Maxillofac Surg 2014; 72 (2): 327–333.
DOI: 10.1016/j.joms.2013.07.035
Neaverth EJ, Burg HA: Decompression of large periapical
cystic lesions. J Endod 1982; 8 (4): 175–182.
DOI:10.1016/s0099-2399(82)80214-8
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 Neck Pathol 2017; 11 (1): 68–77.
DOI: 10.1007/s12105-017-0794-1
Al-Benna S, Arayathinal TG: The use of dual nasal trumpet
stents to decompress keratocystic odontogenic tumours.
Ann R Coll Surg Engl 2018; 100 (6): 497–498.
DOI:10.1308/rcsann.2017.0214
Castro-Núñez J, Rey D, Amaya L: An Innovative Intracystic
Negative Pressure System to Treat Odontogenic Cysts.
J Craniofac Surg 2017; 28 (7): 1883–1884.
DOI: 10.1097/scs.0000000000003917
Catunda IS, Catunda RB, Vasconcelos BC, de Oliveira HF:
Decompression device for cavitary bone lesions using Luer syringe.
J Oral Maxillofac Surg 2013; 71 (4): 723–725.
DOI: 10.1016/j.joms.2012.10.016
Delbem AC, Cunha RF, Vieira AE, Pugliesi DM: Conservative
treatment of a radicular cyst in a 5-year-old child: a case report.
Int J Paediatr Dent 2003; 13 (6): 447–450.
DOI: 10.1046/j.1365-263x.2003.00452.x
Gülşen U, Dereci Ö, Gülşen EA: Treatment of a calcifying epithelial
odontogenic tumour with tube decompression: a case report.
Br J Oral Maxillofac Surg 2018; 56 (10): 979-981.
DOI: 10.1016/j.bjoms.2018.11.008
Kolokythas A, Schlieve T, Miloro M: Simple method for securing
a decompression tube for odontogenic cysts and tumors:
a technical note. J Oral Maxillofac Surg 2011; 69 (9): 2392–2395.
DOI: 10.1016/j.joms.2011.02.062
Morankar R, Bhatia SK, Goyal A, Gulia P: Conservative
management of keratocystic odontogenic tumour in a young
child with decompression and an intraoral appliance:
-year follow-up. BMJ Case Rep 2018.
DOI: 10.1136/bcr-2017-221563
Ozturk G, Dogan S, Gumus H, Soylu E, Sezer AB, Yilmaz S:
Consequences of Decompression Treatment With a
Special-Made Appliance of Nonsyndromic Odontogenic Cysts in
Children. J Oral Maxillofac Surg 2022.
DOI: 10.1016/j.joms.2022.03.013
Shakib K, Heliotis M, Gilhooly M: The nasopharyngeal airway:
reliable and effective tool for marsupialisation.
Br J Oral Maxillofac Surg 2010; 48 (5): 386–387.
DOI: 10.1016/j.bjoms.2009.06.229
Swantek JJ, Reyes MI, Grannum RI, Ogle OE:
A technique for long term decompression of large mandibular cysts.
J Oral Maxillofac Surg 2012; 70 (4): 856–859.
DOI: 10.1016/j.joms.2011.03.029
Zhu F, Huang S, Chen Z, Li W, Zhang D: New method to
secure cyst decompression tube in tooth-bearing areas.
Br J Oral Maxillofac Surg 2017; 55 (2): 200–201.
DOI: 10.1016/j.bjoms.2016.07.001
Kivovics M, Pénzes D, Moldvai J, Mijiritsky E, Németh O:
A custom-made removable appliance for the decompression of
odontogenic cysts fabricated using a digital workflow.
J Dent 2022; (11) 126: 104295.
DOI: 10.1016/j.jdent.2022.104295
Rioux-Forker D, Deziel, AC, Williams LS, Muzaffar AR:
Odontogenic Cysts and Tumors Ann Plast Surg 2019;
(4): 469–477.
DOI: 10.1097/sap.0000000000001738
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