ACTIVE DECOMPRESSION AND DISTRACTION SUGOSTEOGENESIS AS A NOVEL TREATMENT FOR ODONTOGENIC KERATOCYST: A CASE REPORT

Abstract

The Odontogenic Keratocyst is a rare but benign developmental cyst of the oral cavity that arises from cell rests of dental lamina; it is aggressive and typically appears during the second and third decades of life. It is usually detected incidentally or by asymptomatic swelling; 50% of them are commonly located in the posterior body and lower ramus of the mandible. <b>Objective:</b> present the effectiveness of a novel treatment for cyst decompression and distraction sugosteogenesis.<b>Clinical presentation:</b> A 59-year-old female was referred to clinic due to painless swelling in her posterior left side of the oral cavity with one year of evolution. The mass measured 2cmx2cm. After biopsy, a diagnosis of Odontogenic Keratocyst was determined. Radiographical evaluation showed a mass that started at the middle of the ramus and extended to the roots of the second molar, cortical bone from inferior border of the mandible was compromised.<b>Intervention and Outcome:</b> Active decompression of the cyst was elected as the treatment path. The application of negative pressure to osseous cells produces a stretching that creates mechanical cues that trigger signaling pathways, promote fluid flow, and enhance angiogenesis.²Two bone windows were performed on the buccal aspect of the cyst, and a tube was placed into each one of them. One tube was connected to a saline bag, and the other tube was connected to a Hemovac device. For one month, the patient manually irrigated with saline the inside of the cyst through one of the tubes, and manually used the Hemovac pump to aspirate the water out of the cavity. This procedure was performed three times daily.<b>Results:</b> After three months, radiographic evaluation showed remarkable cyst decompression.<b>Conclusions:</b> After three months of device use, we believe it has the potential to remarkably reduce the size of cystic lesions through distraction sugosteogenesis.