Decompression and marsupialization as a treatment for the odontogenic keratocyst

Abstract

Decompression and marsupialization of cysts of By definition, decompression of a cyst involves the jaws were first suggested by Partsch [1,2] in the German literature, and in many parts of the world they are still described as the Partsch I procedure. (The Partsch 2 procedure is enucleation and primary closure.) This treatment was put forward at that time as a definitive treatment for cysts, and essentially it consisted of the removal of the overlying epithelium and bone and the deroofing of the cyst. If possible, suturing of the cyst lining to the oral epithelium with initial packing of the cyst to keep the hole open also was performed. The rationale at that time was that it decompresses the cyst and stops growth. It was a procedure not associated with postoperative infection, although physicians realized that it was not always a successful procedure in causing elimination of the cyst. In the preantibiotic era, it was often the treatment of choice, because attempts at enucleating the cyst with primary closure often met with failure, wound breakdown, and subsequent infection [3], and without antibiotics these conditions easily could proceed to osteomyelitis and bone loss. With the advent of antibiotics and the routine use of endotracheal intubation, the management of dental cysts changed. Enucleation and primary closure, with or without simultaneous or subsequent bone grafting, became the more accepted treatment, because with adequate antibiotic cover and sterile technique it was associated with a more rapid and predictable final result. In many hands, decompression and marsupialization were resigned to the history books.