Investigation of Postoperative Complications of Intrabony Cystic Lesions in the Oral and Maxillofacial Region

Abstract

The purpose of this study was to identify factors that can complicate the surgical removal of intrabony cysts and any relevant correlations between them. The medical records of 249 patients who underwent surgical removal of intrabony cysts were retrospectively reviewed. Outcome variables were postoperative complications, infection, and recurrence. Predictor variables were patient age, gender, comorbidities, anatomic location, pathologic diagnosis, preoperative infection, previous marsupialization, and bone graft methods. Logistic regression analysis was performed to identify risk factors of postoperative infection and recurrence. The cystic lesion was smallest in patients who did not receive a bone graft and increased steadily in those who received a xenogeneic bone graft and an autogenous bone graft, in that order. Paresthesia occurred after enucleation of the cystic lesion in 38 cases. Pathologic fractures were observed in 4 cases. There were 59 postoperative infections. The postoperative infection rate was as high as 63.6% in patients who underwent autogenous bone grafting. In contrast, infection rates were as low as 26.8 and 19.5% in those who underwent xenogeneic bone grafting and no bone grafting, respectively. Location of the cystic lesion in the maxilla or mandible affected the infection rate. When cysts were located in the anterior mandible, no postoperative infection occurred. In contrast, the infection rate was highest for cysts in the mandibular ramus, followed by those in the posterior mandible. Cystic lesion recurrence was observed in 7 cases: 5 cases of odontogenic keratocysts, 1 case of periapical cyst, and 1 case of dentigerous cyst. These findings suggest that cyst pathologic identity affects the recurrence rate. Cyst size was meaningfully correlated with recurrence rate. These results suggest that autogenous bone grafts increase the risk of postoperative infection compared with absence of a bone graft.