Odontogenic Keratocyst: To Decompress or Not to Decompress? A Comparative Study of Decompression and Enucleation Versus Resection/Peripheral Ostectomy

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We discuss the outcome of 2 well-established and widely accepted methods used for the treatment of odontogenic keratocyst (OKC), enucleation with peripheral ostectomy or resection and decompression followed by enucleation and peripheral ostectomy. A retrospective chart review of all cases of OKC treated in the University of Maryland's Department of Oral and Maxillofacial Surgery between 1994 and 2004 was undertaken. A total of 31 patients with OKCs was identified. Three of these patients diagnosed with basal cell nevus syndrome and multiple OKCs and 6 patients who did not have adequate follow-up were excluded from this study; thus, 22 patients were evaluated. Of these 22 patients, 11 were treated with resection or enucleation with peripheral ostectomy (group I) and 11 were treated with decompression followed by enucleation when indicated (group II). A total of 22 patients with biopsy-proven OKC ranging in age from 18 to 90 years were separated into 2 treatment arms. Group I comprised 6 females and 5 males, age 18 to 71 years, with 6 OKCs located in the mandible and 5 in the maxilla. Group II comprised 6 females and 5 males, age 24 to 90 years, with 10 OKCs in the mandible and 1 in the maxilla. The choice of treatment approach was based on the size of the cyst, recurrence status, and radiographic evidence of cortical perforation. The last follow-up revealed no recurrences in group I and 2 recurrences in group II. Both patients with recurrence in group II had undergone enucleation of the same lesion in the past, and both cysts recurred within 2 years after initial treatment. Our study results concur with the literature regarding recurrence rates of OKC. The aggressive nature of some OKCs necessitates equally aggressive treatment, whereas long-term follow up even for nonsyndromic patients with single lesions is of paramount importance. Age of the patient and the site and histological characteristics of the treated lesions were not significantly associated with the incidence of recurrence.