Poster 33: Odontogenic Cysts and Tumors: Decompression Followed by Enucleation and Curettage

Abstract

Decompression of odontogenic cysts and tumors followed by enucleation and curettage of the remaining lesion is a well-established and effective treatment protocol. Several descriptions of phenotypic changes and effects on expression of growth factors and proliferation markers in keratocystic odontogenic tumor (KCOT) exist in the literature. The histologic nature of the decompressed odontogenic cyst or tumor at time of enucleation and curettage and the reasons behind its effectiveness have yet to be elucidated. Also, tooth movement as a result of decompression is commonly noted; however, a quantitative analysis of this movement is lacking in the literature. Patients who presented to the Department of Oral and Maxillofacial Surgery at the University of Illinois at Chicago for treatment of an odontogenic origin radiolucent lesion of the maxillofacial complex who were treated with decompression followed by enucleation and curettage were included in the study data. Thirty-seven patients aged between 13 and 80 have been treated with this technique between May 2008 and December 2010 in our department. Patient demographics, initial diagnosis, decompression time, complications, measurement of lesion size and tooth movement, and final diagnosis were recorded. All patient imaging was completed using the same panoramic machine and measurements were made of the greatest lesion dimension in both width and height. Distance of tooth movement was measured by overlay of an acetate tracing of the initial panoramic radiograph on the final radiograph at time of enucleation and curettage. Our protocol is as follows: decompression of various duration, based upon the nature and size of the lesion, followed by enucleation and curettage. In cases of KCOT, decompression is undertaken for a minimum of 9 months and additional time required is determined based on the reduction in size on serial radiographic examinations. All specimens were submitted for histologic diagnosis following enucleation and curettage. Following decompression of odontogenic cysts and tumors the appearance of the lesion is changed considerably. The lining is thickened and more easily peeled away from surrounding bone. Histologic diagnosis at the time of enucleation and curettage was most often consistent with pre-decompression diagnosis. Change in the size of the lesion varied and was more profound in patients of young age. There was no difference in response between males and females. The degree of tooth displacement decreased in all cases following decompression and often allowed for decreased risk of injury to adjacent structures at the time of extraction. Decompression of odontogenic cysts and tumors followed by enucleation and curettage is an effective treatment paradigm in that it decreases the lesion size thus reducing risk of injury to adjacent structures, changes the phenotype of the lesion to one more easily removed, and is associated with a low rate of complication. The histologic diagnosis at time of enucleation and curettage is most often consistent with pre-decompression diagnosis and thus all lesions should be definitively treated following decompression.