Treatment of Keratocysts: The Case for Decompression and Marsupialization

Abstract

F m ecompression of a cyst involves any technique hat relieves the pressure within the cyst that auses it to grow. Growth of cysts is believed to ccur by a combination of osmotic pressure and ressure resorption, coupled with release of prosaglandins and growth factors. Decompression, by ny means, appears to change to environment and ecreases the amount of interleukinthat is reeased. Decompression can be performed by makng a small opening in the cyst and keeping it open ith a drain of some kind (Fig 1). Marsupializaion, on the other hand, involves converting the yst into a pouch. (The word marsupial is derived rom the Greek for “pouch”) (Fig 2). By converting he cyst to a pouch, the lesion is decompressed, but his is a more definitive treatment for the cavity and xposes the cyst lining to the oral environment. andibular cysts are normally marsupialized into he oral cavity, although maxillary cysts can also be arsupialized into the maxillary sinus or nasal cavty, as well as the oral cavity (Fig 3). Decompression and marsupialization of cysts is robably the earliest advocated treatment and was rst suggested by Partsch in the German literature n the late 19th century. In many parts of the orld, marsupialization is still described as a artsch I procedure (the Partsch II procedure is nucleation and primary closure). At the time, this ethod was put forward as the treatment of choice, ecause without antibiotics any attempt at enucletion and primary closure of a cyst was accompaied by a very high postoperative infection rate.