Marsupialization Research Articles

Clinicopathological analysis of 844 cases of odontogenic keratocysts

To investigate the clinicopathologic features and prognostic factors in odontogenic keratocyst (OKC), and to provide new reference for clinic treatment and management of these patients. Clinicopathological data of 844 cases initially diagnosed as or associated with OKC at Department of Oral Pathology, Peking University Hospital of Stomatology from 2000 to 2018 were collected. The cases were divided into 4 groups: sporadic OKCs (intraosseous, cystic lesion irrelevant to nevoid basal cell carcinoma syndrome), syndromic OKCs, solid OKCs and peripheral OKCs. The patients were follow-up for 6 to 216 months and the factors that might relate to recurrence were analyzed. There were 805 cases (95.4%) of sporadic OKCs, 32 cases (3.8%) of syndromic OKCs, 3 cases of solid OKCs and 4 cases of peripheral OKCs. The main age of sporadic OKCs was 36.03 years with the peak at the second and third decades. Ratio of male and female was 1.27:1. The predilection site was the molar and ramus area of mandibular (56.2%). In the study, 428 cases (71.2%) were unilocular in radiography while 28.8% were multilocular. The recurrent rate of enucleation with the follow-up was 20.1% (118/588) while most of them occurred in 1-3 years after surgery. The recurrent rate of multilocular patients (39.0%) was significantly higher than that of the unilocular. Enucleation after marsupialization (43 cases) or enucleation only (545 cases) showed no difference in recurrence (P>0.05). The syndromic OKCs was younger (main 20.97) and preferred to be multiple compared with sporadic OKCs (30/32, 93.7%). The predilection site was also molar and ramus area of mandibular (41.7%). Age and gender distribution of multiple cases had no significant difference with those in sporadic OKCs. More daughter cysts and epithelial islands were seen (56.3% and 17.9%). Furthermore, the recurrent rate was significantly higher than that of the sporadic OKCs (13/29, 44.9%). But there was no evidence of recurrent-related factors. The age of solid and peripheral OKCs, averaged at 45.00 and 65.75 years, were older than others. Four of peripheral OKCs showed no recurrence after enucleation. The recurrence rate of sporadic OKCs after enucleation is 20.1%. The multilocular lesions prefer to be recurrent. There is no significant difference of recurrence with enucleation only or enucleation after marsupialization. Compared with sporadic OKCs, the syndromic patients are younger and easier to be multiple. It tends to be recurrent frequently and rapidly. There are no related factors about recurrence of syndromic patients. The clinicians should considerate comprehensively and make an individual management of therapy and follow-up. Solid and peripheral OKCs are rare and older.

Decompression or Marsupialization; Which Conservative Treatment is Associated with Low Recurrence Rate in Keratocystic Odontogenic Tumors? A Systematic Review.

Various treatment modalities have been reported for keratocystic odontogenic tumors (KOT), with different recurrence rates. Marsupialization and decompression are two different conservative surgical techniques for the treatment of KOTs. This study aimed at comparing the recurrence rate between marsupialization and decompression in the treatment of KOTs with or without adjunctive treatments. This is a systematic review study. The research sources utilized were PubMed (MEDLINE), Google scholar, Ovid MEDLINE and Cochrane Library. The keywords which were selected based on Medical Subject Heading (MeSH) terms and PICOS criteria were odontogenic keratocyst, keratocyst odontogenic tumor AND marsupialization OR decompression OR cystectomy OR enucleation OR curettage. Statistical analyses were performed to compare the recurrence rate between marsupialization and decompression with or without adjunctive treatments, regarding various follow-up times. The number of subjects that underwent marsupialization was 182. There was a significant difference for the recurrence rate between the marsupialization and decompression groups without considering adjunctive treatments (p= 0.001). However, considering adjunctive treatments, there was no difference between marsupialization and the decompression groups (p= 0.18). It appears that decompression without any adjuvant treatment may have a lower recurrence rate than marsupialization. The recurrence rate was not different when enucleation or cystectomy was performed after decompression and marsupialization.

Controversies Regarding the Management of Teeth Associated with Cystic Lesions of the Jaws.

The continual growth of cystic lesions of the jaws can cause bone expansion, facial deformity, impacted teeth, occlusal disorder and displacement and loosening of the originating tooth or adjacent teeth. The management of teeth associated with cystic lesions of the jaws has been widely debated. When standing teeth with vital pulp are associated with cystic lesions, especially when tooth roots protrude into the cyst cavity, different treatment options have been recommended to support tooth preservation. However, there is no consensus about the extraction of the affected tooth in cases of root involvement by odontogenic keratocyst (OKC). In addition, there is controversy around whether root canal therapy should be considered a necessary treatment to be carried out prior to or after enucleation when standing teeth are associated with cystic lesions. An impacted tooth enclosed in the cavity of a developmental cyst may be treated by various approaches such as marsupialisation or decompression, or enucleation in combination with extraction or coronectomy, depending on the patient's age, root development and the angle and depth of the tooth in the jaw. Successful results obtained in pulp revascularisation after autotransplantation or endodontic regeneration treatments have been reported and pulp tissue functionality after cyst enucleation or apicetomy is a serious concern. In this article, we present an overview of the management of teeth associated with cystic lesions of the jaws.

Effect of oral health instructions in nursing of marsupialized jaw cysts

Objective To evaluate the effect of oral health instructions in nursing of marsupialized jaw cysts. Methods 46 patients with cysts of jaw were divided randomly into two groups (education group and control), 23 in each. In addition of normal nursing processes in both groups, patients in education group were offered more oral health instructions, such as pathogenesis of jaw cysts, mechanism of marsupialization, wear and clean of a cyst plug, and oral hygiene maintenance. 12 months later, compliance, satisfaction, treatment effect and oral hygiene condition of the patients in the two groups were studied and compared. Results 100% of patients in the education group could return to clinical visits on time and 96% of patients did cyst rinsing after every meal, which were significantly higher (χ2=6.9, P 0.05). Oral hygiene condition of patients in the education group was better than control in Debris Index (χ2=9.576, P < 0.05) and Plaque Index (χ2=8.212, P < 0.05). Conclusions Oral health instructions played positive role in improving patients' compliance, degree of satisfaction, treatment effect and oral hygiene condition in patients with jaw cysts. Key words: Oral health instructions; Jaw cysts; Window technique

A Case of Canaliculocele Treated with Punctoplasty and Marsupialization

A Case of Canaliculocele Treated with Punctoplasty and Marsupialization

Congenital dacryocystocele: presentation and treatment

To report the presentation, complications, and treatment strategies for infants with congenital dacryocystocele. We performed a retrospective chart review of all patients presenting with dacryocystoceles to Beijing Children's Hospital between 2007 and 2011. Thirty-one patients (33 eyes) were identified, presenting at a median age of 10 days of life. Twenty-four (72.72%) patients presented with cellulitis or dacryocystitis and required systemic antibiotics. Two (6.45%) patients presented with respiratory compromise. Resolution occurred with conservative treatment for 6 eyes, but 27 (81.82%) required surgical intervention. All 27 eyes received probing, and 20 (74.07%) were successful. The other 7 eyes required marsupialization of an intranasal cyst. Although congenital dacryocystoceles may resolve with conservative measures, many become infected and require systemic antibiotic treatment, and most require surgical intervention. Referral in the early neonatal period can aid in timely intervention before complications such as infection occur.

A retrospective study of 138 patients with jaw odontogenic cystic lesions

Objective To analyze the clinical features and therapeutic methods of jaw odontogenic cystic lesions,and to provide support for evidence-based medicine and references for future clinical practices by exploring the best therapy.Methods The clinical features,therapeutic methods,and efficacies were compared in 138 patients with jaw odontogenic cystic lesions who had been treated during the period of January 2001 to December 2010 in our hospital.Results 102 patients received traditional curettage and none of them had recurrence; 31 patients underwent marsupialization,but 8 of whom needed secondary curettage for cure; and 5 patients had to receive partial jaw resection plus simultaneous autogenous monvascular iliac bone graft,no one developed recurrence and rejection reaction.Conclusions Personalized treatment plans should be obtain to treat jaw odontogenic cystic lesions according to the clinical features of lesions and the subjective desires and individual physical differences in patients. Key words: Jaw odontogenic cystic lesions; Retrospective study; Personalized treatment

Symptomatic lymphocoeles post renal transplant.

The aim of this study was to evaluate the outcome of various treatment modalities of symptomatic lymphoceles and suggest an optimal management protocol. Case records of 744 renal transplant recipients who underwent surgery between January 2000 and December 2007 were retrospectively reviewed. There were a total of 36 (4.38%) lymphoceles detected in the postoperative period, of which 14 (1.88%) were symptomatic. A total of 32 procedures for the treatment of lymphocele were performed in 14 of these patients. Aspiration or percutaneous catheter drainage was performed as a primary procedure in all cases. Open marsupialization and laparoscopic marsupialization procedures were performed as secondary treatments. Percutaneous nephrostomy was required in one case before definitive treatment. Primary aspiration was successful in (n = 2) 28.5% and percutaneous drainage in (n = 3) 42.8%. Sclerotherapy was definitive in (n = 2 of 3) 66.6%. Seven of 14 patients required secondary procedure. Laparoscopic marsupialization was successful in (n = 4 of 5) 80% and open technique (n = 3) was curative in all cases. In our opinion, the first step in the management of symptomatic lymphocele in post-renal transplant recipients should be percutaneous drainage with or without drug instillation. This can stabilize renal function and optimize patients who may require surgery. Surgical marsupialization offers superior definitive treatment of lymphoceles with the least recurrence rates.

A Case of Petrous Apex Mucocele with Unilateral Ear Fullness Treated with Endoscopic Sphenoid Marsupialization

부비동 점액낭종(mucocele)은 점액 물질의 저류에 의해 생 기는 피막에 싸여 있는 병변으로 점액의 축적에 따라 팽창성 변화를 보인다. 이는 자발적으로 나타나는 원발성(primary) 과 수술이나 외상 등에 의하여 나타나는 이차성(secondary) 으로 나눌 수 있다. 부비동 점액낭종은 대부분 전두동과 사 골동에서 발생하는데 최근 영상 기술의 발전에 의해 접형동 점 액낭종의 발견율이 증가하고 있다. 접형동 점액낭종은 비특 이적 증상을 보이고 비내시경 검사상 발견이 어려우나 영상 검 사에서 발견할 경우 대부분 내시경 수술을 통해 합병증 없이 치료하고 증상을 호전시킬 수 있다. 저자들은 편측 이충만감을 주소로 타병원에서 시행한 영상 검 사상 접형동과 추체첨부의 점액낭종 소견을 보여 내원한 환자를 내시경하 조대술로 성공적으로 치료한 예를 보고하고자 한다. 증 례

MANAGEMENT OF THE IMPACTED TOOTH ASSOCIATED WITH DENTIGEROUS CYST IN AUTISTIC YOUNG PATIENTS

Autism is a developmental, neuropsychiatric disorder that begins in early childhood. A patient with autism seen in the dental office frequently may have many complications. Therefore, it may be needed to consider modified or alternative therapy for dental care of autistic patients. This is the case of a 16-year old boy who have autism. He came to the department of the pediatric dentistry, Yonsei University Dental Hospital, for evaluation and treatment of dentigerous cyst associated with impacted teeth(#33,34,35). Under daily hospitalization and general anesthesia, the cyst was enucleated with surgical extraction of #34 and autotransplantation of #33,35. And during the periodic dental followup, apexification of #33,35 was performed for periapical lesion and root maturity. At 2 year 6 months follow- up, now, bony healing was completed and there are some complications like external resorption of #33 and space loss of #34 area. Generally, the marsupialization has been widely recommended for treatment of dentigerous cyst. However, in this case, there is a little possibility of spontaneous eruption after marsupialization considering of patient's age, location and angulation of the impacted tooth, root maturity. And there is necessity to choose the treatment that has low recurrence risk and needs short-term follow-up for autism. Above all, poor oral hygiene and lack of cooperation for decompression treatment is a matter of primary consideration. Consequently, enucleation of the cyst was chosen for the final treatment plan in this case. It is important to consider the conditions that affect the eruption of a dentigerous cyst-associated tooth to predict the successful eruption and special health care needs of the patient when the treatment plan is settled.

Idiopathic Maxillary Sinus Mucocele

Mucocele of the maxillary sinus is a relatively rare location among all the paranasal sinus mucoceles. Maxillary sinus mucoceles usually grow gradually and can erode surrounding structures, which result in associated symptoms. The most common presenting symptoms include dull maxillary facial pain, swelling of the cheek, and nasal obstruction. It is rare to cause orbital and ocular involvement. Here we present a case of a 72-year-old man who sustained swelling around the right cheek and lower eyelid region associated with epiphora and blepharoptosis. Computed tomographic scan of the paranasal sinus revealed a large maxillary mucocele with bony erosion and compression of the right globe. The symptoms of cheek swelling and blepharoptosis resolved immediately after endoscopic marsupialization was performed. The case report demonstrates that maxillary sinus mucoceles may invade the orbit secretly and should be considered in the differential diagnosis in patients presented with eye problems. Early diagnosis and timely surgical intervention are important to reduce inevitable complications.

A Case of Huge Nasopalatine Duct Cyst With Infection

Nasopalatine duct cysts are the most common nonodontogenic developmental cyst originating in the incisive canal of maxilla and occuring in approximately 1% of the population. Clinical presentation is asymptomatic in small cysts, but shows swelling, pain and drainage from the hard palate in large cysts. The definite diagnosis should be based on clinical, radiological and histopathologic findings. The treatment of nasopalatine duct cysts consists of an enucleation of the cystic tissue, only in rare cases a marsupialization needs to be performed. We report a case of infected nasopalatine duct cyst in a 65-year-old man. He complained of painful swelling in the midline and nasolabial area. Physical examination revealed a huge tender mass in the midline of upper jaw. Diagnosis was suggested on the basis of computed tomography. Under the general anethesia, an enucleation was performed via sublabial approach. (Korean J Otorhinolaryngol-Head Neck Surg 2008;51:946-9)

Orthodontic treatment of a patient with an impacted maxillary second premolar and odontogenic keratocyst in the maxillary sinus.

An eight-year-, four-month-old girl was brought to the orthodontic clinic of Okayama University Medical and Dental Hospital. The patient had an impacted upper left second premolar because of an odontogenic keratocyst and showed a skeletal Class II jaw base relationship. At the age of six years four months, marsupialization of a cyst was performed at the Okayama University Medical and Dental Hospital because the patient had shown a swelling of the left cheek because of the cyst. The upper left second premolar was located in the roof of the maxillary sinus. The cyst was histopathologically diagnosed as an odontogenic keratocyst. At the age of nine years 10 months and after regaining the space for eruption of the premolar, the impacted premolar erupted without traction. At the age of 12 years five months, edgewise treatment was initiated, which continued for three years. After removing the edgewise appliance, an optimum occlusion was achieved. The occlusion was maintained without recurrence of the keratocyst after a retention period of five years.

Clinical review of 580 ranulas.

The purpose of this paper was to compare clinical features among 3 patterns of ranula and the recurrence rates of each when treated by different surgical methods. A retrospective review of clinical and pathologic records in 580 ranulas was undertaken. Ranulas were classified into 3 clinical types according to sites of the primary swelling: oral ranula, plunging ranula, and mixed ranula. Information was collected on age at presentation, sex, history of onset, sites of swelling, surgical methods, histological findings, and outcome of treatment. Ranula was most prevalent in the second decade of life and slightly more common in females (male to female ratio of 1:1.2), but a distinct male predilection was noted for the plunging ranula (male to female ratio of 1:0.74). Oral ranula was most commonly involved in the left side (left to right ratio of 1:0.62), while the plunging and mixed ranula were commonly involved in the right side (left to right ratio of 1:1.38, 1:1.16 respectively). In the plunging ranula group, there were more patients who had the history more than 6 months. The recurrence rates of ranulas were not related to swelling patterns and surgical approaches, but intimately related to the methods of surgical procedures. The recurrent rates for marsupialization, excision of ranula, and excision of the sublingual gland or gland combined with lesion were 66.67%, 57.69%, and 1.20%, respectively. Three patterns of ranula have similar clinical and histopathologic findings, although plunging ranula has some different clinical features. Removal of the sublingual gland via an intraoral approach is necessary in the management of various clinical patterns of the ranula. Recurrence rates of ranulas of any type are excessive unless the involved sublingual gland is removed.

Benign tumours of the vulva.

To present clinicopathological analysis of benign tumours of the vulva. A case series. The study was carried out in two phases at JPMC, Karachi from October 1995 to April 1997 and at Usman Memorial Hospital from 1st February 2003 to 30th July 2003. Thirty cases of benign tumours of vulva were studied during 2 years research period. Detailed history along with complete local and general physical examination followed by all necessary pre-operative investigations were carried out. Excision surgery was the treatment of choice in majority of cases while marsupialization was done for Bartholin's cyst. Histopathology of tumours specimen was also collected. A total of 30 cases were studied. Twenty-two were cystic and 8 were solid tumours. Aggressive angiomyxoma was 10% of solid tumours and Bartholin's cyst was 46.6% of cystic tumours. Most of the patients were multipara and between 21-30 years of age. The main site of tumour was labium majus. Excision surgery for all cases and marsupialization for Bartholin's cyst was treatment of choice. Aggressive angiomyxoma is the commonest solid benign vulval tumour. It should be considered in the differential diagnosis of vulval mass in women of reproductive age.

Çocukluk Çağı Hidatik Kistleri

From 1978 to 1993 28 cases of Hydatid cyst were treated at Pediatrics and Pediatric Sur¬gery departments of Ondokuz Mayis University, Faculty of Medicine. We evaluate these cases retrospectively whom 17 of them were male (%60.7) and 11 were female (%39.3). The youngest case was at six and the oldest one was at 16 years old age. The cysts were located mostly in the liver and the second most frequency site for the cysts was the lung. CT scan (%100) and ultrasonography (%94.7) were the most sensitive methods among la-boratory and radiological diagnostic methods. The sensitivities of the Casoni and indirect hemagglutination tests were found to be 71% and 83.3%, respectively. All cases were trea-ted surgically but mebendazol treatment was admitted to 12 cases on the preoperative pe-riod and continued on the postoperative period. Inspite of mebendazol treatment two cysts relapsed in this group. The morbidity rate was found to be higher for the surgical procedure of marsupialization, which was used during the first seven years of the study. At the last eight years usually partial cystectomy+capitonage and/or omentoplasty proce¬dure was used and the morbidity rate was decreased. There is no mortality. 1978-1993 yillan arasinda fakultemiz Cocuk Hastaliklari ve Cocuk Cerrahisi Anabilim Dallari'nda takip ve tedavi edilen 28 kist hidatik olgusu retrospektlf olarak degerlendirildi. 17'si (%60.7) erkek, 11'i (%39.3) kiz olan olgularin en kucugu alti, en buyugu 16 yasindaydi. Kistler en sik karaciger, ikinci siklikta akcigerlerde lokalizeydi. Laboratuvar ve radyolojik tani metodlan arasinda bilgisayarli tomografi (%100) ve ultrasonografi (%94.7) en sensitif melodlar olarak bulundu. Serolojik testlerden Casoni deri testi %71, indirekt hemagglutinasyon testi %83.3 pozitif sonuc verdi. Vakalarin tumu cerrahi olarak tedavi edildi. Vakalardan 12'sine preoperatif mebendazol tedavisi uygulandi ve bu vakalardan iki tanesinde postoperatuar nuks saptandi. Calismanin ilk yansinda kullanilan marsupializa-syon yonteminde morbidite yuksek bulunurken ikinci yanda uygulamaya baslanilan parsiyel kistektomi+kapitonaj ve/veya omentoplasti yonteminde morbiditenin cok azaldigi goruldu. Tum vakalarda mortalite sifir olarak bulundu.

Treatment and prognosis of ameloblastoma—indication for marsupialization : Ueda M, Furune A, Yanbe M, et al. J Jpn Stomatol Soc 38:54, 1989

Treatment and prognosis of ameloblastoma—indication for marsupialization : Ueda M, Furune A, Yanbe M, et al. J Jpn Stomatol Soc 38:54, 1989

The marsupialization operation for pilonidal cysts and sinuses under local anesthesia with lidocaine; an ambulatory method of treatment.

FROM THE SURGICAL DEPARTMENT, GEORGETOWN UNIVERSITY AND THE WALTER REED ARMY HOSPITAL, WASHINGTON, D. C.

Marsupialisation of Degenerated and Infected Fibroid.*

Marsupialisation of Degenerated and Infected Fibroid.*