Retrospective study of spontaneous bone regeneration after decompression of large odontogenic cystic lesions in children

Abstract

Background/Aim. Surgical treatment of odontogenic cysts in childhood could be accompanied by injury of important anatomical structures. Even though enucleation is considered to be preferable treatment of odontogenic cysts, the specificities of pediatric age favor more conservative surgical approach. The aim of this study was to assess the effectiveness of decompression as the uttermost treatment of odontogenic cysts in the pediatric age. Methods. This retrospective study included 22 patients, 7-16 years old, with a single jaw cystic lesion. The majority of these lesions were dentigerous cyst (14), and the rest belonged to keratocystic odontogenic tumor (KCOT) (8). All lesions were primarily treated with decompression; it was a final treatment (one-stage procedure) in 13 dentigerous cysts, and it was followed by enucleation (two-stage procedure) in one dentigerous cyst and all the KCOT. Results. A total of 13 (59.1%) dentigerous cysts were treated successfully only with decompression as one stage procedure, while the other 9 (40.9%) cysts required enucleation (1 dentigerous and 8 KCOT), after decompression (p ≤ 0.001). Conclusion. Related to non-aggressive lesions, more conservative treatment approach, such as decompression as one-stage procedure, should be considered. On the other hand, KCOTs in children require a two-stage procedure for a successful treatment outcome.

Uvod/Cilj. Hirurška terapija odontogenih cista u dečjem uzrastu može da bude udružena sa povredama važnih anatomskih struktura. Mada se enukleacija smatra terapijom izbora viličnih cista, specifičnosti dečjeg uzrasta nameću primenu konzervativnijeg hirurškog pristupa. Cilj istraživanja bio je da se proceni efikasnost dekompresije kao definitivnog terapijskog modaliteta kod odontogenih cista u dečjem uzrastu. Metode. Ova retrospektivna studija obuhvatila je 22 pacijenta, uzrasta 7-16 godina, sa solitarnim cističnim lezijama. Najčešće među njima su bile folikularne ciste (14), a ostale su bile keratocistični odontogeni tumori (KCOT). Sve cistične lezije prvo su tretirane dekompresijom; to je bio i jedini poduhvat (jednofazni postupak) kod 13 folikularnih cista, a potreba za sekundarnim zahvatom - enukleacijom, ukazala se posle dekompresije jedne folikularne ciste i svih KCOT (dvofazni postupak). Rezultati. Ukupno 13 (59,1%) cističnih lezija, od kojih su sve bile folikularne ciste, uspešno je podvrgnuto jednofaznom hirurškom postupku, dok je preostalih 9 (40,9%) cista (1 folikularna i 8 KCOT) zahtevalo naknadnu enukleaciju. Zaključak. Kod neagresivnih cističnih lezija preporučuje se konzervativniji hirurški pristup kao što je dekompresija (jednofazna procedura). Nasuprot tome, KCOT u dečjem uzrastu zahtevaju dvofazni hirurški postupak - dekompresiju praćenu enukleacijom.