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The marsupialization and decompression have the purpose of reducing the volume of the cystic cavity decomprimendola; the marsupialization is, however, understood as definitive treatment, while the decompression as a preliminary treatment to the next enucleation and relies on the placement of a provisional drainage inside the cavity. The advantage of these techniques lie in the histological change that are able to induce epithelium cystic, which for example in some cases results in a loss of keratinization. Moreover, the gradual decrease in the size of cystic time allows to safeguard the surrounding anatomical structures (maxillary sinus, dental elements, neurovascular bundles), minimize the risk of fracture and perform the next enucleation in the presence of a lesion technically easier to remove. They are therefore a greater indication in the case of large tumors. None of the two techniques allows the removal of the epithelium of the cyst lining and therefore appear shortly indicated, especially in the light of the tumoral nature of the lesion in question and the fact that in the literature are reported cases of degeneration of cheratosico tumor or other malignant ameloblastoma forms .
The odontogenic keratocyst, classified by the World Health Organization as keratocystic odontogenic tumor since 2005, is a benign lesion, locally aggressive, with a high tendency to recur. Its ortho-keratinized variant is not included in the tumor classification and it is considered as an odontogenic cyst. As the surgical enucleation is often insufficient for its treatment, additional methods have been proposed with the aim to remove any epithelial remnants and to reduce the risk of recurrence, including: the peripheral ostectomy, the use of Carnoy’s solution or cryotherapy with liquid nitrogen and the resection of the tumor en-bloc.
An aggressive treatment wich includes peripheral ostectomy, chemical curettage with carnoy's solution and resection. The cyst can be properly treated with enucleation if the lesion is removed intact. Complete removal of the keratocyst can be difficult because of the thin, friable epithelial lining, limited surgical access, skill and experience of the surgeon, cortical perforation, and the desire to preserve adjacent vital structures. The goals of treatment should involve eliminating the potential for recurrence while also minimizing the surgical morbidity.
marsupilization because of high rate of recurrence according to thinnest of cyst lining .
Surgical excision and chemical curitage
Surgical removal because keratocysts are benign lesions therefore, they need to be removed surgically and follow up is required to make sure it does not reoccur.
