Marsupialization in the treatment of cysts of the jaw bones: Applicability and advantages

OBJECTIVES The purpose of this paper is to de-scribe the marsupialization technique as part of the surgical treatment of maxillary bone cysts. This procedure is particularly useful for interrupting the expansive growth process of some types of cysts, resulting in a partial, but consis-tent, reduction in the size of the cysts which allows a more conservative management during the subsequent enucleation. Marsupialization preserves noble anatomical structures such as the inferior alveolar nerve and vital structures such as dental ele-ments. Iatrogenic mandibular fracture, possible during more radical interventions is also re-duced. Numerous studies have also shown that following exposure of the cystic lesion to the oral cav-ity, a histological change occurs in the epithelial lining of the cyst. This becomes thicker and as-sumes characteristics more simi-lar to those of the normal oral mu-cosa, helping the enucleation the cyst during the second surgical access. MATERIALS AND METHODS Three marsupialization surgical procedures are described and are related to the treatment of a kera-totic odontogenic tumor and of a follicular cyst. The surgical technique involves the transformation of the cystic lesion into an accessory cavity, in communication with the oral cavi-ty. A shutter device was designed in order to avoid wound contami-nation during meals and to main-tain the opening of the bone lesion into the oral cavity. Patients were instructed to per-form cleansing by daily irrigations. A second surgical access, to complete cyst enucleation, was suc-cessful performed in two cases, while it was not necessary for one of the three subjects. Patients underwent were a fol-low-up period and until complete resolution of the pathological processes. RESULTS AND CONCLUSIONS In patients treated with marsupial-ization, a rapid decrease in the size of the osteolytic lesions was observed, which allowed an im-provement in the initial patients’ symptoms. It was also possible to appreciate bone neo-deposition, which can be evaluated by radio-graphic controls, with a conse-quent increase in the volume of cortical bone reducing the risk of iatrogenic fracture. An increase in the distance between the cystic walls and the relevant anatomical structures such as the inferior al-veolar nerve was also observed. This decreased the probability of iatrogenic damage during the complete removal of the cysts. Complete enucleation was performed by a second surgical pro-cedure, 6 months later in one case and 1 year later in the sec-ond one, while it was not neces-sary in one of the cases. These second surgical accesses were less invasive and safer in terms of intra and post-operative compli-cations. None of the patients to date have had recurrences. CLINICAL SIGNIFICANCE Although other surgical techniques for the permanent removal of jaw-bone cysts are available, in case of extensive cystic lesions, the classi-cal surgical approach could be more aggressive, and destructive and susceptible to early and late complications. The success rate of marsupialization, as a primary step in the treatment of very large cystic lesions, allows a more conservative and less invasive subsequent surgical approach.