Effect Of Decompression As A Treatment For Odontogeic Cystic Lesions Of The Jaw

Objective:To evaluate the effect and difference of decompression as the primary treatment for various types of odontogenic cystic lesions of the jaw for clinical reference.Methods:A total of 32 patients with odontogenic cystic lesions of the jaw, selected from 2012 June to 2015 December in the department of oral and maxillofacial surgery of Stomatology Hospital Affiliated to Zhejiang University College of Medicine, underwent decompression with customized stents as the primary treatment. Pre-and post-decompression panoramic radiographs or/and CBCT were analyzed by measuring the lesion area with Photoshop CS5.Result:(1)The lesion area was significantly decreased after decompression (P< 0.01).27 in 32 cases (84.4%) showed effective (?S>50%) in 6 months, and 24 in 26 cases (92.3%) in 8 months. The rate of extremely effective (?S>80%) gradually rose as time went by after 6 months. In 5 lesions of radicular cysts and 4 lesions of dentigerous cysts, the cysts disappeared macroscopically and further surgery was not done. Only 1 of 20 lesions of keratocystic odontogenic tumor was poorly effective, and all the cases needed secondary surgery except 1 case healed itself. But the effect of ameloblastoma (3 cases) was not good, with 1 case poorly effective and 2 cases moderately effective, and secondary surgery was needed for all 3 cases.(2) The lesion area was significant different in period of 3 months,3-6 months, 6+months after the surgical operation of decompression (P<0.05) and different types of cystic lesions varied. The lesion area of radicular cyst reduced obviously in first three months (79.98+34.67%), while the decrease of lesion area of dentigerous cyst and keratocystic odontogenic tumor were 35.58+27.38% and 41.56+23.63% respectively in first three months and gradually increased to 71.60+5.07% and 60.56+18.14% in 3-6 months. Compared to other three types, the decrease of lesion area of ameloblastoma was minor, only 51.01+20.83% in 6-14 months.(3) The speed of shrinkage of lesion area after decompression in radicular cyst, dentigerous cyst, and keratocystic odontogenic tumor lesion slowed down gradually as time went on, with maximum speed in the first 2 months. But in ameloblastoma, the change of the shrinking speed was not significant, and the speed was relatively slow throughout the time after decompression.Conclusion:Decompression is an effective and feasible treatment in decreasing odontogenic cystic lesions of the jaw and increasing bone density, especially in radicular cyst and dentigerous cyst. As first phase of treatment of keratocystic odontogenic tumor, decompression can significantly ameliorate facial swelling and deformity, decrease the lesion area, promote bone repair, and is propitious to the implementation of secondary surgery. For ameloblastoma, decompression can only be used as a trial conservative treatment at first period, and it needs follow-up closely. Once the lesion was not reduced or even enlarged, decompression should stop immediately, and needs surgical resection timely. The effect of lesion-decrease after decompression is significant in 6-8 months, but no significant difference in next months as the shrinking speed slows down too much, so the secondary surgery can be carried out 6-8 months after the operation of decompression, which shortens the duration of treatment and contributes to the clinical popularization and implementation of decompression.