Management of Odontogenic Keratocyst by Decompression: A Case Report
Abstract
Odontogenic keratocyst (OKC) is a locally aggressive intrabony cyst of odontogenic origin and one of the most debated jaw pathologies because of its high recurrence potential and variable treatment strategies. This report presents the long-term outcome of a mandibular OKC treated by decompression alone. A 31-year-old woman presented with painless right mandibular swelling. Imaging showed a well-defined unilocular radiolucency from the mandibular angle to the distal root of the first molar, associated with an impacted third molar and external root resorption of the second molar. Decompression was performed by creating a buccal bone window, evacuating the cyst, extracting tooth 48, and placing an acrylic plug. Histopathology confirmed an odontogenic keratocyst. Serial panoramic and cone-beam computed tomography scans demonstrated progressive bone fill, so secondary enucleation and curettage were not undertaken. At 7-year follow-up, complete radiographic healing and no recurrence were observed. This case demonstrates that, in carefully selected mandibular OKCs, decompression alone followed by strict and prolonged radiographic surveillance can achieve complete resolution while avoiding the morbidity of more aggressive procedures. Conservative treatment with decompression may therefore be considered a viable option in selected patients. Keywords: Conservative treatment; Curettage; Decompression; Surgical; Jaw cysts; Odontogenic keratocyst.
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10. GN Antonoglou, Sándor GK, Koidou VP, Papageorgiou SN, "Non-syndromic and syndromic keratocystic odontogenic tumors: systematic review and meta-analysis of recurrences." Journal of cranio-maxillofacial surgery, vol. 42, no. 7, pp. e364-e71, 2014.
11. RA Agha, et al., "The SCARE 2020 guideline: updating consensus surgical CAse REport (SCARE) guidelines." Int J Surg, vol. 84, no. pp. 226-30, 2020.
12. EA Al-Moraissi, et al., "What surgical treatment has the lowest recurrence rate following the management of keratocystic odontogenic tumor?: A large systematic review and meta-analysis." Journal of Cranio-Maxillofacial Surgery, vol. 45, no. 1, pp. 131-44, 2017.
13. AA Khan, et al., "Management of an extensive odontogenic keratocyst: A rare case report with 10-year follow-up." Medicine, vol. 98, no. 51, pp. 2019.
14. FN Bushabu, Titinchi F, Bing L, Davda L, "Clinical indications for radical resection of odontogenic keratocyst: A systematic review." National Journal of Maxillofacial Surgery, vol. 14, no. 2, pp. 177-84, 2023.
15. SS Moraes, et al., "Functional and cosmetic surgery for management of the calcifying odontogenic cyst intruding into maxillary sinus and nasal cavity-Case report." Oral Maxillofac Surg Cases, vol. 3, no. 4, pp. 116-21, 2017.
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17. AM Al-Juhni, Al-Omar AF, Muaadi HA, Al-Anazi AM, "Conservative management of odontogenic keratocyst by marsupialization." Saudi Journal of Oral Sciences, vol. 8, no. 3, pp. 2021.
18. J Castro-Núñez, "An innovative decompression device to treat odontogenic cysts." J Craniofac Surg, vol. 27, no. 5, pp. 1316, 2016.
19. MM Soliman, Hassan H, Elgazaerly H, Sweedan TO, "Marsupialization as a treatment modality of large jaw cysts." World Appl Sci J, vol. 21, no. 12, pp. 1752-9, 2013.
20. MA Pogrel, "Treatment of keratocysts: the case for decompression and marsupialization." J Oral Maxillofac Surg, vol. 63, no. 11, pp. 1667-73, 2005.
21. MA Pogrel, Jordan R, "Marsupialization as a definitive treatment for the odontogenic keratocyst." Journal of oral and maxillofacial surgery, vol. 62, no. 6, pp. 651-5, 2004.
22. L Tolstunov, Treasure T, "Surgical treatment algorithm for odontogenic keratocyst: combined treatment of odontogenic keratocyst and mandibular defect with marsupialization, enucleation, iliac crest bone graft, and dental implants." Journal of Oral and maxillofacial Surgery, vol. 66, no. 5, pp. 1025-36, 2008.
23. MS De Castro, et al., "Conservative surgical treatments for nonsyndromic odontogenic keratocysts: a systematic review and meta-analysis." Clinical Oral Investigations, vol. 22, no. 5, pp. 2089-101, 2018.
24. HL Moellmann, Parviz A, Goldmann-Kirn M, Rana M, Rana M, "Comparison of Five Different Treatment Approaches of Mandibular Keratocystic Odontogenic Keratocyst (OKC): A Retrospective Recurrence Analysis of Clinical and Radiographic Parameters." Journal of Maxillofacial and Oral Surgery, vol. 23, no. 1, pp. 145-51, 2024.
25. S Al-Qurmoti, et al., "Volumetric reduction in large cystic jaw lesions postoperative enucleation: a longitudinal clinical study." BMC Oral Health, vol. 23, no. 1, pp. 660, 2023.
26. MU Zaman, "Comparing Radiation Doses in CBCT and Medical CT Imaging for Dental Applications." J Pharm Bioallied Sci, vol. 16, no. Suppl 1, pp. S883-s5, 2024.
2. PM Speight, Takata T, "New tumour entities in the 4th edition of the World Health Organization Classification of Head and Neck tumours: odontogenic and maxillofacial bone tumours." Virchows Arch, vol. 472, no. 3, pp. 331-9, 2018.
3. PJ Stoelinga, "Long-term follow-up on keratocysts treated according to a defined protocol." Int J Oral Maxillofac Surg, vol. 30, no. 1, pp. 14-25, 2001.
4. T Kaczmarzyk, Mojsa I, Stypulkowska J, "A systematic review of the recurrence rate for keratocystic odontogenic tumour in relation to treatment modalities." International journal of oral and maxillofacial surgery, vol. 41, no. 6, pp. 756-67, 2012.
5. M Dioguardi, et al., "Factors and management techniques in odontogenic keratocysts: a systematic review." European Journal of Medical Research, vol. 29, no. 1, pp. 287, 2024.
6. MM Elshafei, Afifi NS, Ghazy SE, Gad HA, Rasmy MM, "Odontogenic Keratocyst: A Review of Histogenesis, Classification, Clinical Presentation, Genetic Aspect, Radiographic Picture, Histopathology and Treatment." Egyptian Journal of Histology, vol. 45, no. 2, pp. 325-37, 2022.
7. JA Regezi, "Odontogenic cysts, odontogenic tumors, fibroosseous, and giant cell lesions of the jaws." Mod Pathol, vol. 15, no. 3, pp. 331-41, 2002.
8. F Titinchi, "Protocol for management of odontogenic keratocysts considering recurrence according to treatment methods." J Korean Assoc Oral Maxillofac Surg, vol. 46, no. 5, pp. 358-60, 2020.
9. A Kolokythas, Fernandes RP, Pazoki A, Ord RA, "Odontogenic keratocyst: to decompress or not to decompress? A comparative study of decompression and enucleation versus resection/peripheral ostectomy." J Oral Maxillofac Surg, vol. 65, no. 4, pp. 640-4, 2007.
10. GN Antonoglou, Sándor GK, Koidou VP, Papageorgiou SN, "Non-syndromic and syndromic keratocystic odontogenic tumors: systematic review and meta-analysis of recurrences." Journal of cranio-maxillofacial surgery, vol. 42, no. 7, pp. e364-e71, 2014.
11. RA Agha, et al., "The SCARE 2020 guideline: updating consensus surgical CAse REport (SCARE) guidelines." Int J Surg, vol. 84, no. pp. 226-30, 2020.
12. EA Al-Moraissi, et al., "What surgical treatment has the lowest recurrence rate following the management of keratocystic odontogenic tumor?: A large systematic review and meta-analysis." Journal of Cranio-Maxillofacial Surgery, vol. 45, no. 1, pp. 131-44, 2017.
13. AA Khan, et al., "Management of an extensive odontogenic keratocyst: A rare case report with 10-year follow-up." Medicine, vol. 98, no. 51, pp. 2019.
14. FN Bushabu, Titinchi F, Bing L, Davda L, "Clinical indications for radical resection of odontogenic keratocyst: A systematic review." National Journal of Maxillofacial Surgery, vol. 14, no. 2, pp. 177-84, 2023.
15. SS Moraes, et al., "Functional and cosmetic surgery for management of the calcifying odontogenic cyst intruding into maxillary sinus and nasal cavity-Case report." Oral Maxillofac Surg Cases, vol. 3, no. 4, pp. 116-21, 2017.
16. GNdS Pinto, Figueira JA, Gonçales ES, Sant'ana E, Tolentino EdS, "Marsupialization as definitive treatment of odontogenic cysts: report of two cases." RFO UPF, vol. 20, no. 3, pp. 361-6, 2015.
17. AM Al-Juhni, Al-Omar AF, Muaadi HA, Al-Anazi AM, "Conservative management of odontogenic keratocyst by marsupialization." Saudi Journal of Oral Sciences, vol. 8, no. 3, pp. 2021.
18. J Castro-Núñez, "An innovative decompression device to treat odontogenic cysts." J Craniofac Surg, vol. 27, no. 5, pp. 1316, 2016.
19. MM Soliman, Hassan H, Elgazaerly H, Sweedan TO, "Marsupialization as a treatment modality of large jaw cysts." World Appl Sci J, vol. 21, no. 12, pp. 1752-9, 2013.
20. MA Pogrel, "Treatment of keratocysts: the case for decompression and marsupialization." J Oral Maxillofac Surg, vol. 63, no. 11, pp. 1667-73, 2005.
21. MA Pogrel, Jordan R, "Marsupialization as a definitive treatment for the odontogenic keratocyst." Journal of oral and maxillofacial surgery, vol. 62, no. 6, pp. 651-5, 2004.
22. L Tolstunov, Treasure T, "Surgical treatment algorithm for odontogenic keratocyst: combined treatment of odontogenic keratocyst and mandibular defect with marsupialization, enucleation, iliac crest bone graft, and dental implants." Journal of Oral and maxillofacial Surgery, vol. 66, no. 5, pp. 1025-36, 2008.
23. MS De Castro, et al., "Conservative surgical treatments for nonsyndromic odontogenic keratocysts: a systematic review and meta-analysis." Clinical Oral Investigations, vol. 22, no. 5, pp. 2089-101, 2018.
24. HL Moellmann, Parviz A, Goldmann-Kirn M, Rana M, Rana M, "Comparison of Five Different Treatment Approaches of Mandibular Keratocystic Odontogenic Keratocyst (OKC): A Retrospective Recurrence Analysis of Clinical and Radiographic Parameters." Journal of Maxillofacial and Oral Surgery, vol. 23, no. 1, pp. 145-51, 2024.
25. S Al-Qurmoti, et al., "Volumetric reduction in large cystic jaw lesions postoperative enucleation: a longitudinal clinical study." BMC Oral Health, vol. 23, no. 1, pp. 660, 2023.
26. MU Zaman, "Comparing Radiation Doses in CBCT and Medical CT Imaging for Dental Applications." J Pharm Bioallied Sci, vol. 16, no. Suppl 1, pp. S883-s5, 2024.
| Files | ||
| Issue | Vol 13, No 1 (Winter 2026) | |
| Section | Case Report(s) | |
| Keywords | ||
| Conservative treatment; Curettage; Decompression; Surgical; Jaw cysts; Odontogenic keratocyst. | ||
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How to Cite
1.
Gholami M, Kazemian N, Mirzaei A, Sharifi F. Management of Odontogenic Keratocyst by Decompression: A Case Report. J Craniomaxillofac Res. 2026;13(1):113-117.
