Decompression as a method of treatment for cystic lesions of the jaws: a review of the literature

Treatment options for odontogenic cystic lesions of the jaws have evolved since the 19th century. In 1892, Polish professor Carl Franz Maria Partsch introduced the concept of cystostomy, which involves transforming the cystic cavity into a “pocket” by suturing the cyst wall to the oral mucosa, a procedure that later became known as marsupialization. In 1947, developing the idea of C.F.M. Partsch, E.H. Thomas introduced decompression, a technique that creates an artificial fistula between the cystic cavity and the external environment by inserting a drainage tube. Both techniques aim to reduce the size of the cystic lesion by reducing intracavitary pressure through the formation of a window in the cyst wall, allowing continuous drainage, which not only prevents the lesion from growing but also promotes gradual formation of new bone through apposition. Radical surgical methods, such as enucleation and resection of the jaw, are often considered the methods of choice, but their use is often associated with complications, including defects and deformities of the maxillofacial area, pathological fractures of the jaws, loss of teeth and sensory disturbances. Decompression along with cystostomy represents a minimally invasive surgical treatment. Indications for decompression include extensive cystic lesions of the jaws, lesions located near or adjacent to the mandibular canal, the base of the mandible, the maxillary sinus, the nasal cavity, the tips of the tooth roots, cystic lesions in children and the elderly, in whom reducing the trauma and extent of surgical intervention is of great importance. The optimal time interval for decompression is from 6 to 14 months, with a mean of 9.5 months. Reduction of cystic cavities after marsupialization and decompression varies from 34 to 97%, with a mean of about 60%. The effectiveness of decompression in the treatment of patients with radicular and follicular cysts, odontogenic keratocysts and unicystic ameloblastomas has been proven. It can be used as a single-stage treatment, or in combination with subsequent enucleation, to treat patients with cystic lesions of the jaws. In cases of more aggressive jaw lesions, a second, radical stage of surgical treatment is recommended. Reducing the volume of cystic lesions minimizes the risks of surgical damage to important anatomical structures and pathological jaw fracture during repeated interventions, or, in some cases, eliminates the need for the latter. Other positive aspects of the method include the possibility of simultaneous biopsy; minimal invasiveness; preservation of viability and integrity of teeth; possibility of outpatient treatment or reduction of hospital stay, as well as the shortest postoperative rehabilitation.
Keywords: decompression, cystotomy, cystectomy, marsupialization, enucleation, radicular cyst, follicular cyst, keratocyst, ameloblastoma, jaw fracture
Conflicts of interest. The authors have no conflicts of interest to declare.
Financing. The paper was done without sponsorship.