The use of decompression in the treatment of patients with cystic lesions of the mandible

Cystic lesions of the jaws, including cysts and cystic neoplasms, are one of the most common pathologies of the maxillofacial region. Reaching large sizes, they present serious difficulties in the treatment of patients, due to the involvement of important anatomical structures in the pathological process, which increases the risk of permanent complications occurrence, such as sensitivity disorders, loss of teeth, orosinusal and oronasal communications, pathological fracture of the jaw, formation of defects and deformations of the maxillofacial region. The method of decompression for the treatment of patients with cystic lesions of the jaws consists in creation of an artificial fistulous passage between the cystic cavity and the external environment by inserting a drainage tube into it. Its main goal is to reduce the volume of the cystic cavity, which allows maintaining the viability of the teeth involved in the pathological process, as well as the integrity of important, adjacent anatomical structures, with a decrease in the risk of postoperative complications. The article presents the protocol and results of the use of decompression as the first stage of treatment of three patients with large mandibular cystic lesions – odontogenic keratocyst, follicular cyst and unicystic ameloblastoma, followed by the second stage cystectomy after decompression was completed. Due to the regeneration of cortical and trabecular bone tissue, restitution of the mandibular canal walls, after 9-11 months of decompression, it was possible to reduce the invasiveness of the second surgery and the associated risks of a pathological fracture of the mandible, impaired sensitivity in the zone of innervation of the lower alveolar nerve, and also maintain viability of the teeth with roots closely adjacent to or located in the cystic cavity. Decompression can be used as a single-stage, conservative surgical treatment, or in combination with subsequent cystectomy in the treatment of patients with cystic lesions of the jaws. In cases of aggressive lesions, it is recommended to perform the second, radical stage of surgical treatment. The method is recommended for: extensive cystic lesions of the jaws; lesions located in close proximity or adjacent to the mandibular canal, the base of the lower jaw, the maxillary sinus, the orbit, the nasal cavity, the apices of the roots of the teeth; cystic lesions in children and the elderly, in order to reduce the trauma and volume of surgery.
Keywords: decompression, cystostomy, cystectomy, enucleation, radicular cyst, follicular cyst, keratocyst, ameloblastoma, mandible, jaw fracture
Conflict of interest. The authors declare that there is no conflict of interest.
Funding. This research received no specific grant from any funding agency in the public, commercial, or not-forprofit sectors.