Clin Oral Invest DOI 10.1007/s00784-015-1552-y
REVIEW
Long-term results after treatment of extensive odontogenic cysts of the jaws: a review Robert Wakolbinger 1 & Johann Beck-Mannagetta 2
Received: 27 April 2015 / Accepted: 27 July 2015 # Springer-Verlag Berlin Heidelberg 2015
Abstract Aim The aim was to perform a literature review concerning long-term results after treatment of extensive cysts of the jaws. Methods The following databases were searched: MEDLINE, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, The Cochrane Library, and EMBASE. Case reports and abstracts were excluded. Results Three hundred fifty-six articles were found, of which 30 were included. Only the minority of the studies reported long-term results. Most authors did not distinguish between temporary complications and permanent deficiencies (incomplete bone healing, permanent sensory deficits). Conclusion Based on this review, it is recommended to consider primary decompression or marsupialization ± later definitive surgery for the treatment of extensive jaw cysts in order to achieve satisfying clinical results. Clinical relevance Complications (occurring within the first 6 months postoperatively, e.g., infection) and remaining deficits (after a minimum of 6 months and not changing over time, e.g., bony or sensory deficit) should be clearly separated from each other. Knowledge of permanent deficits and bone healing after different therapeutic approaches is important for decision making. Patients should be informed not only about complications but also about the risk of permanent deficits for each method.
* Robert Wakolbinger [email protected] 1
Medical University of Vienna, Vienna, Austria
2
Paracelsus Medical University, Salzburg, Austria
Keywords Jaw cysts . Treatment . Complications . Long-term results . Review
Introduction More than 100 years have passed since the first publications on the surgical approach to jaw cysts appeared in the German literature [1, 2]. Although today the treatment of small cysts (radiologic diameter less than 1.5 cm) is rarely problematic, the approach to larger cysts still remains controversial: While some authors recommend to enucleate even large cysts [3], others prefer decompression or marsupialization [4]. Only few studies deal with the long-term results after surgical cyst therapy. In addition, most authors do not clearly distinguish between postoperative complications (e.g., infection) and permanent deficits (that are loss of sensitivity and/or incomplete ossification). For these reasons, it seemed desirable to carry out a review of the literature with special regard to the long-term results after the treatment of extensive cysts of the jaws.
Methods An extensive literature review using the following databases was conducted (Table 1): PubMed interface of MEDLINE, Cochrane CENTRAL Register of Controlled Trials, Cochrane Database of Systematic Reviews (CDSR), The Cochrane Library, and EMBASE (searches were last conducted on April 5, 2014). References were checked as well. Inclusion criteria were full articles, at least case series (single case reports or abstracts were excluded), follow-up examination as well as language (English or German). Nonrelevant articles were excluded.
Clin Oral Invest Table 1
Search terms used for the respective databases
PubMed
Keywords: Bjaw cyst long term,^ Bjaw marsupialization long term,^ Bjaw cystostomy long term,^ Bjaw decompression long term,^ Bjaw cystectomy long term,^ Bjaw cyst enucleation long term,^ Bjaw cyst sensitivity,^ Bjaw cyst hypoesthesia^
Cochrane CENTRAL
Heading Bjaw cyst^
Cochrane Database of Systematic Reviews (CDSR) The Cochrane Library
Keyword Bjaw cyst^
EMBASE
Headings Bjaw cyst,^ Bodontogenic keratocyst^
Keyword Bjaw cyst^
If an article was found by more than one search terms, it was assigned only to the first one.
Discussion Cysts of the jaws are pathologic cavities within the bone of the maxilla or the mandible, lined by odontogenic epithelium (odontogenic cysts) [5–7].
Parameters/key points All included articles were reviewed for the following key points: the article’s main topic, number of cysts analyzed, mean cyst diameter, surgical method(s) used, mean followup period, and long-term deficits mentioned.
Clarification of terms The authors defined Blong-term deficit^ as permanent sensory deficits (that is impaired sensitivity of teeth or the skin area next to the mental foramen) and/or incomplete bone healing, regardless of the defect size.
Results In total, 356 articles were found, of which 30 were included (Table 2). Table 3 and Fig. 1 give an overview on articles reporting long-term results after treatment of jaw cysts, according to the parameters mentioned above. Articles covering only keratocysts were listed separately (Table 4).
Diagnosis Cystic cavities enlarge over time, tend to expand and weaken the bone, and endanger the vitality of neighboring teeth. Complications can occur, such as infection, mandibular fracture, or encroachment upon the maxillary sinus or the nasal cavity. Possible signs are swelling with or without pain and loosening or displacement of teeth [8–10]. Radiographically, the orthopantomogram renders a summation of teeth, bone, temporomandibular joint, and the inferior part of the nose and the maxillary sinus. In this imaging modality, cysts of the jaws appear as sharply delineated radiolucencies. In the case of infection, the margin can appear blurred [7, 8]. Modern techniques, such as computed tomography (CT), magnetic resonance imaging (MRI), or cone beam CT, can sometimes yield additional information about the cyst’s size and relationship to endangered structures. Therefore, CT is an established technique, even though it brings about a higher radiation dose [11–13]. Of course, CT and cone beam CT were not available in the older publications. Management
Table 2
Number of articles found and included, for each database
Database
Articles found
Articles included
PubMed Cochrane CENTRAL CDSR Cochrane Library EMBASE By references Total
228 8 0 1 119 N/A 356
16 0 0 0 3 11 30
Patients suffering from cysts of the jaws should undergo surgery [5, 14]. There are mainly two different procedures: (a) Enucleation (Bcystectomy,^ i.e., complete removal of the cyst lining and primary closure of the wound [2, 5]) or (b) Two different forms of Bcystostomy^: Marsupialization, that is a wide opening of the cyst and suturing of the lining to the oral mucosa; often, a so-called obturator is inserted for several months to prevent spontaneous closure of the opening.
73
53
20
90
336
32
33
71
90
40
33
18
1107 (38 cysts)
209
110
Anavi 2011a
Baumann 1976
Enislidis 2004a
Fenner 1985
Fickling 1965
Gao 2013a
Ihan Hren 2008a
Knezevic 2010a
Koseoglu 2004a
Motamedi 2005
Richter 1986a
Rubio 2015
Schultze-Mosgau 1993
Van Doorn 1972a
Yoshikawa 1982
Keratocysts included
14
Akay 2011
a
Number of cysts
Marsupialization in postop maxillary cyst
Primary closure after enucleation
Sensitivity disturbances after dentoalveolar surgery
Bone regeneration
Bone grafts for large defects
Assessment criteria
Epidemiology
Bone regeneration
Bone density
Desensitization+tooth mobility after cystectomy vs cystostomy Overview of types+treatment Decompression speed, bone density
Reduction rate, description of the stent
Long-term results after marsupialization
Long-term results of marsupialization in children with dentigerous cysts Decompression time, area
Main topic
n.g.
1.1–12.5 cm
n.g.
2.9 cm (0.9–4.2 cm)
3–10 cm
n.g.
2–5 cm
82 %>3 cm
2–5 cm
13.5–35 cm2
n.g.
2–8 cm
>4 cm
n.g.
n.g.
Not given (n.g.)
Cyst size
Ten authors stated to provide long-term results after treatment of jaw cysts
Name
Table 3
Enucleation, marsupialization
Enucleation
Enucleation
Enucleation
Enucleation
In all but one, enucleation
Extraction+enucleation
Marsupialization, enucleation
Enucleation (if
REVIEW
Long-term results after treatment of extensive odontogenic cysts of the jaws: a review Robert Wakolbinger 1 & Johann Beck-Mannagetta 2
Received: 27 April 2015 / Accepted: 27 July 2015 # Springer-Verlag Berlin Heidelberg 2015
Abstract Aim The aim was to perform a literature review concerning long-term results after treatment of extensive cysts of the jaws. Methods The following databases were searched: MEDLINE, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, The Cochrane Library, and EMBASE. Case reports and abstracts were excluded. Results Three hundred fifty-six articles were found, of which 30 were included. Only the minority of the studies reported long-term results. Most authors did not distinguish between temporary complications and permanent deficiencies (incomplete bone healing, permanent sensory deficits). Conclusion Based on this review, it is recommended to consider primary decompression or marsupialization ± later definitive surgery for the treatment of extensive jaw cysts in order to achieve satisfying clinical results. Clinical relevance Complications (occurring within the first 6 months postoperatively, e.g., infection) and remaining deficits (after a minimum of 6 months and not changing over time, e.g., bony or sensory deficit) should be clearly separated from each other. Knowledge of permanent deficits and bone healing after different therapeutic approaches is important for decision making. Patients should be informed not only about complications but also about the risk of permanent deficits for each method.
* Robert Wakolbinger [email protected] 1
Medical University of Vienna, Vienna, Austria
2
Paracelsus Medical University, Salzburg, Austria
Keywords Jaw cysts . Treatment . Complications . Long-term results . Review
Introduction More than 100 years have passed since the first publications on the surgical approach to jaw cysts appeared in the German literature [1, 2]. Although today the treatment of small cysts (radiologic diameter less than 1.5 cm) is rarely problematic, the approach to larger cysts still remains controversial: While some authors recommend to enucleate even large cysts [3], others prefer decompression or marsupialization [4]. Only few studies deal with the long-term results after surgical cyst therapy. In addition, most authors do not clearly distinguish between postoperative complications (e.g., infection) and permanent deficits (that are loss of sensitivity and/or incomplete ossification). For these reasons, it seemed desirable to carry out a review of the literature with special regard to the long-term results after the treatment of extensive cysts of the jaws.
Methods An extensive literature review using the following databases was conducted (Table 1): PubMed interface of MEDLINE, Cochrane CENTRAL Register of Controlled Trials, Cochrane Database of Systematic Reviews (CDSR), The Cochrane Library, and EMBASE (searches were last conducted on April 5, 2014). References were checked as well. Inclusion criteria were full articles, at least case series (single case reports or abstracts were excluded), follow-up examination as well as language (English or German). Nonrelevant articles were excluded.
Clin Oral Invest Table 1
Search terms used for the respective databases
PubMed
Keywords: Bjaw cyst long term,^ Bjaw marsupialization long term,^ Bjaw cystostomy long term,^ Bjaw decompression long term,^ Bjaw cystectomy long term,^ Bjaw cyst enucleation long term,^ Bjaw cyst sensitivity,^ Bjaw cyst hypoesthesia^
Cochrane CENTRAL
Heading Bjaw cyst^
Cochrane Database of Systematic Reviews (CDSR) The Cochrane Library
Keyword Bjaw cyst^
EMBASE
Headings Bjaw cyst,^ Bodontogenic keratocyst^
Keyword Bjaw cyst^
If an article was found by more than one search terms, it was assigned only to the first one.
Discussion Cysts of the jaws are pathologic cavities within the bone of the maxilla or the mandible, lined by odontogenic epithelium (odontogenic cysts) [5–7].
Parameters/key points All included articles were reviewed for the following key points: the article’s main topic, number of cysts analyzed, mean cyst diameter, surgical method(s) used, mean followup period, and long-term deficits mentioned.
Clarification of terms The authors defined Blong-term deficit^ as permanent sensory deficits (that is impaired sensitivity of teeth or the skin area next to the mental foramen) and/or incomplete bone healing, regardless of the defect size.
Results In total, 356 articles were found, of which 30 were included (Table 2). Table 3 and Fig. 1 give an overview on articles reporting long-term results after treatment of jaw cysts, according to the parameters mentioned above. Articles covering only keratocysts were listed separately (Table 4).
Diagnosis Cystic cavities enlarge over time, tend to expand and weaken the bone, and endanger the vitality of neighboring teeth. Complications can occur, such as infection, mandibular fracture, or encroachment upon the maxillary sinus or the nasal cavity. Possible signs are swelling with or without pain and loosening or displacement of teeth [8–10]. Radiographically, the orthopantomogram renders a summation of teeth, bone, temporomandibular joint, and the inferior part of the nose and the maxillary sinus. In this imaging modality, cysts of the jaws appear as sharply delineated radiolucencies. In the case of infection, the margin can appear blurred [7, 8]. Modern techniques, such as computed tomography (CT), magnetic resonance imaging (MRI), or cone beam CT, can sometimes yield additional information about the cyst’s size and relationship to endangered structures. Therefore, CT is an established technique, even though it brings about a higher radiation dose [11–13]. Of course, CT and cone beam CT were not available in the older publications. Management
Table 2
Number of articles found and included, for each database
Database
Articles found
Articles included
PubMed Cochrane CENTRAL CDSR Cochrane Library EMBASE By references Total
228 8 0 1 119 N/A 356
16 0 0 0 3 11 30
Patients suffering from cysts of the jaws should undergo surgery [5, 14]. There are mainly two different procedures: (a) Enucleation (Bcystectomy,^ i.e., complete removal of the cyst lining and primary closure of the wound [2, 5]) or (b) Two different forms of Bcystostomy^: Marsupialization, that is a wide opening of the cyst and suturing of the lining to the oral mucosa; often, a so-called obturator is inserted for several months to prevent spontaneous closure of the opening.
73
53
20
90
336
32
33
71
90
40
33
18
1107 (38 cysts)
209
110
Anavi 2011a
Baumann 1976
Enislidis 2004a
Fenner 1985
Fickling 1965
Gao 2013a
Ihan Hren 2008a
Knezevic 2010a
Koseoglu 2004a
Motamedi 2005
Richter 1986a
Rubio 2015
Schultze-Mosgau 1993
Van Doorn 1972a
Yoshikawa 1982
Keratocysts included
14
Akay 2011
a
Number of cysts
Marsupialization in postop maxillary cyst
Primary closure after enucleation
Sensitivity disturbances after dentoalveolar surgery
Bone regeneration
Bone grafts for large defects
Assessment criteria
Epidemiology
Bone regeneration
Bone density
Desensitization+tooth mobility after cystectomy vs cystostomy Overview of types+treatment Decompression speed, bone density
Reduction rate, description of the stent
Long-term results after marsupialization
Long-term results of marsupialization in children with dentigerous cysts Decompression time, area
Main topic
n.g.
1.1–12.5 cm
n.g.
2.9 cm (0.9–4.2 cm)
3–10 cm
n.g.
2–5 cm
82 %>3 cm
2–5 cm
13.5–35 cm2
n.g.
2–8 cm
>4 cm
n.g.
n.g.
Not given (n.g.)
Cyst size
Ten authors stated to provide long-term results after treatment of jaw cysts
Name
Table 3
Enucleation, marsupialization
Enucleation
Enucleation
Enucleation
Enucleation
In all but one, enucleation
Extraction+enucleation
Marsupialization, enucleation
Enucleation (if
