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LETTER TO THE EDITOR |
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Year : 2014 | Volume
: 7
| Issue : 6 | Page : 825-826 |
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Is marsupialization still the treatment of choice for large unicystic lesions of the jaws?
Yadavalli Guruprasad, Dinesh Singh Chauhan
Department of Oral and Maxillofacial Surgery, AME'S Dental College Hospital and Research Centre, Raichur, Karnataka, India
Date of Web Publication | 18-Nov-2014 |
Correspondence Address: Yadavalli Guruprasad Department of Oral and Maxillofacial Surgery, AME'S Dental College Hospital and Research Centre, Raichur, Karnataka India
Source of Support: None, Conflict of Interest: None | Check |
DOI: 10.4103/0975-2870.144902
How to cite this article: Guruprasad Y, Chauhan DS. Is marsupialization still the treatment of choice for large unicystic lesions of the jaws?. Med J DY Patil Univ 2014;7:825-6 |
Sir,
The surgical approach to cystic lesions of the jaws is either marsupialization or enucleation. The treatment of choice is dependent on the size and localization of the lesion, the bone integrity of the cystic wall, and its proximity to vital structures. [1] The technique of marsupialization, or Partsch's technique, consists of removing a window from the lesion and suturing the surrounding mucoperiosteum to the margins of the cyst wall. The ensuing cavity is filled with gauze, which is removed after 7-10 days. If necessary, the gauze is changed during this period. This procedure aims to reduce the size of the cyst: opening the cyst eliminates its osmotic pressure and bone apposition gradually occurs at the site previously occupied by the epithelial covering of the cyst. [2] These procedures can be used as a single treatment for a cyst or as preliminary treatment for subsequent enucleation
A 23-year-old male patient was referred to the Department of Oral and Maxillofacial Surgery with a history of swelling in right mandibular region since 1.5 years. On extraoral examination, facial swelling with a size of around 5 × 1.5 × 2 cm was present on the right mandibular region and was nontender with normal overlying skin. Correlating with the history and clinical examination, orthopantomogram was advised which revealed a well-defined large unilocular radiolucency in the right mandible, extending from the first molar to involve the entire ramus and coronoid process, displacing the third molar to the ramus of the mandible [Figure 1]. The patient was posted for marsupialization under general anesthesia and the lesion was decompressed by excising a part of the cystic lining. The excised tissue was sent for biopsy which revealed unicystic ameloblastoma. After 2 years of regular follow-up, the size of the lesion decreased and the residual cystic lining was excised along with the impacted third molar [Figure 2],[Figure 3] and [Figure 4]. | Figure 1: Orthopantomogram (OPG) showing unilocular radiolucent lesion at the junction of body and ramus of mandible with root resorption of involved teeth along with impacted third molar
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| Figure 2: Orthopantomogram (OPG) after 1 year showing considerable decrease in the size of the lesion along with deposition of bone
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| Figure 3: Orthopantomogram (OPG) after 1.5 years showing considerable decrease in the size of the lesion along with deposition of bone
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| Figure 4: Orthopantomogram (OPG) after 2 years showing considerable decrease in the size of the lesion along with deposition of bone
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Neaverth and Burg [1] presented an alternative treatment in which a tube was inserted inside the cystic cavity. This tube was periodically reduced in length as the lesion decreased in size. Several types and sizes of radiopaque tubes were used, such as: angiographic catheter, percutaneous catheter, urethral catheter, and umbilical arterial catheter. [2],[3] Some authors use an acrylic button that can be crossed by a drill, or a metal or plastic tube is used to keep the wound open, thereby allowing drainage and irrigation of the cystic cavity and keeping it clean. [4] These devices are removed when radiographic examination shows that new bone has formed. [5] The age of the patient is another influencing factor that is related to the choice of treatment. As unicystic ameloblastoma (UA) tends to affect young adolescent patients, the concern to minimize surgical trauma and permit jaw function should be one of the important aspects in tumor management. While conservative surgery seems to have been justified with preference over mutilating radical surgery for this young patient, the choice of treatment has to be considered in conjunction with other clinical and pathological factors such as the size, location, and growth pattern of the tumor. Whatever surgical approach the surgeon decides to take, long-term follow-up is mandatory, as the recurrence of UA may be long delayed. Whereas treatment based on histopathologic subtypes is concerned, intraluminal type which has less recurrence rate can be treated conservatively, when compared to intramural type which requires more aggressive approach. [6]
Good results can be achieved in the treatment of large cystic lesions using marsupialization in the modern era of more aggressive surgical procedures and reconstructive techniques. Marsupialization revealed to be more advantageous in many respects, and is therefore considered a worthwhile procedure in large unicystic lesions.
References | | |
1. | Neaverth EJ, Burg HA. Decompression of large periapical cystic lesions. J Endod 1982;8:175-82. [ PUBMED] |
2. | Farmand M. Indication and results of marsupialization of large cysts. Dtsch Zahnarztl Z 1985;40:623-30. |
3. | Pogrel A. Decompression and marsupialization as a treatment for the odontogenic keratocyst. Oral Maxillofac Surg Clin North Am 2003;15:415-27. |
4. | Sakkas N, Shoeen R. Obturator after marsupialization of a recurrence of a radicular cyst of the mandible. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103:16-8. |
5. | Fujii R, Kawakami M, Hyomoto M, Ishida J, Kirita T. Panoramic findings for predicting eruption of mandibular premolars associated with dentigerous cyst after marsupialization. J Oral Maxillofac Surg 2008;66:272-6. |
6. | Guruprasad Y, Chauhan DS, Babu R. Unicystic ameloblastoma of maxilla. J Cranio Max Dis 2012;1:44-8. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
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