(33) What are the Outcomes Following Decompression Tube Placement after Initial Biopsy of Non-keratocystic Lesions?

Abstract: Decompression is a common treatment for intrabony lesions of the jaws. The goal of decompression is to relieve the internal pressure and allow bony regeneration to decrease cystic size. Our standard institutional practice is to place decompression tubes within all cystic lesions at time of the initial biopsy.1 In maladies such as the odontogenic keratocyst, the literature has shown significant benefit of decompression in volume reduction, as well as increased wall thickness.2,3 Decompression of other cystic lesions has not yet proven beneficial. The purpose of this study was to determine the clinical course and outcome of decompression for non-keratocystic lesions.

We performed a retrospective cohort study from January 2017 to January 2022 at the University of Illinois Chicago Department of Oral and Maxillofacial Surgery. Subjects were identified through surgical logs and chart queries. IRB approval was obtained from UIC (IRB #2022-0071).

Eighty-three subjects (34 Female; 49 Male) were identified with an average age of 32.8 years. The most common lesion was a dentigerous cyst (n=45, 54.2%), followed by periapical cyst (n=12, 14.5%). The average decompression period was 279.2 days (SD 233.8 days), with subjects completing on average 3.3 follow-up appointments. Of the 83 subjects, 71.1% (n=59) required an additional panoramic radiograph or CBCT during the treatment period. The overall rate of complications was 30.1%, with 25 out of 83 subjects having displacement or requiring replacement of their decompression tube. Most subjects were eventually treated with enucleation and curettage (n=52, 62.7%), followed by resection with or without reconstruction (n=12, 14.5%), and 9 cases (10.9%) showed resolution with eventual removal of decompression tubes. Six subjects (7.23%) were lost to follow-up after the decompression tube was placed, and all of these subjects were scheduled for enucleation and curettage. There were 3 cases of recurrence identified (3.61%).

Decompression of non-keratocystic lesions should be performed only after appropriate patient selection. Although the benefit of decompression can be significant for some patients in attempts to avoid or decrease surgical morbidity, the placement can be technically challenging, and appropriate maintenance, irrigation, and close follow-up by the patient is imperative.

1. Enislidis G, Fock N, Sulzbacher I, Ewers R. Conservative treatment of large cystic lesions of the mandible: a prospective study of the effect of decompression. Br J Oral Maxillofac Surg. 2004;42(6):546-550. doi:10.1016/j.bjoms.2004.06.020
2. Asutay F, Atalay Y, Turamanlar O, Horata E, Burdurlu MÇ. Three-Dimensional Volumetric Assessment of the Effect of Decompression on Large Mandibular Odontogenic Cystic Lesions. J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg. 2016;74(6):1159-1166. doi:10.1016/j.joms.2015.12.010
3. Oh JS, You JS, Kim SG. Clinical and histomorphometric evaluation of decompression followed by enucleation in the treatment of odontogenic keratocyst. J Dent Sci. 2018;13(4):329-333. doi:10.1016/j.jds.2018.06.001