Page 306 - Read Online

Although the well‑considered modality, marsupialization
satisfies certain therapeutic requirements in such
large lesions, it has significant drawbacks such as slow
healing and cicatrization. Moreover, this procedure
[12]
is hard to rely on when treating a dentigerous cyst
because it is difficult to maintain patency in a bony
lesion. Also, a lateral window could drive the developing
permanent dentition toward ectopic eruption, resulting
in malocclusion and creating a potential need for further
interceptive orthodontics. [7‑9]
However, the treatment, prognosis and cure rates in
such large dentigerous cysts are all dependent upon the
various factors such as growth characteristics, anatomic
site, clinical extent size, age, gender, etc.
Figure 8: Three months post operative occlusal view (intact) Various studies have shown predictable spontaneous bone
regeneration in young patients after enucleation of such
large cysts. Many authors believe that bone grafting in
young patients should be considered carefully and in most
of the instances it is unnecessary. [11]
In view of the aforementioned, we preferred cystectomy
rather a radical procedure, which may otherwise usually
recommended in such large cysts. In our opinion, a
radical treatment in a growing child might result in severe
mutilation. Therefore, we would opine that it is always
advisable to be conservative in such scenarios.

But, many authors differ in their opinion with regard
to enucleation of large dentigerous cysts. This is
largely due to the fact that larger cystic cavities lack
organization of a blood clot and formation of new bone
is questionable. A blood clot in a devitalized area is a
[12]
great risk, as it can easily become infected and may lead
Figure 9: Three months CT scan showing bone filling in the defect
to the unwanted consequences of local inflammation.
There is also possibility of nerve damage and incomplete
removal of cystic lining due to the encompassment of
the roots of the posterior teeth by the cyst. [12]
However, in a large case series study [Figure 11] a
[15]
decision tree for treating large unilocular cysts of the
jaws has been suggested. The authors recommended
enucleation for all the unilocular cysts irrespective of
its size followed by chemical cauterization. They also
deferred biopsy prior to a definitive surgical procedure
as a valid practice. This is because the wound created by
biopsy may impede clean first‑hand surgical procedure
Figure 10: Three months post operative orthopantomogram showing with regards to tissue planes and wound infection. [15,16]
successful bone regeneration
We strongly agree with the tenet and further believe that
watertight primary closures followed by unstressed jaw
in those instances where jaws have completed the growth. movements are crucial for uneventful bone regeneration
But, choosing a treatment modality becomes critical when after enucleation therapy.
young growing jaws suffer a massive lesion. In the present
case, the patient was only 13 years old at the time of In our case, there was an intact lower basal bone, which
presentation. Any radical approach may result in sever favored the enucleation therapy. Postoperative maintenance
mutilation of the jaw along with the loss of its function. such as sustaining intercondylar distance, avoiding jaw
stress by IMF for eight weeks, and using liquid diet
In such situations proper decision making in selecting the subsequently contributed equally for the success of this
appropriate treatment modality plays a crucial role in the therapy. However, this type of cases demands a long‑term
prognosis of the overall therapy. For the present case, follow‑up to monitor for any recurrence.
we had considered all possible modalities by taking into
account the factors such as age, gender, location, size as The above‑described approach will certainly prevent
well as the patient’s socioeconomic status. the aggressive radical treatment protocol, which would
Plast Aesthet Res || Vol 2 || Issue 5 || Sep 15, 2015 297