PathologyDecompression of Odontogenic Cystic Lesions: Past, Present, and Future
Section snippets
Early Descriptions of Odontogenic Entities
The texts by Bunting2 and Thoma,3 published in 1929 and 1941, respectively, were the epitome of work that had started 3 centuries previously, mostly with French and British doctors. For example, in 1671 Iean Scultet4 described cysts of the jaws as “liquid tumors.” The idea that a cyst was capable of exerting enough pressure to cause bony expansion was formed at that time.5 In 1746 Pierre Fauchard6 provided the first accurate description of an odontoma. In 1774 John Hunter7 described what seems
Classifying Odontogenic Tumors
Owing to the increased activity in research and the wide variety of reports on the subject in Europe and the Americas, in 1869 Paul Pierre Broca12 published Traité des tumeurs, where he suggested the first classification of OTs:
- I.
Ordinary odontomas
- 1.
Embryoplastic period
Embryoplastic odontomas
Fibroplastic
Fibrous
- 2.
Odonto-plastic period
Odonto-plastic odontomas
Cemental
Bulbar
- 3.
Crown formation period
Coronal odontomas
Cemental
Pulpal or dentinal
- 4.
Root formation period
Radicular odontomas
Cemental
Dentinal
- 1.
- II.
Composed
Classification of Odontogenic Cysts
At the beginning of the 20th century, a myriad of tooth-related cystic conditions had been described and a classification system was urgently needed.17 In his 1937 oral diagnosis and treatment planning textbook, Thoma18 subdivided the classification of the follicular cyst in the following manner:
- 1.
Simple (without tooth formation)
- 2.
Dentigerous
- 3.
With odontoma
In 1949 he added a fourth category, the multiple cyst.19
Also in 1937, Hamilton Robinson,20 one of the most influential early oral pathologists in
Rise and Fall of Decompression: the Past
Understanding the behavior of benign and malignant conditions of the maxillofacial region has taken almost 4 centuries, if the work of Scultet4 is used as a starting point. Four hundred years of research have helped to not only undress these pathologies to the point of knowing them as they are, but also to understand how they are best treated. Long before World War II, investigators knew that odontogenic cysts and tumors had the potential to recur, regardless of the treatment modality used.
Reborn as the Phoenix: the Present
In 1991 an article by Brøndum and Jensen45 paved the way for the reintroduction of marsupialization and decompression, which recently had resurrected like the Phoenix. In 1996 Marker et al46 successfully decompressed 23 odontogenic keratocysts using small polyethylene tubes (Fig 6). They concluded that decompression resulted in new bone formation, thickening of the cyst wall, and conservation of bone and anatomic structures. Another interesting conclusion was that the keratocyst epithelium was
The Future of Decompression
Decompression, as any other treatment technique, is not a panacea. The benefits of this old method have been described and proved over the years, and as patients and surgeons become less aggressive, this technique will become more popular when indicated. Cases must be carefully selected and the surgeon has to weigh many factors, such as patient age, type of lesion and time of evolution, and the patient's cooperation.
A Closing Remark: Introduction and Acceptance of a Pleonasm
To the unprepared eye, the word pleonasm might be confused with neoplasm, but they are different! A pleonasm is the use of more words than necessary to convey meaning, as a fault of style or for emphasis. This seems to be the case of the expression odontogenic origin, which was introduced to the dental literature in the late 1970s. In this sense, Shafer's Textbook of Oral Pathology52, a book widely used in North American and Latin American dental schools, helped disseminate the pleonasm. In the
Acknowledgments
The artwork included in this article was done beautifully by Glenna Castro-Núñez, to whom the author expresses his most sincere gratitude. A word of gratitude is extended to the American Board of Oral and Maxillofacial Pathology, especially to Clarita Scioscia, for her invaluable assistance during the preparation of this article.
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Cited by (23)
Effect of Intracapsular Pressure on Decompression Effectiveness
2022, International Dental JournalCitation Excerpt :Some studies have used decompression combined with negative pressure suction and pressure balls or other devices to deal with negative intracapsular pressure for a certain time every day, with good results.18,19 Some studies have reported that the longer the window decompression time, the greater the decrease in cystic lesion volume, and the higher the initial cystic lesion volume, the faster the recovery rate,20,21 which is consistent with the results of this study. In addition, we studied the osteogenesis rate at different time points after fenestration.
A custom-made removable appliance for the decompression of odontogenic cysts fabricated using a digital workflow
2022, Journal of DentistryCitation Excerpt :According to the literature, decompression followed by enucleation of the remaining lining of the cyst is a safe and predictable method to manage large odontogenic cysts. Compared to cystectomy, it is a minimally invasive approach that decreases the prevalence of complications to the anatomical landmarks (maxillary sinus, nasal cavity, nerves, blood vessels, and roots of neighboring teeth) included by large cysts [2,4,5]. Complications of cystectomy may include loss of vitality of the neighboring healthy teeth, OAC, OAF, and nerve damage.
Efficacy and duration of odontogenic keratocyst treated with decompression: A systematic review and meta‐analysis
2022, Journal of Oral and Maxillofacial Surgery, Medicine, and PathologyCitation Excerpt :Currently, decompression is a common surgical method for OKC treatment. The surgeon creates a window between the cyst and the external environment in order to balance the pressure, uses postoperative irrigation to promote the outflow of capsular fluid, changes dressing to facilitate the growth of osteoblasts [3], promoting the formation of new peripheral bone to repair the capsular cavity [4,5]. When the cyst affects the teeth, the use of decompression is conducive to the recovery of pulp vitality and the closure of the apical foramen [6].
Management of Large Radicular Lesions Using Decompression: A Case Series and Review of the Literature
2019, Journal of EndodonticsBenign Neoplasms of the Gnathic Bones
2019, Head and Neck Pathology: A Volume in the Series: Foundations in Diagnostic PathologyDecompression of an extensive Keratocystic Odontogenic Tumor in an elderly patient
2017, Journal of Oral and Maxillofacial Surgery, Medicine, and PathologyCitation Excerpt :Several treatment modalities have been proposed, and are usually classified as conservative or aggressive [6,7]. In order to choose from such therapies various factors such as the patient's age, size and location of the lesion, soft tissue involvement and history of recurrence need to be considered [2,11]. In that way, the aim of this study is to report a 65-year-old patient who presented an extensive KCOT that involved the mandible from its middle portion of the body to its coronoid process and who was treated only with decompression.