For treatment of odontogenic keratocysts, is enucleation, when compared to decompression, a less complex management protocol?

PURPOSE: To determine whether the clinical management of odontogenic keratocysts (OKCs) is more complex in patients who undergo enucleation with or without adjuvant therapy than in patients who undergo decompression with or without residual cystectomy.

MATERIALS AND METHODS: The authors implemented a retrospective cohort study and enrolled a sample composed of patients presenting for the evaluation and management of OKCs. The predictor variable was treatment group, classified as decompression with or without residual cystectomy versus enucleation with or without adjuvant therapy (Carnoy solution, cryotherapy, or peripheral ostectomy). The outcome variables were measurements of complexity of management, including total number of procedures, venue of procedure (operating room vs office), type of anesthesia, hospital admissions, and total number of follow-up visits. Data analyses were performed using univariate and bivariate statistics and a multiple linear regression model.

RESULTS: The study sample was composed of 45 patients (66 OKC lesions) with a mean age of 43.3 years. Of the 66 OKCs treated, 34 (51.5%) were treated with decompression with or without residual cystectomy and 32 (48.5%) were treated with enucleation with or without adjunctive therapy. Larger lesions and lesions with radiographic evidence of cortical perforation were treated more often with decompression with or without residual cystectomy. Based on the multiple linear regression model, patients who underwent enucleation with or without adjuvant therapy compared with those who underwent decompression with or without residual cystectomy had on average 1) 1.1 fewer total procedures (P < .01), 2) 0.8 fewer total office procedures (P < .01), 3) 0.6 fewer local anesthesia procedures (P < .01), and 4) 4.8 fewer postoperative visits (P < .01). There was no difference in the number of general anesthesia procedures, office sedation procedures, or hospital admissions.

CONCLUSION: Given comparable recurrence rates, the increased complexity of managing OKCs with decompression with or without residual cystectomy might not be warranted. Enucleation with or without adjunctive therapy could be the more efficient treatment option.