LETTERS TO THE EDITOR J Oral Maxillofac Surg 72:1231-1232, 2014
DECOMPRESSION AS A TREATMENT FOR ODONTOGENIC CYSTIC LESIONS OF THE JAW
3. Ribeiro Junior O, Borba AM, Alves CA, et al: Keratocystic odontogenic tumors and Carnoy’s solution: Results and complications assessment. Oral Dis 18:548, 2012
To the Editor:—With great interest, we read an article recently published in the Journal of Oral and Maxillofacial Surgery, titled ‘‘Decompression as a Treatment for Odontogenic Cystic Lesions of the Jaw.’’1 Indeed, we carry out decompression for radicular cysts and keratocyst odontogenic tumors (KCOTs) quite often in our practice; however, we have not carried out decompression in unicystic ameloblastomas and hope to try it after reading this article. We appreciate the fact that decompression of the KCOT decreases the stigma attached to the radical treatment of resection and reconstruction. However, we would like to ask Gao et al1 how they addressed the issue of recurrence, although they recommended secondary definitive surgery for aggressive lesions. We present the following queries. 1. Schlieve et al2 mentioned that the histologic picture of the KCOT remains the same after decompression. We regularly use Carnoy solution as an adjunct to decompression, which can help prevent recurrence to a larger extent.3 However, Gao et al1 made no mention of Carnoy solution. 2. Was there any case in this series in which the lesion was limited to the ramus of the mandible without extending into the corpus crossing the angle of the mandible? Unlike lesions extending to the corpus in which an opening can be made in a gravity-dependent area and an acrylic stent can be placed, how did they manage to decompress lesions limited to the ramus of the mandible? We normally manage this difficult area by making an opening along the anterior border of the ramus and using a small segment of a Ryle tube held in situ with a suture to maintain patency. SANTHOSH RAO, MDS, FIBOMS SRUTHI RAO, MDS, PDCR All India Institute of Medical Sciences Raipur, India
References 1. Gao L, Wang XL, Li SM, et al: Decompression as a treatment for odontogenic cystic lesions of the jaw. J Oral Maxillofac Surg 72: 327, 2014 2. Schlieve T, Miloro M, Kolokythas A: Does decompression of odontogenic cysts and cystlike lesions change the histologic diagnosis? J Oral Maxillofac Surg 72:1094, 2014
In reply—We thank Drs Rao and Rao for their commentary regarding our publication ‘‘Decompression as a Treatment for Odontogenic Cystic Lesions of the Jaw.’’1 In this study, our main aim was to evaluate the effectiveness of decompression as the initial treatment of odontogenic cystic lesions of the jaw involving factors that affect relative shrinking speed and bone regeneration, so there was less discussion about secondary definitive surgery and recurrence. Because of its aggressive nature and high recurrence rate, the treatment of keratocyst odontogenic tumor (KCOT) remains varied, which includes curettage plus liquid nitrogen cryotherapy, curettage plus Carnoy solution, curettage with peripheral ostectomy, localized en bloc resection, and occasionally mandibular segmental resection. In our study, for patients with KCOT, decompression followed by curettage with peripheral ostectomy was performed, which decreased the risk of injury to adjacent structures and the recurrence rate. We also support the treatment described by Drs Rao of using Carnoy solution as an adjunct to decompression, which is consistent with studies by Sivanmalai et al2 and Ribeiro Junior et al3 showing that Carnoy solution promotes a superficial chemical necrosis and lowers recurrence rates of odontogenic keratocyst. However, neuropathic complications occurred in a few cases that had neural and vascular bundle exposure. Therefore, as reported by Ribeiro Junior et al,3 we believe that Carnoy solution and peripheral ostectomy could provide efficient treatment for KCOT. Regarding treatment of the ramus of the mandible, Anavi et al4 reported that most cysts were located in the body (77.3%), followed by the ramus of the mandible with an extending angle (13.3%). The nasopharyngeal airways and modified decompression tubes were frequently used to secure the mucosal opening after decompression, but this method contributed to patients’ discomfort and interfered with occlusion. Customized thermoplastic resin stents were used to maintain the opening of cystic lesions, especially for the ramus of the mandible with an extending angle. A stainless steel wire clasp could be used to supplement the undercut around the periphery of the adjacent dental crown at the retromolar region.
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LETTERS TO THE EDITOR
Moreover, the shape of the stent could be adjusted as the cystic lesions gradually decrease. In our study, there were few cystic lesions limited to just the ramus of the mandible, and a negative-pressure drainage tube was performed to maintain patency, which is theoretically similar to using a small segment of a Ryle tube as described by Drs Rao.
KE-QIAN ZHI, MD LING GAO, PHD WEN-HAO REN, MD SHAO-MING LI CHANG-YANG LIU Xi’an, Shaanxi, People’s Republic of China
References 1. Gao L, Wang X-L, Li S-M, et al: Decompression as a treatment for odontogenic cystic lesions of the jaw. J Oral Maxillofac Surg 72: 327, 2014 2. Sivanmalai S, Kandhasamy K, Prabu N, et al: Carnoy’s solution in the management of odontogenic keratocyst. J Pharm Bioallied Sci 4:S183, 2012 3. Ribeiro Junior O, Borba AM, Alves CA, et al: Keratocystic odontogenic tumors and Carnoy’s solution: Results and complications assessment. Oral Dis 18:548, 2012 4. Anavi Y, Gal G, Miron H, et al: Decompression of odontogenic cystic lesions: Clinical long-term study of 73 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 112:164, 2011