Decompression of keratocystic odontogenic tumours: an effective treatment strategy based on clinical evidence!

      Background: Keratocystic odontogenic tumour (KCOT) is a pathological entity with a significant destructive potential in oral and maxillofacial region. Aggressive treatments were routine till recently because of its high rate of recurrence and the degree of destruction it had already caused. These aggressive treatments usually involved enucleation of cysts leaving behind a very weak bony scaffold and at times resections that had to be reconstructed subsequently. Recently there has been an increased interest of the surgeons in decompression of these cysts to restrict their destructive activity causing significant decrease in the size of these lesions which are enucleated at a later stage without causing much morbidity.
      Objectives: To assess the role of a modified decompression procedure for preservation of bone and vital structures in large KCOTs.
      Methods: A total of 14 patients with large biopsy proven KCOTs were followed clinically after a modified decompression procedure. Two patients had multiple KCOTs in both jaws while remaining 12 had single cystic lesions in mandible. All patients were followed-up for a period of 8–20 months (depending upon the response of the decompression procedure) after which they underwent routine enucleation procedure while safely preserving the bone and teeth involved.
      Findings: Decompression resulted in significant bone repair around the cystic lesion in all 14 patients. Three patients had the complication of dislocation of decompression device and had to be reoperated to make the openings patent again. All patients were safely treated with enucleation after significant reduction in size of the lesion.
      Conclusion: Decompression of large KCOTs is an effective treatment method for the management of lesion that have caused significant bone destruction on primary presentation.