Marsupialization for odontogenic keratocysts: Long-term follow-up analysis of the effects and changes in growth characteristics

Objective. This study evaluated the effects of marsupialization on odontogenic keratocysts (OKCs) and its role in conjunction with enucleation and curettage. Study design. Twenty-eight primary OKCs, treated by marsupialization before enucleation and curettage, were examined in this study. The effect of marsupialization and recurrence data after a follow-up period of at least 3 years were evaluated. The changes of growth characteristics during marsupialization were analyzed by means of histopathologic and immunohistochemical studies with monoclonal anti-Ki-67 antibody. Results. The effect of marsupialization was evaluated as extremely effective (64.3%), moderately effective (32.1%), and poorly effective (3.6%). In 5 lesions, the cysts disappeared macroscopically and further surgery was not done. Recurrence was observed in 6 lesions (21.4%), and there was no significant difference in recurrence rates between the lesions treated with or without marsupialization. There appeared to be a predilection for recurrence in the lesions in the mandibular ramus region and also for radiographically multilocular lesions. Microscopic examination showed substantial changes from a parakeratinized or orthokeratinized epithelium into a hyperplastic, stratified, nonkeratinizing squamous epithelium after marsupialization in many cases. There was no significant difference in labeling index between premarsupialization (20.2% +/- 12.0%) and postmarsupialization (15.3% +/- 10.3%). Conclusions. Marsupialization was found to be effective as a preliminary treatment for large OKCs. This procedure does not appear to affect the recurrence tendency of OKCs, and the probable changes in growth characteristics become rather less aggressive.