Conservative management of large mandibular odontogenic keratocysts using decompression and enucleation: a two-case...

Odontogenic keratocyst (OKC) is a developmental odontogenic cyst characterized by aggressive behavior, infiltrative growth, and a high recurrence rate. Large mandibular lesions frequently involve critical anatomical structures, posing a therapeutic challenge and often leading to aggressive surgical approaches with significant morbidity. Conservative strategies aimed at reducing lesion size while preserving anatomical integrity have become increasingly relevant in clinical practice.

This report describes two female patients, aged 22 and 55 years, presenting with large multilocular radiolucent lesions involving the mandibular body and ascending ramus. Histopathological examination confirmed the diagnosis of OKC in both cases. A conservative treatment protocol based on cystic decompression was implemented, followed by simple enucleation in one case. Clinical and radiographic follow-up demonstrated progressive reduction in the lesions and bone regeneration. In one patient, histopathological analysis after enucleation revealed replacement of the original parakeratinized epithelial lining by non-keratinized stratified squamous epithelium. Recurrence was observed in one case during follow-up, highlighting the need for prolonged monitoring.

Decompression reduced intracystic pressure, facilitated bone regeneration, and minimized the need for radical surgical intervention. This approach preserved anatomical structures and reduced treatment-associated morbidity. The observed recurrence underscores the importance of individualized treatment planning and long-term follow-up.

Conservative management with decompression, with or without subsequent enucleation, is a viable approach for large mandibular OKCs. Careful case selection and prolonged follow-up are essential to optimize clinical outcomes and detect potential recurrence.