Management of Odontogenic Keratocyst by Decompression: A Case Report

Abstract

Odontogenic keratocyst (OKC) is a locally aggressive intrabony cyst of odontogenic origin and one of the most debated jaw pathologies because of its high recurrence potential and variable treatment strategies. This report presents the long-term outcome of a mandibular OKC treated by decompression alone. A 31-year-old woman presented with painless right mandibular swelling. Imaging showed a well-defined unilocular radiolucency from the mandibular angle to the distal root of the first molar, associated with an impacted third molar and external root resorption of the second molar. Decompression was performed by creating a buccal bone window, evacuating the cyst, extracting tooth 48, and placing an acrylic plug. Histopathology confirmed an odontogenic keratocyst. Serial panoramic and cone-beam computed tomography scans demonstrated progressive bone fill, so secondary enucleation and curettage were not undertaken. At 7-year follow-up, complete radiographic healing and no recurrence were observed. This case demonstrates that, in carefully selected mandibular OKCs, decompression alone followed by strict and prolonged radiographic surveillance can achieve complete resolution while avoiding the morbidity of more aggressive procedures. Conservative treatment with decompression may therefore be considered a viable option in selected patients