Biopsy Oral Surgery

Marsupialization

When jaw lesions present, a surgeon wants to treat the lesion in completion with the least possible morbidity to the patient. There are multiple options in treating jaw lesions. Treatment options include: curettage, enucleation with or without peripheral ostectomy, marsupialization, and resection.
Marsupialization is a method in treating jaw cysts, when the lesion is near vital structures and there is concern for jaw fracture. This will also decrease the morbidity to the patient.

Marsupialization, allows for surgical decompression of the given cyst to decrease surrounding injury. In the case presented below, the jaw lesion is a keratocystic odontogenic tumor. A lesion with a high incidence of recurrence if not treated correctly.

With such lesions, enucleation with peripheral ostectomy is recommended. However, with the lesions presenting in such a manner, pushing on the inferior alveolar nerve towards the inferior portion of the mandible, there is risk of paresthesia and/or jaw fracture.

In cases such as these, surgical decompression with marsupialization can be utilized. Obtaining surgical access to the cyst is performed by elevating the gingiva and creating a bony window, subsequently opening into the cystic cavity. Tubing is then placed into the cystic cavity (either IV tubing or a nasopharyngeal tube). Over subsequent months, the tube is irrigated daily, and the patient is followed up every 3-4 weeks to evaluate the progress in decompressing the cyst. Once decreased to a size that will result in less morbidity, the cyst will then be enucleated with peripheral ostectomy.