Cyst Decompression in Medically and Anatomically Complex Situations: A Case Series Demonstrating Radiographic Dimensional Changes

Abstract

Introduction: Cyst decompression is a well-documented treatment modality for managing jaw cysts. Indications for decompression include contraindications to general anesthesia and situations where enucleation poses a risk of damage to nearby structures. Purpose(s): This study aims to demonstrate the role of cyst decompression in cases where enucleation is not viable and highlights its role as a safe, less invasive treatment modality for managing jaw cysts. Method(s): The authors present a series of five patients who underwent cyst decompression (with and without extraction of associated teeth). General anesthesia was contraindicated in three patients. One patient presented with a cyst immediately adjacent to a dental implant, and one patient presented with a cyst intimately associated with the inferior dental canal. Plain film imaging was used to compare cyst dimensions (anterior-posterior and superior-inferior) at baseline and, on average, 13 months after decompression under local anesthesia. Result(s): Three cases were biopsy-proven dentigerous cysts, and two were biopsy-proven radicular cysts. The average reduction in cyst size was 76% (anterior-posterior) and 73% (superior-inferior). Bony infill was noted in all cases, with two cases showing almost complete bony infill without a second procedure. In all three cases of dentigerous cysts, the associated teeth spontaneously repositioned. No significant complications were reported in the perioperative period. Conclusion(s): Cyst decompression offers an alternative to enucleation for larger cysts. In cases where enucleation is less favorable due to the proximity of at-risk structures, decompression reduces the risks and facilitates subsequent enucleation, if required. A second surgery may not be necessary in select cases.Copyright © 2025