Large Dentigerous Cyst Management — ORE Part 1 MCQ

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ModerateOral SurgeryLarge Dentigerous Cyst ManagementORE Part 1

A patient has a dentigerous cyst associated with an impacted lower third molar. Radiography shows a large, well-defined lesion extending anteriorly from the third-molar region to the lower canine region. What is the most appropriate initial management?

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Correct answer: D — Decompress the cyst before definitive surgery

A large dentigerous cyst extending through much of the mandible is best managed initially by decompression (or marsupialisation). Establishing drainage lowers intracystic pressure, allows progressive reduction in cavity size and bony infill, and can make later definitive enucleation safer. This is particularly important where immediate removal would leave a substantial bony defect and increase risks such as mandibular fracture or injury to adjacent structures. Enucleation is appropriate for many smaller, accessible dentigerous cysts, but is not the preferred initial approach for this extensive lesion. Radiotherapy and chemotherapy have no role in a benign odontogenic cyst. Segmental resection would be disproportionate unless there were exceptional features, such as aggressive neoplasia or inability to manage the lesion conservatively.

Reference: Berretta LM, et al. Effectiveness of marsupialisation and decompression on the reduction of cystic jaw lesions: a systematic review. British Journal of Oral and Maxillofacial Surgery, 2021. https://pubmed.ncbi.nlm.nih.gov/34749963/