Decompression as conservative treatment of multiple odontogenic keratocysts in a patient with Gorlin-Goltz syndrome: 6-year follow-up

Abstract

Odontogenic keratocyst is an intraosseous lesion with aggressive potential and infiltrative behavior, presenting high recurrence rates. The occurrence of multiple odontogenic keratocysts in the same patient may be associated with Gorlin–Goltz syndrome, a condition characterized by a predisposition to neoplasms and other developmental abnormalities. There is no consensus regarding the best treatment modality. In cases of multiple or large lesions, surgical management may be associated with significant morbidity, resulting in aesthetic and functional impairment. Conservative approaches, such as decompression, represent an effective treatment option due to their simplicity and low morbidity.

Aim  This study aims to describe the case of a 13-year-old female patient diagnosed with Gorlin–Goltz syndrome and multiple odontogenic keratocysts in the mandible.

Methods  The patient was treated using surgical decompression techniques and posterior enucleation. Decompression devices were fabricated from surgical suction tips or needle cap tips and were placed under local anesthesia in five mandibular lesions. After 17–21 months following the decompression procedures, a significant volumetric reduction was observed in four out of five lesions. Subsequently, the patient underwent enucleation surgery. The patient has been under long-term postoperative follow-up for six years after decompression and approximately five years after enucleation, demonstrating satisfactory postoperative recovery, bone neoformation, and absence of aesthetic or functional sequelae.

Conclusion  Conservative techniques such as surgical decompression for the treatment of odontogenic keratocysts are simple, low-cost, and effective options, reducing surgical morbidity and ensuring favorable aesthetic and functional outcomes. However, continuous follow-up and patient compliance are essential for optimal results.

Keywords
Odontogenic cysts; Basal cell nevus syndrome; Decompression, surgical