Effectiveness of marsupialisation and decompression on the reduction of cystic jaw lesions: a systematic review

Abstract This study aimed to systematically review and critically appraise available literature concerning the effectiveness of marsupialisation and decompression on the reduction of cystic jaw lesions. The “Preferred Reporting Items for Systematic Reviews and Meta-Analysis” guidelines were followed and the study protocol was registered at the “International Prospective Register of Systematic Reviews” (CRD42019116099). Six main databases were searched: Embase, LILACS, PubMed, Scopus, The Cochrane Library, and Web of Science. Searches were complemented with three grey literature sources: Google Scholar, ProQuest, and Open Grey. Any reduction measures, compared to preoperative status or other procedures, were considered. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Tool. Thirty-one studies were included, of which 5 were judged with low, 24 with moderate, and 2 with high risk of bias. Considering surgical approach, 20 studies assessed the decompression and 11 the marsupialisation technique. Most studies considered these techniques as preliminary treatments, followed by enucleation. From 1088 lesions found, most were odontogenic keratocysts (33.8%), followed by unicystic ameloblastomas (21.0%), dentigerous cysts (20.6%), and radicular cysts (8.4%). Large lesions and younger individuals frequently presented more favourable treatment responses and anatomic location was overall not associated with lesion reduction. The intervention duration generally ranged between one to two years. In conclusion, marsupialisation and decompression were mostly considered as preliminary treatments, followed by enucleation. Lesions’ reduction was generally considered insufficient for these techniques to be used as definitive therapies, although benefits concerning the diminished invasiveness of the secondary surgery were often proposed.