Conservative Marsupialization of a Large Mandibular Odontogenic Keratocyst with CBCT Follow-Up: A Case Report

Abstract

Background: Odontogenic keratocyst (OKC) is a developmental odontogenic cyst characterized by aggressive biological behaviour and a relatively high recurrence rate. Management of large lesions in young patients is challenging because radical surgical approaches may compromise mandibular integrity and functional outcomes. Conservative treatment strategies such as marsupialization have gained increasing attention for their ability to reduce intracystic pressure, promote gradual lesion shrinkage, and stimulate bone regeneration while preserving surrounding structures. Case Presentation: A 19-year-old female patient presented with a bony hard swelling in the left mandibular region that had progressively increased in size over one year. Cone beam computed tomography (CBCT) revealed a well-defined radiolucent lesion measuring approximately 51.7 × 22.2 mm involving teeth 34, 35, and 36. Management included extraction of the involved teeth, creation of a bony window through the alveolar crest, and marsupialization of the cystic cavity. Straw-coloured fluid was aspirated intraoperatively, and a custom acrylic obturator was placed after 15 days to maintain patency of the surgical window. Weekly follow-up visits included irrigation and replacement of chlorhexidine-impregnated packing. After one year, CBCT imaging demonstrated a reduction in lesion size to 38.5 × 13.6 mm, with radiographic evidence of progressive bone regeneration. Histopathological examination confirmed the diagnosis of odontogenic keratocyst, showing a parakeratinized epithelial lining with palisaded basal cells and satellite cysts. Conclusion: Marsupialization proved to be an effective conservative approach for managing a large mandibular odontogenic keratocyst while preserving mandibular integrity. The technique facilitated progressive lesion shrinkage and bone regeneration, preparing the site for definitive surgical management. Continued long-term clinical and radiographic follow-up is essential due to the recurrence potential of OKC.