Dental School, Federal University of Santa Catarina - Florianópolis, Santa Catarina, Brazil.
Postgraduate Programme in Dentistry, Federal University of Santa Catarina - Florianópolis, Santa Catarina, Brazil.
Br J Oral Maxillofac Surg. 2021 Dec;59(10):E17-E42. doi: 10.1016/j.bjoms.2021.03.004. Epub 2021 Mar 23.
In this study, we aimed to systematically review and critically appraise the 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 with 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 five were judged with low, 24 with moderate, and two 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 responses to treatment and anatomical location was not associated with lesion reduction overall. The intervention duration generally ranged between one to two years. In conclusion, marsupialisation and decompression were mostly considered as preliminary treatments, followed by enucleation. Lesion 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.
在这项研究中，我们旨在系统地回顾和批判性评估有关牙囊切开术和减压术减少囊性颌骨病变的有效性的现有文献。研究方案遵循了“系统评价和荟萃分析的首选报告项目”指南，并在“国际前瞻性系统评价注册库”（CRD42019116099）中进行了注册。共检索了六个主要数据库：Embase、LILACS、PubMed、Scopus、The Cochrane Library 和 Web of Science。还通过三个灰色文献来源（Google Scholar、ProQuest 和 Open Grey）进行了补充检索。任何与术前状态或其他手术相比的减少措施都被认为是有效的。使用 Joanna Briggs 研究所的批判性评估工具评估偏倚风险。共纳入 31 项研究，其中 5 项被评为低风险，24 项为中风险，2 项为高风险。考虑到手术方法，20 项研究评估了减压术，11 项研究评估了袋形术。大多数研究认为这些技术是初步治疗方法，随后是切除术。在 1088 个病变中，最常见的是牙源性角化囊肿（33.8%），其次是单囊型成釉细胞瘤（21.0%）、含牙囊肿（20.6%）和根尖囊肿（8.4%）。大病变和年轻个体的治疗反应通常更有利，病变减少与解剖位置总体上没有关联。干预持续时间通常在一到两年之间。总之，牙囊切开术和减压术通常被认为是初步治疗方法，随后是切除术。尽管二次手术的侵入性较小，但这些技术通常被认为不足以作为确定性治疗方法，因此病变减少被认为是不充分的。
