The KCOT is one of the most aggressive odontogenic cysts

The KCOT is one of the most aggressive odontogenic cysts. It can become quite large because of its ability for significant expansion, extension into adjacent muscarinic receptor antagonists and rapid growth (Morgan et al., 2005). Different studies showed the incidence of KCOT to be 3–11% of the odontogenic cysts (Chuong et al., 1982; Payne, 1972). Generally, KCOT are solitary lesions unless they are associated with nevoid basal cell carcinoma syndrome (Payne, 1972; Chirapathomsakul and Sastravaha, 2006).
KCOT arises from cell rests of the dental lamina (Neville et al., 1995). Histopathologically, KCOT typically shows a thin, friable wall, which is often difficult to enucleate from the bone in one piece, and have small satellite cysts within the fibrous wall. Therefore odontogenic keratocysts often tend to recur after treatment (Brannon, 1977; Gang et al., 2006). Radiographically KCOT demonstrates a well-defined unilocular or multilocular radiolucency with smooth and often corticated margins. In 25–40% of cases, there is an unerupted tooth involved in the lesion. KCOT tend to grow in the anteroposterior direction within the medullary cavity of the bone without causing obvious bone expansion causing its delayed observation by the patients (Brannon, 1977; Gang et al., 2006; Neville et al., 2002).
The treatment of the KCOT remains controversial. Treatments are generally classified as conservative or aggressive. Conservative treatment generally includes simple enucleation, with or without curettage, or marsupialization. Aggressive treatment generally includes peripheral ostectomy, chemical curettage with Carnoy’s solution, cryotherapy, or electrocautery and resection (Morgan et al., 2005; Meiselman, 1994; Williams and Connor, 1994; Bataineh and Al Qudah, 1998; Blanas et al., 2000).
The choice of treatment should be based on multiple factors; patient age, size and location of the cyst, soft tissue involvement, history of previous treatment and a histological variant of the lesion. The goal is to choose the treatment modality that carries the lowest risk of recurrence and the least morbidity (Rogerson, 1991; Williams, 1991).

Decompression and marsupialization
Decompression of a cyst involves any technique that relieves the pressure within the cyst as this pressure is the way by which the cyst grows by expansion. Decompression can be performed by making a small opening in the cyst and keeping it open with a drain (Pogrel, 2005; Eyre and Zakrzewska, 1985; Brondum and Jensen, 1991).
Marsupialization, on the other hand, involves converting the cyst into a pouch so the cyst is decompressed, but this is a more definitive treatment than decompression as it exposes the cyst lining to the oral environment. Mandibular cysts are normally marsupialized into the oral cavity, while maxillary cysts can also be marsupialized into the maxillary sinus or nasal cavity, as well as the oral cavity (Pogrel, 2005, 2003; Seward and Seward, 1969).
Decompression and marsupialization of cysts is probably the earliest recommended treatment and was first suggested by Partsch in the late 19th century. In many parts of the world, marsupialization is still described as a Partsch I procedure (the Partsch II procedure is enucleation and primary closure) (Partsch, 1892, 1910).
Although decompression or marsupialization was not recommended as treatment for the KCOT by some authors, because it was thought that the pathologic tissue would be left in situ (Pogrel and Jordan, 2004), decompression or marsupialization has been recommended in a number of studies as a technique that allows partial decrease in size in the KCOT so that vital structures like teeth or the inferior alveolar nerve can be preserved, then the KCOT was certainly enucleated (Pogrel and Jordan, 2004; Partridge and Towers, 1987; Marker et al., 1996).
Those authors who are against the use of marsupialization or decompression for the treatment of KCOT depend on, that this technique does not remove completely the whole cystic covering, which would lead to a continuation of epithelial proliferation and facilitate the recurrence (Bataineh and Al Qudah, 1998; Maurette et al., 2006). Brondum and Jensen (1991) reported a recurrence rate of 25% in 32 (OKCT) patients treated with decompression of the lesion. On the other hand, other studies have shown that marsupialization of KCOT can be followed by total resolution of the lesion without any further surgery (Eyre and Zakrzewska, 1985; Pogrel and Jordan, 2004; Hopper, 1982).