Investigation of the effects of marsupialization on histomorphological and immunohistochemical markers of odontogenic keratocysts.

BACKGROUND: Despite its extensive bone resorption and high recurrence rate, marsupialization is the preferred option in the treatment of odontogenic keratocysts (OKCs). AIM: We aimed to assess the effect of marsupialization on histomorphological and biochemical markers of OKCs. MATERIALS AND METHODS: The study is conducted on 48 paraffin blocks of 24 OKC cases between the years 2012 to 2018. The main clinical, radiographic, and histomorphometric measurements were recorded. Immunohistochemical staining with E-cadherin, Ki67, IL1alpha, TNFalpha, Slug, and Snail were performed and compared for pre-marsupialization and post-marsupialization values. RESULTS: OKCs mostly located in the mandibular posterior region. The mean marsupialization period was 8.8 +/- 6.5 (3-25) months. The mean radiographic size of OKC (57.1 +/- 53.5 mm) was significantly reduced after marsupialization (22.6 +/- 19.9 mm, P = 0.002). Histologically, significantly increased thickness of the OKC epithelium (p = 0.002) and collagen production (p = 0.034) was detected after marsupialization. The post-marsupialization group showed positive correlation of inflammation score to both TNFalpha (r: 0.69, P < 0.001) and IL-1alpha (r: 0.58, P = 0.008) expressions in connective tissue. Among immunohistochemical parameters, only Slug expression was significantly higher after marsupialization (p = 0.019). CONCLUSION: Our study suggests that increased Slug expression may enable the second surgery by increasing fibrosis in the cyst wall.